Table 2

Key elements of a choosing Wisely campaign

High-level goal	Concrete objectives	Associated activities	Planned outputs	Anticipated outcomes	Measurement approaches
To reduce unnecessary care, harm and waste	Change physician attitudes to clinical practice	Raise physician awareness of the issue of unnecessary care	Medical journal article, news stories, interviews	Receptivity to learning how to approach unnecessary care in daily practice	Physician baseline attitude survey
		Engage physicians in list development and implementation	Increased number of specialties sign on	Members of specialties buy-into the initiative	Physician survey and interviews of attitudes
		Educate by inclusion in undergraduate and postgraduate teaching and in continuing professional development	Educational materials for use in medical schools and for continuing professional development	Informed trainees and practitioners confident in discussing unnecessary care with patients	Documented curriculum inclusion in medical school, residency programmes, and continuing education
	Foster patient engagement and acceptance	‘More is not better’ public messaging	Public service messages, posters, social media campaign	Public awareness of the issue of unnecessary care	Patient survey of awareness and acceptability of messaging
	Foster patient engagement and acceptance	Develop partnerships with patient and public organisations	Features in partner newsletters and on web sites	Patient and public gain confidence in the campaign	Patient surveys and interviews of attitudes
	Change key clinical practices	Promote increased shared decision making	Increased frequency of discussions about necessity	Incorporation of shared decision making in practice	Patient surveys of care experiences
	Change key clinical practices	Follow Choosing Wisely lists in practice	Better fit between need and care	Reduced unnecessary care	Measurement of rates of necessary and unnecessary care for select services
	Promote alignment with the healthcare system	Recruit partners among clinics, hospitals, regions and others	Incorporation into standard orders and clinical support systems	Enhanced adherence to Choosing Wisely guidance	Audit of clinical performance in a healthcare setting or region
	Promote alignment with the healthcare system	Advocate for fit with payment system	Adjusted fee codes	Reduced incentives for overuse	services Measurement of rates of necessary and unnecessary care for select