Patient Safety First: Saudi Arabia’s Journey to Cut Low-Value Healthcare Practices

Choosing Wisely Saudi Arabia, led by the Ministry of Health and Saudi Patient Safety Center, has significantly reduced overuse of low-value medical services through targeted, evidence-based interventions. The initiative demonstrates strong governance, clinician leadership, and measurable improvements in patient safety and healthcare efficiency.

Saudi Arabia has undertaken a pioneering healthcare reform through the “Choosing Wisely Saudi Arabia” programme, a collaborative initiative led by the Ministry of Health and the Saudi Patient Safety Center, with support from Ada’a Health and the Riyadh Region General Directorate of Health Affairs. Drawing inspiration from the international Choosing Wisely campaign initiated by the American Board of Internal Medicine Foundation, this initiative aims to reduce the overuse of low-value medical services that burden the healthcare system without benefiting patients. The national intervention, launched as a pilot in 2019 and formally expanded in 2021, also enlisted several scientific societies and medical institutions to formulate evidence-based recommendations aligned with Saudi Arabia’s healthcare context. This campaign represents a major component of the country’s Vision 2030 Health Transformation Plan, signaling a shift toward more sustainable, efficient, and patient-centered care.

Understanding the Root Causes of Overuse

Saudi Arabia’s extensive healthcare system, with over 60% of services provided by the Ministry of Health, has long faced issues related to medical overuse. The availability of free healthcare in public hospitals and insurance-backed treatment in the private sector encourages both providers and patients to seek and offer unnecessary tests, prescriptions, and procedures. This phenomenon is exacerbated by the fee-for-service model dominant in private healthcare, which does not tie payment to outcomes. As a result, Saudi Arabia processes nearly 80 million insurance claims annually, amounting to roughly SAR 25 billion, much of it linked to questionable clinical necessity. Overuse is particularly common in pharmacy prescriptions, redundant laboratory tests, and excessive radiological imaging. Addressing these inefficiencies is vital not just for cost control but also for ensuring patient safety and improving clinical outcomes.

Building a Robust Framework for Change

At the heart of Choosing Wisely Saudi Arabia is a well-structured governance model operating across national, regional, and hospital levels. A central steering committee, comprising stakeholders from the Public Health Agency, Therapeutic Medicine Agency, and Electronic Health Agency, was created to direct programme strategy and monitor progress. A scientific committee was responsible for technical guidance and validation of recommendations. At the regional level, champions were appointed based on criteria such as leadership ability, clinical expertise, and experience in quality improvement. These regional leaders were responsible for selecting and mentoring hospital champions who would spearhead implementation at the facility level. Educational materials and implementation manuals were produced and distributed by the Saudi Patient Safety Center to support the rollout, including versions tailored for both healthcare professionals and patients.

Tailored Interventions, Measurable Impact

Over the programme’s first four years, 16 out of 20 health regions in Saudi Arabia implemented Choosing Wisely initiatives. A total of 74 regional and hospital champions led 67 documented projects, supported by 91 recommendations developed by nine medical societies, including those representing emergency medicine, rheumatology, clinical pharmacy, and maternal–fetal health. The interventions produced measurable reductions in medical overuse. For example, at King Khalid General Hospital, prescriptions of amoxicillin-clavulanic acid for sinusitis dropped from 79.5% to 54.6% following targeted clinician and patient education. At Taif’s Children’s Hospital, replacing intravenous fluids with oral rehydration therapy for children with mild dehydration led to a 72.4% drop in IV use and a 138% increase in oral therapy usage, alongside a decline in phlebitis cases. The Prince Sultan Cardiac Center in Riyadh reported a dramatic 98.45% reduction in vitamin D testing following intervention. Radiological services also saw significant reforms, with brain CT use for minor head trauma reduced from 12.4% to 9.3% and various types of unnecessary MRI imaging cut by over 35% in Madinah’s King Fahad Hospital.

Challenges, Lessons, and the Road Ahead

Despite its successes, the programme has not been without challenges. Cultural expectations that equate more tests with better care, limited awareness among clinicians, and fear of medicolegal consequences have slowed adoption in some regions. Resource constraints and frequent staff reassignments further hampered consistency. Patient engagement, crucial to the success of the programme, was at times difficult to secure, especially when patients feared that reduced services might mean lower quality care. Nevertheless, early political commitment, multi-level stakeholder coordination, and the use of clinician champions proved crucial to overcoming resistance. Education emerged as a key enabler, interactive sessions, workshops, and public health campaigns helped to reframe perceptions and boost compliance with the recommendations.

To ensure long-term sustainability, the Ministry of Health and its partners have committed to regular performance monitoring, broader stakeholder involvement beyond the ministry itself, and continuous refinement of the programme strategy. They also call for independent documentation of regional and hospital-level implementation experiences to inform future initiatives, both within Saudi Arabia and globally.

A Model for Healthcare Reform in the Region

Choosing Wisely Saudi Arabia stands as a regional model for how systemic change can be achieved in a complex healthcare environment. Through structured governance, clinical leadership, and evidence-based recommendations, the programme has effectively demonstrated that reducing overuse is not only possible but beneficial on multiple fronts, improving patient safety, conserving resources, and enhancing the quality of care. Its early outcomes, marked by substantial reductions in unnecessary medical services, validate the campaign’s guiding principle: that doing less, when appropriate, can indeed mean doing better. With ongoing support and adaptation, the initiative promises to catalyze a broader cultural shift toward more judicious, patient-centered medical practice across the Kingdom.