Choosing Wisely: Next Steps

Caring Wisely: A Program to Support Frontline Clinicians and Staff in Improving Healthcare Delivery and Reducing Costs


We describe a program called “Caring Wisely”®, developed by the University of California, San Francisco’s (UCSF), Center for Healthcare Value, to increase the value of services provided at UCSF Health. The overarching goal of the Caring Wisely program is to catalyze and advance delivery system redesign and innovations that reduce costs, enhance healthcare quality, and improve health outcomes. The program is designed to engage frontline clinicians and staff—aided by experienced implementation scientists—to develop and implement interventions specifically designed to address overuse, underuse, or misuse of services. Financial savings of the program are intended to cover the program costs. The theoretical underpinnings for the design of the Caring Wisely® program emphasize the importance of stakeholder engagement, behavior change theory, market (target audience) segmentation, and process measurement and feedback. The Caring Wisely® program provides an institutional model for using crowdsourcing to identify “hot spot” areas of low-value care, inefficiency and waste, and for implementing robust interventions to address these areas. Designed and launched by the UCSF Center for Healthcare Value in 2013, the annual Caring Wisely® program identifies projects that meet the following criteria: (1) potential to measurably reduce UCSF Health’s costs of care without transferring costs to patients, insurers, or other providers; (2) plan for insuring that health outcomes are maintained or improved; (3) envision disseminating the intervention within and beyond UCSF; and (4) demonstrate commitment and engagement of clinical leadership and frontline staff. Caring Wisely® consists of 3 stages: (1) the Ideas Contest —an open call to all faculty, staff, and trainees to crowdsource the best ideas for identifying areas of waste; (2) the Request for Proposals stage; and (3) the Project Implementation stage, during which project and implementation science teams meet regularly to develop an implementation strategy for each of three projects with the first test of change occurring within 3-6 months. Project specific budgets are limited to $50,000, and program administration costs approximately $150,000 per year, for a total program budget of about $300,000 per year. Since 2013, three Caring Wisely® program annual cycles have been completed, encompassing 9 specific projects. The projects have been led by a variety of individuals including physicians, nurses, pharmacists, administrators, and residents, and topics have ranged from reducing overutilization of tests, supplies, and treatments to improving patient throughput in the perioperative period and reducing length of stay. Estimated cumulative savings to date from the Caring Wisely® program have exceeded $4 million. We conclude that a program that empowers frontline project teams to work on crowd-sourced ideas with institutional leadership support and implementation science coaching is an effective strategy for reducing in-patient healthcare costs while maintaining high quality care.

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