Earlier this fall, Sunnybrook Health Sciences Centre became a designated Choosing Wisely Canada Hospital at the Leadership Status level – the highest achievement awarded under this national program. Sunnybrook has been an early adopter and champion for Choosing Wisely Canada since its inception. Notably, Sunnybrook was the inaugural hospital in Canada to attain the top designation in a prior iteration of our Hospital Designation Program. Choosing Wisely Canada recently caught up with Dr. Adina Weinerman and Dr. William Silverstein to learn more about Sunnybrook’s leadership efforts.

Choosing Wisely Canada: Tell us a bit about how your hospital got involved in Choosing Wisely or more specifically, reducing overuse/low-value care?

Dr. Adina Weinerman: Choosing Wisely has been a longstanding priority for Sunnybrook. We have had many clinical leads and hospital staff who have championed resource stewardship efforts across different departments. When Choosing Wisely Canada officially launched in 2014, it was an opportunity to get involved in resource stewardship in a more organized fashion. We started a committee that included professionals from various disciplines, both clinical and non-clinical. Engaging decision support specialists in the hospital, communications team members and frontline staff made us successful in spreading and scaling initiatives. We were able to spotlight this work and make it known across the hospital that Sunnybrook was Choosing Wisely.

CWC: What motivated your hospital to pursue the Choosing Wisely Canada Hospital Leadership Status?

Dr. Adina Weinerman: The designation status is a way to recognize the significant contributions and efforts of many individuals engaged in this work. Our senior leadership has always been actively supportive of Choosing Wisely, recognizing its benefits for patients and improving hospital processes. Post-COVID, with backlogs in diagnostic imaging and surgeries relying on testing and imaging, we continue to see relevance in Choosing Wisely.

Dr. William Silverstein: The designation status is also a way for us to sustain and build on our past efforts or explore new areas to focus on. As Adina mentioned, we’re seeing so many opportunities post-COVID to reinvigorate Choosing Wisely at Sunnybrook and continue to foster a culture of resource stewardship in practice. The Leadership Status is a way to keep Choosing Wisely top of mind and relevant across the hospital – from medical learners to senior leadership.

CWC: What was it like to mentor another hospital? What learnings from that experience will you take forward?

Dr. Adina Weinerman: Mentoring hospitals allows us to share insights and lessons learned along the way. Our experiences with committee structures, local challenges, and successes are invaluable lessons we extend to other hospitals. We can emphasize the significance of interprofessional collaboration, effective communication and garnering senior leadership support when undertaking this work across hospital systems.

CWC: What were some key projects or examples of your work?

Dr. William Silverstein: As early adopters, Sunnybrook led a quality improvement project packaged into a Choosing Wisely Canada toolkit for wider adoption. Lose the Tube focused on reducing unnecessary urinary catheter use led by Dr. Jerome Leis and nursing staff, and serves as a guiding example for other hospitals to implement. Additionally, Sunnybrook actively participates in national programs like Using Blood Wisely and Using Labs Wisely. These remain core areas of focus for improving utilization at our hospital.

Dr. Adina Weinerman: We’ve also involved learners in scholarly projects by engaging residents and medical students in quality improvement initiatives. For example, we’ve had publications on reducing excessive use of CT pulmonary angiography in the BMJ Open Quality, or improving iron deficiency anemia in Transfusion. Sharing our resource stewardship projects allows others to learn from our interventions.

CWC: In the future, how do you plan to continue Choosing Wisely efforts?

Dr. William Silverstein: Celebrating our achievements is the first step. We also aim to maintain Sunnybrook’s leadership in resource stewardship, continuing to invest in clinicians and staff committed to quality improvement. Addressing overuse issues like unnecessary imaging, improving blood work utilization and prescribing practices remain our focus. We’re also interested in aligning our processes with environmental sustainability.

Dr. Adina Weinerman: We look forward to continuing efforts to integrate Choosing Wisely efforts into our daily operations and routine practices. Seeing the impact across different departments, even in some of the busiest clinical areas, has been very rewarding. We will continue engaging trainees and exploring new avenues to foster a generation of clinicians and staff dedicated to Choosing Wisely.