Taking action on overuse: Creating the culture for change

Area of Science:

• Health Services Research
• Organizational Behavior
• Behavioral Science

Background:

• Unnecessary medical care increases costs and patient harm.
• Engaging providers in reducing low-value care requires sustained change.
• An action-planning framework is presented to address provider engagement.

Purpose of the Study:

• To describe an action-planning framework for engaging healthcare providers in reducing overused medical services.
• To provide a structured approach for healthcare organizations to implement value-based care initiatives.

Main Methods:

• Comprehensive review of social science theory and literature.
• Analysis of published reports on reducing low-value care.
• Interviews with innovators in value-based care initiatives across 23 US healthcare organizations.
• Feedback from a multi-stakeholder advisory committee.

Main Results:

• The framework identifies four necessary conditions for change: prioritization, trust-building, shared language, and resource commitment for measurement.
• These conditions facilitate sense-making conversations among providers, patients, and teams regarding overuse and harm.
• Conversations promote coordinated action and behavior change to reduce low-value care.

Conclusions:

• Organizational strategies engaging providers in value-based care should focus on creating conditions for productive sense-making conversations.
• This framework can strengthen provider engagement to reduce potentially harmful care and enhance beneficial interventions.