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Kia āta kōwhiri Choosing Wisely

The Choosing Wisely campaign seeks to reduce harm from unnecessary and low-value tests and treatment.

This stage of Kōrero mai is about co-designing potential improvements and deciding on and implementing improvement activities. The ‘Improve’ stage involves using the plan-do-study-act (PDSA) cycle and Quality Improvement approach.

At this point, you need to decide how you are going to measure and test your improvements. You should also revisit the project’s problem and aim statement to check it still reflects what you want to achieve.

Across the Kōrero mai projects, findings from the data led to improvements in communication with patients. The aim was to reduce the impression of ‘busyness’ as a barrier to calling for concern.

Sites introduced ideas to test: Kōrero mai name badges, leaflets, posters and consumer cards setting out the escalation process; a communication e-learning course; and scripts (conversation prompts) for staff responding to calls.

Supporting improvement

The Synergia evaluation of Kōrero mai found the following factors support putting in place improvement projects:

  • meeting regularly while moving from testing to implementation – this lets project teams respond quickly to challenges and makes sure staff are well educated about the patient, family and whānau escalation ideas and processes
  • socialising the change before rolling out ideas – this fosters interest in putting in place a consumer, family and whānau centred escalation system
  • connecting work to existing teams (such as the patient at risk team) or systems (such as the incident management system) – this helps move ideas from testing to implementation
  • communicating regularly with senior management and leadership.

Downloadable examples and resources

PDSA cycle and quality improvement approach (Appendix A of the Commission’s Recognising and responding to patient deterioration preparation and implementation guide)

From case studies

  • Southern Cross Hospital, Christchurch example of co-designing potential improvements (see pp 6-12 of the case study)
  • Canterbury DHB leaflet example (see page 17 of the case study)
  • Canterbury DHB Kōrero mai resource design principles (see page 14 of case study)
  • Southern Cross Hospital, Christchurch image of opportunities for improvement (see page 12 of case study)
  • Waitematā DHB example of a script for responders in their conversations and decision-making (see page 35 of case study)

Published: 21 Oct 2021 Modified: 13 Nov 2021