Table 1

Choosing Wisely programme summaries

CountryName and goalCurrent statusOrganising groupRole of physician/healthcare provider
Role of patient
FunderSpecial issues
AustraliaChoosing Wisely Australia
facilitate dialogue between health professionals and patients about improving quality of care through reduction in unnecessary tests, treatments and procedures
Planning and implementation stages: First wave of lists currently in development in anticipation of 2015 launch Stakeholder engagement ongoing Advisory group to inform on longer term strategy for implementation and evaluation NPS MedicineWise ( to have physicians and patients lead with NPS MedicineWise playing facilitator role (akin to American Board of Internal Medicine (ABIM) Foundation)Government grant to NPS MedicineWise to support quality use of diagnosticsFederated government structure means hospital funding is via the states and primary care funding via the federal government
Emphasis on evaluating impacts of the programme to measure effectiveness of the campaign
Strong emphasis on demonstrating evidence to support recommendations
CanadaChoosing Wisely Canada
help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care
Launched nine national specialty societies in April 2014
Additional 25 plus societies in progress with release of second wave recommendations in October 2014
Choosing Wisely Canada (based at University of Toronto) is partnering with the Canadian Medical AssociationGeneral practitioners (GPs)/family physicians and specialty societies creating and disseminating lists
Engaging large patient groups (ie, Patients Canada) to endorse and disseminate
Advertising to public
Mixed funding (Government of Ontario, Canadian Medical Association, University of Toronto)Healthcare is delivered provincially; choosing Wisely Canada is national
DenmarkN/ANot planned presently.
recent survey of specialties showed quite limited interest in Choosing Wisely process
N/AN/AN/ADanish Health and Medicines Authority, Danish Medical Societies and five Danish regions are continuously developing national guidelines and measuring on clinical indicators
EnglandProbably Choosing WiselyPlanning stage with launch early 2015The Academy of Medical Royal Colleges (AoMRC)
A Steering Group is to be established involving key stakeholders to guide the programme
This will comprise colleges, clinicians, patient groups, BMJ, commissioners, providers
Medical Royal Colleges and Specialist Societies will develop lists with an expectation of patient involvement at all stages
National Voices, the coordinating body for patient groups, will be a co-partner
NHS England wish to engage in the process but would not lead it
Potentially NHS England
The National Institute for Clinical Effectiveness has extensive history of guideline products including 1000 recommendations on a 'do not do' database
AoMRC has published a report about waste in clinical care
The intention would be for all lists to collate together into a single database or document
Despite large databases and high-quality evidence recommendation, practice does not align
GermanyFacilitate dialogue about value-based healthcare, inform the public and facilitate transfer of priority recommendations of high-quality guidelines into practicePlanning stages
Working group on Choosing Wisely established based on the Initiative of the German Network for Evidence Based Medicine
Annual guideline conference of the Association of the Scientific Medical Societies (AWMF) to discuss potential benefits, risks and implementability of a campaign as a complementary tool to transfer guidelines into practice in November 2014
AWMF has a 20-year history of coordinating and supporting the guideline activities of its 168 member societies and runs a quality managed guideline register
AWMF-Institute for Medical Knowledge Management (AWMF-IMWi) takes on responsibility for these tasks on the operational level
Guideline developing Scientific Medical Societies to take leadership key
Plan to engage multidisciplinary guideline development groups including representatives of healthcare providers as well as patient representatives
At the beginning self-funding of the AWMF and its member societies on a small scale— later to be determined, additional funding will need to be sought forBuilding on existing efforts of multidisciplinary guideline groups (including representatives of patients and other health professions) to give shape to a German Choosing Wisely initiative
Topic-related approach, based on existing evidence-based, multidisciplinary guidelines
Plan to address 'don't do' as well as 'do' recommendations based on a systematic process of criteria-driven priority setting
The development of a manual /generic method report is in progress
Italy‘Doing more does not mean doing better’ launched by Italy's Slow Medicine
Primary goal is culture change—‘doing more does not mean doing better’
Improve quality and appropriateness of care and ensure patient safety through reduction of tests and treatments; decrease harm; promote partnership
Campaign launched December 2012
25 specialty physician and nurse societies engaged
10 Italian lists done
Now in implementation stage
Board of Italy's Slow Medicine, with the collaboration of: National Federation of Medical Doctors and Dentists; National Federation of Nurses’ Colleges; Society for Quality in Healthcare; Altroconsumo and other patients and public organisationsMedical and nurse societies creating and disseminating lists
Altroconsumo and other patients and public organisations developing patient materials and disseminating lists and culture
Italy's Slow Medicine, an independent organisation, is funded partly by medical societies
Seeking funding
Part of the broader goal of Italy's Slow Medicine has three components including measured (doing more does not mean doing better), respectful (patient values) and equitable care (appropriate and good quality of care for all)
Early implementation with Italian Society of General Practitioners in Piedmont region
JapanChoosing Wisely—Japan
Top have Japanese medical professionals and public be aware of current overuse of expensive diagnostic and therapeutic measures and to encourage change
Planning stages
Using recommendations from Choosing Wisely and BMJ ‘Too Much Medicine Series’
Dissemination through publication and conferences
A booklet in Japanese language entitled, ‘Choosing Wisely in Japan—Less is More’ which includes 26 ‘Lists of Five’ from US specialty societies has been published The contributors of the publication have proposed their list of five applicable to Japanese setting
Creating working groups in primary care and specialty care societies
Establishment of a subcommittee in Japan Primary Care Association (JPCA)
Collaboration of JPCA and Japanese Chapter of American College of Physicians, and eventually with Japanese Society of Internal Medicine
Medical specialty plus primary care group leading
Patient engagement in planning stages
VolunteeringConflict of interest of university clinical researchers with pharmaceutical industry has recently been publicised by media
NetherlandsChoosing Wisely—The Netherlands
Improve quality of care by geographical measuring of unnecessary treatments; eliminating unproven treatments; searching for knowledge gaps in effectiveness; creating value by helping physicians and patients make wise(r) choices
Launched October 2012
14 medical societies actively involved (29 endorsed)
Creating Dutch lists based on Choosing Wisely
6 scientific societies created lists of wise choices, most of them did already base that on evidence maps of practice variation
Dutch Association of Medical Specialists and Netherlands Organization for Health Research and Development
Dutch Patient and Consumer Organization is partner
Physician ledFunds dedicated to quality for medical specialist care in the Netherlands
Netherlands Organization for Health Research and Development (a non-governmental organisation)
Organisation covers four pillars of campaign include Wise Choices; measuring clinical practice variation; knowledge gaps by effectiveness research; shared decision making
Drawback: Although Medical Specialist Societies did successfully create this campaign, covered by insurance companies and patient organisations GPs are not involved yet
New ZealandTo deliver better value for money in health servicesPlanning stages
Adopting Choosing Wisely to engage physicians in two conditions (chronic obstructive pulmonary disease and ischaemic heart disease)
Clinical working groups on these topics
National Health Committee (NHC)
Health Technology Assessment organisation.
Makes recommendations to Minister of Health
Physicians input solicited by NHC
Work open for public comment
SwitzerlandSmarter Medicine
To reduce care that brings no or little benefit, causes side effects, or increasing cost
Launched May 2014
Top 5 list for ambulatory care general internal medicine complete
Swiss Society of Internal Medicine
Contact with consumer organisation for partnership
Medical society led.
Patients not engaged yet
Swiss Society of Internal MedicineSwiss Society of Internal Medicine funded two research projects on overuse
USAChoosing Wisely
To foster conversation between physicians and patients about unnecessary care
Campaign focuses on physician professionalism and leadership
Launched in 2012
60 medical societies created lists
Major distribution to patients and public through patient material
Implementation in a variety of healthcare settings
ABIM Foundation and Consumer ReportsPhysician led
Patient/public education
ABIM Foundation
Consumer Reports
Robert Wood Johnson Foundation
Implementation is distributed across many types of organisations (network to learn from one another)
Some societies have not chosen robust recommendations
Regarded as highly successful but not measuring use (20% of all US physicians know about Choosing Wisely)
WalesPrudent Healthcare
To ensure patients receive the best care from available resources
Planning phase based on Bevan Commission ‘Prudent Healthcare Report’ (2013) and Provisional Principles 2014
Early stakeholder engagement re: Choosing Wisely.
Workshop on four topics to test principles
Bevan Commission is independent
Prudent Healthcare has Ministerial support
Being developedGovernmentEarly stages
Have to align with existing organisations and recommendations (National Institute of Health and Care Excellence (NICE) recommendations, etc)