Catalysts for Change

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.

Download the full change package for examples of how to make the key changes below.


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.

Key Changes

  • Consistently communicate the organization’s commitment to reducing overuse, ensuring patient safety, and preventing patient harm as part of an overall quality improvement strategy.
  • Allocate or obtain resources to support overuse-reduction initiatives.
  • Make protected time and space available for discussions about how addressing overuse can help protect patient safety.
  • Establish clear roles and teams to lead overuse-reduction initiatives.


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.

Key Changes

  • Provide training and educational resources on strategies for reducing overuse.
  • Commit to maintaining a safe, non-threatening, blame-free environment for clinicians and teams to honestly compare experiences and exchange ideas about reducing overuse.
  • Share transparent, meaningful, and actionable metrics for all overuse-reduction initiatives.
  • Routinely seek input from clinicians, staff, patients, and external stakeholders in efforts to reduce overuse.


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.

Key Changes

  • Establish shared purpose by linking overuse reduction initiatives to the organization’s strategic priorities and a larger professional movement.
  • Establish and reinforce meaningful shared language among clinicians, care teams, and patients for communicating about overuse reduction.


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.

Key Changes

  • Devote time and resources to defining, clarifying, and validating measures of overuse.
  • Develop an analytic infrastructure for reporting trusted, transparent data on overuse.

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