Leading the Adoption of Choosing Wisely Recommendations into Practice: Drawing on Principles from EBP

Higher-quality care is a national goal for nurse leaders and is expressed by the National Quality Strategy to achieve better care for individuals, better health for populations, and greater value (lower per capita costs).  The importance of choosing care that is supported by evidence (EBP) was raised to new heights in the IOM Quality Chasm and Future of Nursing reports.  The new Choosing Wisely initiative examines the “flip-side” of evidence-based practice (EBP), that is, removing from practice those approaches for which there is evidence of ineffectiveness or harm.  Unnecessary and ineffective procedures and interventions add to cost while desired health outcomes are not reached, eroding the value of care.

The Choosing Wisely campaign generates evidence-based recommendations to help providers and consumers engage in conversations to make informed decisions and avoid unnecessary and ineffective care. Such decisions are enacted by the healthcare team, with nurses playing a vital role.  Many times ineffective clinical approaches are embedded in common practice, so targeted change initiatives are needed to remove them.  

One Future of Nursing recommendation urges nurses to lead interprofessional teams to change care in achieving safety and quality.  Just as nurse leaders employ principles to promote adoption of best practices, they can also draw on principles to remove useless practices from daily care. Practical principles can be derived from a number of sources commonly used in promoting adoption of best practices. These include principles of change management, team leadership, creating a sense of urgency, and empowering through capacity building.  The new concept of “implementation” is defined as “the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings” (NIH, 2013, no pagination).  Strategies include embedding change champions in care settings, garnering buy-in from executive and frontline nurses, and managing organizational culture.  Additional strategies include promoting public awareness and engagement of patients and families, engaging policy agents in supporting these changes, and tracking the practices changes accomplished by the Choosing Wisely campaign.