Catalysts that Create the Conditions for Change
Sustainably reducing medical overuse requires change in established practice patterns. Like any behavior change, it requires attentive cultivation of an environment where change feels safe, possible, and supported at all levels of an organization. The four change concepts detailed below create the conditions for success of the other two change concepts that are part of the framework: Conversations among providers, care teams, and patients; and indicators of successful awareness, ownership, and action on overuse.
Emphasizing the seriousness of reducing medical overuse can encourage health care providers and front-line staff to dedicate the time necessary for change to occur. Leadership at every level of an organization can convey the priority of this work through a consistent message and actions that demonstrate committed support.
Conversations about the potential for harm from overused services are more productive where both mutual trust and a commitment to improving care exist. In this environment, everyone shares a vision of care that is safe and effective, conversations about overuse are non-judgmental and non-punitive, and creative thinkers are welcomed.
When individuals align around a shared purpose, they have a framework for focusing the direction of change. A shared understanding of the language used to speak about an issue (e.g., overuse, low-value care, safe, effective) makes conversations more productive and ensures everyone is moving in the same direction.
Health care providers often underestimate how frequently they deliver a specific service, and they are typically unaware of how their behavior compares to peers. Transparently sharing reliable, trusted measures of use at the individual level can spur health care providers to work toward a shared purpose of reducing medical overuse and greater alignment with their peers.