Choosing Wisely: the art of choosing wisely

Even with the enormous technological progress in clinical equipment and management tools, the waste of time and resources is still one of the most urgent challenges.

According to the Map of Private Healthcare Services by the ANS (Brazil’s National Supplementary Health Agency), there were a total of 1.94 billion health plan coverage events in 2024, including tests, medical consultations, outpatient visits, dental procedures, therapies and hospital admissions. Tests are the most common type of event, with 1.18 billion in the same year.

However, the constant increase in additional tests and interventions does not always translate into better outcomes for the patient. On the contrary, excessive diagnosis and treatment (known as overdiagnosis and overtreatment) can create unnecessary risks and waste resources.

It is in this context that the Choosing Wisely campaign becomes an indispensable strategic tool for hospital managers.

What is Choosing Wisely?

Launched in 2012 by the ABIM Foundation in the US and represented in Brazil by Choosing Wisely Brasil, the initiative aims to promote dialogue between physicians and patients about whether certain tests and procedures are really necessary.

The goal is not arbitrary cost cutting, but the pursuit of value in healthcare: ensuring that care is evidence-based, not duplicated and truly necessary.

The concept behind the campaign is based on studies by Harvard Medical School and Beth Israel Deaconess, which seek to better assess the clinical effectiveness of certain tests and treatments.

Why it matters for the hospital ecosystem

For a hospital, embracing this concept means moving from a volume-focused model to one focused on clinical appropriateness. Brazil has rates of tests, such as MRI scans, higher than those of many developed countries.

Reducing this excess protects patients from adverse events (such as unnecessary exposure to radiation or complications during internal transport for tests) and frees up the institution’s operational capacity for those who really need it.

Key lessons for hospital managers

Implementing the Choosing Wisely philosophy offers valuable lessons that can transform a healthcare facility:

Optimizing critical resources

Especially in Intensive Care Units (ICUs), the campaign recommends avoiding the prolonged use of unnecessary antibiotics, excessive sedation or keeping invasive devices in place without a clear indication. For the manager, this translates into shorter lengths of stay, fewer hospital-acquired infections and better bed turnover.

Fighting waste and high loss ratios

Management should look at the lists of recommendations from the specialty societies. By discouraging preoperative screening tests in low-risk surgeries or follow-up CT scans without clinical change, the hospital reduces direct operating costs and avoids denials from health plans, improving financial sustainability.

A culture of patient safety

The most important lesson is that doing more does not always mean doing better. Managers should encourage the use of the Safe Surgery Protocol and the review of practices that immobilize the patient unnecessarily. Fewer unnecessary interventions mean fewer errors and greater patient satisfaction.

Decisions based on data and evidence

Choosing Wisely teaches that management should be backed by robust clinical protocols. Implementing appropriateness checklists before authorizing high-cost procedures helps standardize care and ensures that technology is used ethically and efficiently.

The Rivio view

For the modern hospital manager, Choosing Wisely is an ethical direction, but also an operational guideline. By focusing on what is essential, management can strike the balance between economic sustainability and clinical excellence. This ensures that the hospital is, above all, an environment of safe and mindful care.

This thinking connects with Rivio’s philosophy, which seeks to automate hospital management processes so that healthcare professionals can focus on what matters most: caring for people’s lives.

Rivio was born with the purpose of transforming hospital management through artificial intelligence. By automating analyses, reducing rework and supporting decisions with reliable data, we help hospitals operate more efficiently, free up their teams’ time and create the conditions to focus on quality of care and the patient experience.