Choosing Wisely Canada

Choosing Wisely Canada
Name	Choosing Wisely Canada
Formation	2014
Type	Nonprofit organization
Location	Toronto, Ontario, Canada
Leader title	Executive Director
Leader name	Dr. Wendy Levinson

Choosing Wisely Canada is a Canadian health initiative that promotes conversations between Canadan health professionals and patients about reducing unnecessary medical tests, treatments, and procedures. Launched in 2014, the initiative connects professional societies, academic hospitals, provincial health authorities, and patient organizations to translate evidence from clinical practice guidelines into actionable recommendations. It aims to improve care quality, patient safety, and resource stewardship across Ontario, British Columbia, Alberta, and other Canadian provinces and territories.

History

Choosing Wisely Canada grew from international movements in health care stewardship and comparative effectiveness that trace to organizations such as American Board of Internal Medicine's Choosing Wisely campaign, the National Institute for Health and Care Excellence's de-implementation work, and initiatives at St. Michael's Hospital (Toronto) and University Health Network in Toronto. Early leadership involved clinicians affiliated with University of Toronto, McMaster University, and the Canadian Medical Association, who adapted messaging and methodology used by American College of Physicians and American Academy of Pediatrics. The campaign formally launched with support from foundations and federal–provincial collaborators, drawing on experiences from projects at Ottawa Hospital Research Institute and international conferences such as the World Health Organization patient safety forums.

Purpose and Principles

The program's core purpose is to reduce low-value care by issuing specialty-specific recommendations developed by professional societies and endorsed by clinician leaders from institutions like Montreal General Hospital and Vancouver General Hospital. Its principles emphasize evidence-based practice, clinician leadership, patient engagement, and transparency modeled after frameworks from Institute of Medicine and Health Quality Ontario. Work is guided by stewardship concepts drawn from Canadian Patient Safety Institute reports and aligned with policy instruments used by Canadian Institute for Health Information and provincial health ministries such as Ministry of Health (Ontario).

Campaigns and Recommendations

Choosing Wisely Canada coordinates lists of "things clinicians and patients should question" produced by more than a hundred participating professional societies, hospitals, and patient groups including Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, and specialty organizations such as the Canadian Paediatric Society and Canadian Cardiovascular Society. Recommendations address areas like imaging in low-back pain (relevant to practices at Sunnybrook Health Sciences Centre), antibiotic stewardship in respiratory infections (linked to work at Alberta Health Services), and screening pathways referenced by population health programs like Cancer Care Ontario. Campaign materials have been adapted for primary care networks, emergency departments at St. Paul's Hospital (Vancouver), and surgical services at Toronto General Hospital. Collaborative projects have partnered with patient organizations such as Patient Voices Network and advocacy groups including Heart and Stroke Foundation of Canada.

Governance and Funding

The initiative operates under a governance structure that includes a board of clinician leaders, advisory councils with representatives from institutions like McGill University Health Centre and Saskatchewan Health Authority, and working groups aligned with specialty societies such as Canadian Psychiatric Association. Funding sources have included philanthropic foundations modeled after Gordon and Betty Moore Foundation, government grants from provincial health ministries, and contributions from professional associations including College of Family Physicians of Canada. Financial stewardship and conflict-of-interest policies reference standards from bodies like the Canadian Medical Protective Association and the Canadian Institutes of Health Research.

Impact and Evaluation

Evaluations have examined changes in ordering rates for low-value services, drawing on administrative data sets maintained by Canadian Institute for Health Information and provincial health data repositories like ICES (Institute for Clinical Evaluative Sciences). Published studies from research teams at McMaster University and University of British Columbia have reported variable reductions in some imaging and laboratory orders, while other work indicates limited or mixed impact on overall health care utilization. Quality improvement collaboratives implemented at academic centres such as Hamilton Health Sciences and community clinics affiliated with Fraser Health have used audit-and-feedback, shared decision-making tools, and patient education campaigns adapted from evidence syntheses by Cochrane and guideline methodologies from GRADE Working Group.

Criticism and Controversies

Critics have raised concerns about unintended consequences, including underuse of necessary care, measurement challenges, and potential misapplication of recommendations in geographically diverse settings such as remote communities served by Indigenous Services Canada programs. Scholars affiliated with University of Calgary, Queen's University, and independent health policy think tanks have debated whether the campaign sufficiently considers socioeconomic determinants and system-level incentives shaped by provincial funding mechanisms. Debates also reference tensions between professional autonomy defended by associations like the Canadian Federation of Nurses Unions and centralized guideline implementation strategies promoted by governmental agencies such as Health Canada. Transparency, conflict-of-interest management, and the balance between clinician-led versus top-down approaches remain active areas of scholarly and policy discussion.

Category:Medical and health organizations based in Canada