Background: Choosing Wisely Canada has made over 450 recommendations about tests and treatments that should be avoided in certain clinical situations. However, many of these tests and treatments still occur because changing health care processes is not an easy task. Implementation science aims to understand the underlying reasons for health care processes and to develop and test potential solutions to improve them.

Aim: This project links Choosing Wisely Canada, patients, and health system partners in three provinces (Alberta, Ontario and Newfoundland) with leading Canadian implementation scientists to develop and test solutions for two important topics:

  • Imaging scans that are not needed for patients with low-risk back pain
  • Pre-operative tests that are not needed for patients having low-risk surgery
  • Antibiotics that are not needed for upper respiratory tract infections

Previously Completed Work: We have done preliminary studies to make sure we fully understand the different reasons for unnecessary care and are now developing targeted solutions using insights from behavioural and system science that support both health professionals and patients to make informed decisions about whether these tests are needed.

Ongoing Work: We will test these practice changes in studies. Some health organizations (either family practices for low back pain imaging or hospitals for pre-operative testing) will receive the suggested intervention and some will not. All organizations will receive the intervention to use as they wish at the end of the study.

We will determine who gets the practice change intervention at the organization level by flipping a coin, also called randomization, to ensure that health organizations have the same chance to receive or not receive the intervention.

We are working with the Canadian Institute for Health Information and other partners to use the data already routinely collected to measure whether the intervention worked. Whether the intervention works or not, we will engage our partners and networks to share what we have learned across Canada and worldwide.

Ethics: Our study has been revised and approved by the Ottawa Health Science Network Research Ethics Board (20180746-01H) and at each local hospital and/or academic institution as required.

An essential part of this study is to engage patients throughout the study process. The patients on our team are full team members, and are involved however they wish to be, from receiving regular updates all the way to conducting data collection and analysis.

A first step that the Patient Partnership Council took was to develop some helpful patient engagement tips for all members of our team.

This research is funded by the Canadian Institutes for Health Research, Strategy for Patient Oriented Research Innovative Clinical Trial Grant (MYG-158642).

We would also like to thank and acknowledge the funding partners that have contributed matched funding to support this study.

  • Alberta Health Services
  • Alberta Innovates
  • Alberta Medical Association
  • Canadian Institute for Health Information
  • Choosing Wisely Canada
  • Dr. Proton Rahman
  • LifeLabs
  • Memorial University of Newfoundland
  • Newfoundland & Labrador Chiropractic Association
  • Newfoundland & Labrador Chiropractic Board
  • Ontario Health – Quality
  • Ottawa Hospital Research Institute
  • Ottawa Methods Centre
  • University Health Network
  • Women’s College Hospital Institute for Health System Solutions & Virtual Care
  • Workers’ Compensation Board – Alberta

For more information about this research study, please contact our National Research Lead Andrea Patey ( or Research Program Manager Stefanie Linklater (