Choosing Wisely Action Manual: Your guide to reducing low-value care

By Teresa Litton, MPH, Manager for Performance Improvement and Susie Dade, MPA, Deputy Director, Washington Health Alliance

If you work in primary care, you’ve probably heard of Choosing Wisely. Established in 2012 by the American Board of Internal Medicine (ABIM) Foundation, Choosing Wisely is a national initiative to reduce “low-value care” that includes the overuse of tests and procedures that are unnecessary or potentially harmful to patients.

The initiative’s ultimate goal is to support clinician efforts to help patients make smart, effective health care choices. To that end, Choosing Wisely aims to promote conversations among clinicians and patients that facilitate care choices that are:

  • truly necessary
  • supported by evidence
  • not duplicative of other tests or procedures already received
  • free from harm

Get started with the Choosing Wisely Action Manual

At the Washington Health Alliance (the Alliance), we’re working with the Washington State Medical Association (WSMA) and the Washington State Hospital Association (WSHA) to bring Choosing Wisely principles and resources to primary care practices across the state. No matter what size your practice is or where it’s located, we encourage you to check out the Choosing Wisely Action Manual (PDF)—a free, step-by-step guide to implementing Choosing Wisely activities in your practice environment.

The action steps in the manual are based on Kotter’s 8-Step Process for Leading Change. With each step, you’ll find practical tips, helpful resources, and the latest evidence that Choosing Wisely works to improve value and prevent harm to patients. Each step can also be adapted to fit with an existing change framework if your organization already has one. Here is a preview of the eight steps:

  • Create a sense of urgency
  • Build the guiding coalition
  • Form a strategic vision and initiatives
  • Enlist a volunteer army
  • Enable action by removing barriers
  • Generate short-term wins
  • Sustain acceleration
  • Institute change

How Choosing Wisely is about ‘raising all boats’ in Washington

The action manual was created by the Washington State Choosing Wisely Task Force—a collaboration among the Alliance, WSMA, and WSHA. Launched in 2013 with funding from the ABIM Foundation, the task force includes more than 20 physician leaders from clinics, hospitals, and health systems across the state who are leading efforts to integrate the Choosing Wisely campaign in their organizations.

The task force has proven to be a powerful tool for change. The members have been catalysts for each other—encouraging one another to do more and fueling the fire that is spreading this initiative across the state. It’s remarkable, really. Many of these organizations are competitors in the marketplace. But with Choosing Wisely, it’s been about collaboration and “a rising tide lifts all boats.”

Choosing Wisely is unique because it creates space for innovation, inspires people at a deeper level, and appeals to their professionalism. What we’ve seen in our task force members is a real excitement to collaborate and innovate. And what we’re aiming for in the long run is the beginning of a cultural change across the state—a shift in thinking from “more care is better care” to “safe and medically necessary care is better care.”

The task force is still active, and we welcome new organizational representatives. If you would like to join our effort and don’t already see your organization on our list of participants, please contact us at

Find more Choosing Wisely resources

In addition to the action manual, the Alliance, WSMA, and WSHA offer several other resources to help you start and sustain Choosing Wisely activities in your practice:

  • State and county-level results (PDF) for 11 Choosing Wisely measures provide insight into which Choosing Wisely recommendations are already standard practice in Washington State and which ones have room for improvement.
  • The Choosing Wisely Claims-Based Technical Specifications (PDF) are available to help your practice better understand what diagnoses codes are in each measure and can even be used to build the measures into your EHR.
  • On the WSMA Choosing Wisely website, you’ll find links to online educational modules for clinicians, as well as materials to help guide your conversations with patients about tests or procedures that may be inappropriate or potentially harmful.

Teresa Litton, MPH, is the Manager for Performance Improvement and Susie Dade, MPA, is the Deputy Director at the Washington Health Alliance (the Alliance). The Alliance and the Washington State Medical Association are currently working with Group Health Cooperative and Swedish Health Services on a project to reduce wasteful and potentially harmful care in three areas: overuse of antibiotics for acute upper respiratory viral infections, imaging for uncomplicated headaches, and overly frequent Pap tests for women (see news release). Funding for this project comes from the Robert Wood Johnson Foundation through the American Board of Internal Medicine Foundation. Learn more about this project in this “In Action” video from ABIM.

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