In health care, more is not always better.
We know what to do less of, but how?

Reducing medical overuse is a long-term proposition. It requires us to challenge our long-held beliefs and practices regarding tests, medications and treatments, and discuss their potential for harm. It involves examining trusted, reliable data about overused services and making sense of the story they tell. And it necessitates new approaches to what were once standard ways of delivering care.

Sense-making conversations are the key to achieving these goals. These conversations:

• Offer a safe space for discussing overused services and brainstorming possible solutions
• Give providers and care teams an opportunity to reflect on the implications of how often they provide overused services
• Create common understanding about incidents in which overuse has occurred and the potential for harm to past, current, and future patients
• Pull the levers of intrinsic motivation by inspiring care teams to take ownership of the problem
• Build the momentum for action that leads to major reductions in medical overuse

The full Taking Action on Overuse Framework offers examples of how to integrate sense-making conversations into your overuse reduction initiatives.

Sense-making literally means making sense of events. A typical conversation during our day is a simple exchange of information or feelings. Sense-making conversations are different in that they are reflective and often generative, with participants’ ideas informing and building on one another. The main result: Participants arrive at a common understanding of what the events and data mean—for them, for their patients, for health care—and have a foundation for taking action.

In the case of medical overuse, care providers may leave a sense-making conversation with the shared understanding of how they contribute to the overuse of a particular service and the degree to which their patients are exposed to potential harm. Through further discussion they may develop new ideas and approaches for reducing the unnecessary overuse of a particular service—and begin to act on them.

Read more about the conceptual underpinnings of sense-making conversations in “Sensemaking of Patient Safety Risks and Hazards.” (Battles, J.B. etal. (2006). Health Services Research. Aug; 41(4 Pt 2): 1555–1575.)

In 2017 we are working with UCLA Health, Swedish Hospital System, and Missouri Primary Care Association to learn from their experiences and develop a complete change package with tools for implementation. Check back here for updates on what we are learning!