CHOOSING WISELY NEW ZEALAND Putting the Theory into Practice

TE PAPA, WELLINGTON, FRIDAY 2 MARCH, 9AM–5PM

Dear Delegates

On behalf of the Council of Medical Colleges I welcome you to the second Choosing Wisely New Zealand national meeting – this time focusing on what work has been achieved to date, so we can all learn from each other.

We have made a lot of progress over the past 15 months, and now have work started, or being progressed, in 14 DHBs; over 35 sector supporters; 129 Choosing Wisely recommendations on our website; and 35 patient resources. A new initiative, which we will canvas at this workshop, is our work with medical students and medical educators to embed Choosing Wiseley concepts into medical education.

We hope this meeting will result in identifying the next steps for Choosing Wisely in this country, ways we can all work together to be more effective.

We thank the Ministry of Health for their assistance in making this campaign a reality, and all our sponsors and supporters.

Our thanks also to you, the attendees – for your interest in the campaign and commitment to improving the quality of care for New Zealanders. We hope we are all able to learn and share our experiences over the day and strengthen Choosing Wisely work in New Zealand.

Yours sincerely

Derek Sherwood Chair, Council of Medical Colleges in New Zealand

Social Media Would you like to have your say during the symposium? Follow @ChooseWiselyNZ and tweet your comments.

Choosing Wisely - Putting the Theory into Practice Te Papa, Wellington | 9am – 5.00 pm | 2 March 2018

Time 8.00 Registration opens

9.00 Mihi Whakatau followed by opening address from Dr Andrew Simpson, CMO at Ministry of Health

9.15

Implementing Choosing Wisely in services – how to get started and keep up the momentum Learning from others’ experiences of setting up Choosing Wisely

• RNZCGP approach Dr Richard Medlicott

• Supported through Clinical Quality Governance Dr Sharon Kletchko • Involving allied health professionals Harsh Vardhan • Using a steering group Dr Nick Rogers • Work at ACC Sunita Goyal

Developing a Choosing Wisely campaign – involving staff and consumers

Carol Limber

Lessons learnt in an Australian health service Asmara Jammali-Blasi

Consumer perspectives Morning tea 11.15 - 11.35

11.35

Special interest groups. Group work identified at registration, topics include:

• Polypharmacy Sarah Shellard • Working in general practice and links to ED Dr Michael Ardargh • Medico legal issues for Choosing Wisely Dr Derek Sherwood • Competencies for medical education and next steps for

student groups Dr Steven Lillis and Sam Grainger

• Working with nursing and allied health professionals Harsh Vardhan • Involving consumers Vicki Culling Discussion on best ideas from each special interest group of session 2 Consumer perspectives

Lunch 1.00 - 1.45

1.45

Making sense of guidelines and statistics and measuring Choosing Wisely

• Evidence behind the guidelines Dr John O’Donnell • Cognitive bias regarding risks and benefits Dr Brian Robinson

• Measuring Choosing Wisely Aidan Wilson and Adam Sangster • Using Health Pathways Dr Michael Ardagh

Afternoon tea 3.00 - 3.25

3.25

Communicating shared decision-making - Dr John Marwick Consumer perspectives

4.15 The future – what are the next steps for Choosing Wisely in New Zealand?

4.30 Conclusions Dr Derek Sherwood

Dr Derek Sherwood CMC Chair and Choosing Wisely Clinical Lead MBChB(Otago) FRCS(Ed), Fellow, Royal Australian and New Zealand College of Ophthalmologists Derek completed his Medical degree at Otago University and did his Ophthalmology training in the UK Edinburgh in 1987. Derek has previously been involved in providing eye surgery in Nepal and the Pacific Islands, but over the last 10 years in addition to his busy clinical practice he has focussed on improving Eye Health Services in New Zealand. In 2014 he was elected Chair of the Council of Medical Colleges and is now a clinical lead of Choosing Wisely.

Speaker Profiles

Dr Richard Medlicott

Richard Medlicott is a GP at Island Bay Medical Centre in Wellington and is Medical Director for the Royal NZ College of GPs. The College has a good working partnership with the Choosing Wisely campaign and is keen for more uptake of this useful driver for quality.

Dr Sharon Kletchko

Dr Sharon Kletchko, is a Specialist Physician, currently working as the Quality Risk Clinical Governance Director at Lakes District Health Board New Zealand. Sharon chairs the DHB's Clinical Quality Governance Executive and oversees the 'listening, learning, improving' model of Clinical Quality Governance across the whole of the Lakes’ DHB population. Within the hospital services this model is driven from the patient-clinical interface and integrated through ward/department level oversight. It is at the Service Level Clinical Quality Governance that leadership and accountability rests in terms of the quality of care being delivered.

Harsh Vardhan Harsh Vardhan is a Choosing Wisely champion and allied health representative in the Choosing Wisely steering committee at Hutt Valley District Health Board (HVDHB). He is President, Tangata Tiriti of Occupational Therapy New Zealand – Whakaora Ngangahau Aotearoa (OTNZ-WNA). He is employed as an occupational therapist and clinical coordinator at child development services, HVDHB. Harsh is currently completing a Masters of Management (Health Services) from Massey University, and is a prior winner of the 2014 Hutt Valley DHB Quality Award for his commitment to quality improvement. Harsh was also placed nationally among the top three in the 2016 Clinician’s Challenge, a joint initiative by the Ministry of Health and Health Informatics New Zealand (HiNZ). In 2017 he received AIOTA occupational therapy achiever award. He believes that Choosing Wisely gives an opportunity to be more efficient, learn, and innovate, all at the same time.

Asmara Jammali-Blasi Asmara Jammali-Blasi is the Project Manager leading the implementation of Choosing Wisely at Austin Health. She has previously worked as an epidemiologist for NPS MedicineWise as well as for the Northern Territory Department of Health. Asmara has completed a Masters in Public Health and is currently completing an MBA at Deakin University.

Dr Nick Rogers Dr Nicolas Rogers MBChB (Otago), FANZCA, is a consultant anaesthetist working in Wellington for Capital and Coast District Health Board (CCDHB). He is a medical graduate of Otago University and undertook his anaesthetic training in NZ, working as a consultant in both NZ and the UK. Nick has been a member of the CCDHB Choosing Wisely steering group since it was set up in 2014.

Sunita Goyal (on behalf of Dr Robin Griffiths) Sunita is the Lead Pharmaceutical Advisor at the Accident Compensation Corporation. She leads the team that assesses pharmaceutical funding requests. Having commissioned ACC Research on opioid use after injury, alongside Dr Rob Griffiths, ACC is now scoping a Choosing Wisely programme to target opioid use in the elderly. Dr Robin Griffiths is a part-time Senior Medical Advisor at the Accident Compensation Corporation. He is qualified in occupational medicine and public health, and also works at the University of Otago Wellington.

Carol Limber Carol Limber has a clinical background with 30 years of clinical, operational and leadership expertise and currently leads change programmes across Canterbury, Bay of Plenty and Northland Health Systems. Carol is an Executive Member of the Australasian Hospital in the Home Programme (HiTH) representing NZ and is the Acute Services Improvement Lead for the Ministry of Health.

Dr John O’Donnell MB ChB Dip Obs FRACP FRCPA GAICD Clinical Immunologist and Immunopathologist Canterbury Health Laboratories and Christchurch Hospital Canterbury District Health Board (CDHB) Dr O’Donnell is an Otago graduate. He was appointed clinical immunologist and immunopathologist to the North Canterbury Hospital Board (subsequently the Canterbury District Health Board – CDHB) in 1989 after completing specialist training at Flinders Medical Centre Adelaide. He has wide ranging clinical and laboratory experience in his specialist field encompassing organ specific and systemic autoimmunity, auto inflammation, primary immunodeficiency and allergy. He has a number of diagnostic and research interests including the determinants of good clinical decision making. John is a clinical senior lecturer with the Christchurch School of Medicine and Health Sciences, University of Otago and trainee supervisor and past examiner for both the RCPA and RACP. He is a past NZ president of the RACP and the New Zealand Rheumatology Association. He holds a graduate diploma from the Australian Institute of Company Directors. He has held advisory roles for Health Commissioners (and other government agencies) in both New Zealand and Australia. He is a member of the Choosing Wisely working group of the CDHB.

Dr Brian Robinson Brian Robinson is Senior Lecturer at the Graduate School of Nursing, Midwifery & Health, Victoria University of Wellington, teaching patient safety, applied pathophysiology, and clinical pharmacology. His research background includes pathophysiology, anaesthesia, pharmacology, patient safety and simulation with current research interests in clinical risk, benefit and decision making.

Aidan Wilson

Aidan Wilson is a third-year medical student at the University of Otago, who has recently completed a summer research project for Choosing Wisely at Hutt Valley District Health Board. This project evaluated the progress of a Choosing Wisely recommendation to stop unnecessary urine cultures. Adam Sangster Adam Sangster is a third-year medical student at the University of Otago, studying in Dunedin. Adam was recently involved in a summer research project about Choosing Wisely implementation in the Capital & Coast District Health Board (CCDHB) - concerning testing and treatment of urinary tract infections.

Dr Michael Ardagh

Mike Ardagh is Professor of Emergency Medicine at the University of Otago and an Emergency Medicine specialist at the Canterbury District Health Board (CDHB). His roles at the CDHB include being clinical lead for Hospital HealthPathways and a clinical leader for the Canterbury Initiative.

Dr John Marwick A general practitioner with over 40 years’ experience John is currently a member of the Medical Protection Society’s education team. He presents seven workshops on a range of medicolegal subjects, helps develop new educational material, and supports presenters in the MPS Asia Pacific region.

Chairing and Leading Sessions Dr John Bonning Emergency Medicine Physician, MBChB (Otago) Fellow, Australasian College for Emergency Medicine

As an Emergency Physician, Board member of Australasian College for Emergency Medicine and Chair of the NZ Faculty of ACEM I have represented the interests of Emergency Physicians on both sides of the Tasman for some years. Also Clinical Director of Waikato Hospital’s Emergency Department, New Zealand Rugby Union Match Doctor and Police Medical Officer I am in (very) active clinical practice.

Dr Ian Page MB BS 1979 Lond: FRCOG 1998, CMC Executive Member

Dr Page is a consultant Obstetrician and Gynaecologist at Northland DHB. Ian has always been interested in the avoidance of harm, and so looking at the zero option of doing nothing has always been part of his practice.

Iwona Stolarek is the Health Quality & Safety Commission's Medical Director. Before joining the Commission she was chief medical officer at Hutt Valley DHB. Iwona has interests in medical education, clinical governance, clinical leadership as well as system improvement. Lizzie Price is Director of Communications at the Health Quality & Safety Commission. She has worked in health communications for over twenty years and has a special interest in social marketing and multimedia approaches. She started off her career as a journalist for the NZ Herald and has also run her own public relations company.

Polypharmacy - Sarah Shellard – Table 1 Sarah is a Clinical Nurse Specialist, and a member of the Palliative Care Service at Hutt Valley DHB. As a result of the Choose Wisely initiative, a working group has been established to run a pilot study amongst patients aged 75-84 years on 11 or more medications within the HVDHB. The aim is to reduce inappropriate polypharmacy by raising awareness amongst patients and health professionals and provide resources to support this.

Working in general practice and links to ED - Dr Michael Ardagh – Table 2

Medico legal issues for Choosing Wisely – Dr Derek Sherwood – Table 3

Competencies for medical education and next steps for student groups – Table 4

Dr Steven Lillis - Steven graduated from Auckland medical school, trained as a general practitioner and then became interested in academic wok. He has completed a Master’s degree from Otago University and a PhD from Auckland. He now works as medical adviser for the Medical Council of New Zealand. Choosing Wisely provides a structure for better medicine, better patient safety and a way for doctors to keep themselves safe.

Sam Grainger - Sam Grainger is a student representative for Choosing Wisely. Sam has completed his fifth year of medicine and is now completing a BMedSc(Hons) in the department of Surgical Sciences (Dunedin).

Working with nursing and allied health professionals – Harsh Vardhan – Table 5

Involving consumers - Vicki Culling – Table 6 Vicki is the Director and Principal Trainer of Vicki Culling Associates, providing training and education in the area of perinatal and infant loss, grief and bereavement support to health professionals and volunteers. Vicki was a member of the NZ Perinatal and Maternal Mortality Review Committee (PMMRC) from 2005-2011, on the HQSC’s Consumer Network from 2011-2016, and is currently a member of the Perinatal Society of Australia & NZ (PSANZ) Consumer Advisory Panel and the NZ Ministry of Health’s Maternal Fetal Medicine Governance Board. She is also a lay reviewer for the Medical Council and Dental Council, and on the steering group for Choosing Wisely NZ.

Consumer Participants

Vicki Culling Sarah Derrett Philippa Hyndman Diane Strong

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