Table 8 Examples of systematic prompts and triggers to initiate disinvestment decisions

▪ Approve introduction or continuation of TCPs for limited time only and require review of desired outcomes, costs, etc. before re-approval is granted at end of time period

▪ Approve new guidelines and protocols for limited time only and require review of evidence, costs, etc. and appropriate revision before re-approval is granted at end of time period

▪ Include steps that consider disinvestment of existing practices in manuals for guideline and protocol development

▪ Include steps that consider disinvestment of existing practices in checklists for a range of organisational decisions

▪ Add consideration of disinvestment to templates for meeting agendas where appropriate

▪ Mandate consideration of disinvestment in procurement processes: include in requistion documents and require sign off by relevant body overseeing disinvestment at appropriate level

▪ Systematically ascertain evidence from research, data or stakeholder feedback, send directly to decision-makers and seek and/or require response

▪ Incorporate flags and/or question use of low value TCPs in clinical decision support systems

▪ Build questions about potential disinvestment into business case templates and application forms for grants, changes to formulary, introduction of new TCPs, etc.

▪ Introduce requirements for consideration of disinvestment into documents governing scope of decisions such as position descriptions and committee Terms of Reference

▪ Add prompts to consider disinvestment to data reports, scorecards, dashboards, etc.

▪ Add prompts to consider disinvestment in project management templates and training programs for project management, change management, quality improvement processes, etc.

▪ Build disinvestment into strategic planning processes

▪ Build disinvestment KPIs into business plans or performance plans

▪ Consider ‘one for one’ swaps where a new TCP can only be introduced if an old one is removed