Evolve
Better care. Better decision-making. Better use of resources. 

Part of a global movement, Evolve is an initiative led by physicians and the RACP to drive high-value, high-quality care in Australia and New Zealand. Evolve identifies a specialty's Top 5 clinical practices that, in particular circumstances, may be overused, provide little or no benefit, or cause unnecessary harm. Evolve aims to: 
  • safely and responsibly phase out low-value tests, treatments and procedures where appropriate;  
  • support physicians in providing high-value care to patients based on evidence and expertise;
  • provide a trusted process for each specialty to remain up-to-date with the latest evidence;​
  • enable physicians to influence the best use of health resources, reducing wasted expenditure; and
  • ensure patients receive the test, treatment or procedure they need.

Choosing Wisely

RACP is a founding member of Choosing Wisely in Australia and New Zealand. All Evolve recommendations are made available ​through these campaigns. By bringing together recommendations from multiple medical colleges and healthcare organisations, together with expertise in consumer and patient care, Choosing Wisely helps healthcare providers and consumers start important conversations about improving the quality of healthcare. 

Call to Action

The RACP ​encourages physicians to implement these recommendations in their work and health services. Evolve encourages physicians reflect and consider why a clinical practice will not be of benefit to a patient by asking:
  • Are these low-value practices that I do? 
  • Are these low-value practices that I see happening?​
  • Are there systems, processes or expectations that encourage or drive these low-value practices in my health service​? 

Considering the Individual Patient

Evolve encourages physicians to engage in shared decision-making with a patient and/or carer. In partnership with Choosing Wisely Australia's '5 questions to ask your doctor', Evolve asks physicians to ask these 'Top 5 questions before making a clinical decision': 

  1. Should I undertake this practice for this patient?
  2. Do the risks to the patient outweigh the benefits?
  3. Does the patient really need this test, treatment or procedure?
  4. Is there a simpler​ and safer test, treatment or procedure?​
  5. Does this Evolve recommendation make a difference to my clinical decision-making?

Implementation

Evolve encourages physicians to include the recommendations in routine clinical care, for example:

  • Clinical handovers (e.g. between health services, between clinicians) 
  • Clinical audits and feedback 
  • Computer decision support systems, (e.g. electronic ordering, prescribing systems) 
  • Education sessions (e.g. grand rounds, clinical case reviews, teachable moments) 
  • Nominate Evolve Clinical Champions in health services or specialties
  • Engage hospital management/executive with Evolve initiatives

Evolve Top 5 List Development

All RACP specialty societies are invited to develop their Top 5 List of low-value practices. The Evolve Top 5 List development process is rigorous and robust. To develop an Evolve Top 5 List, a specialty requires a:

  • Lead Fellow: Acting as an Evolve Clinical Champion and the primary point of contact with RACP
  • Working Party: Small group of specialty members that drive the evidence review and Evolve Top 5 List development
  • Membership Body: Provides feedback throughout the Evolve Top 5 List development process and actively engaged in implementation of the final Evolve Top 5 List.  

There are three steps involved in developing a specialty's Evolve Top 5 List​: 

  1. Development of an initial list of low-value practices in your specialty;
  2. Refinement of the initial list through research and data analysis, and seeking feedback from the specialty's membership; and
  3. Finalisation of the ​Evolve Top 5 List using pre-determined criteria and membership feedback to identify the final Top 5 low-value practices.
More information on Evolve Top 5 List development