“The role of conversation in health care interventions: enabling sense-making and learning”
Drawing on literature from sociolinguistics and complex adaptive systems theory, this article describes how conversation can increase the success of health care change efforts by promoting sense-making and learning.

Choosing Wisely® Physician Communication Modules
This set of interactive instructional modules are designed to help clinicians talk with patients about the overuse of health care services. The modules include strategies for building trust and responding to patient attitudes and beliefs.

Choosing Wisely® Patient-Facing Materials
These informational materials from Choosing Wisely® and Consumer Reports are designed for patients and their families to learn more about overused tests and procedures. They can support conversations and shared decision making among clinicians and patients.

Safer Management of Opioids for Chronic Pain: Principles and Language Suggestions for Talking with Patients

These language suggestions for talking with patients help to effectively communicate the risks of opioid use, implement safety monitoring, and introduce changes to treatment.

The selected resources below can support implementation of the Taking Action on Overuse Framework and initiatives to reduce medical overuse.


A How-To Guide to Reducing Unwarranted Variations in Care
This is a collection of lessons from clinical and organizational leaders who have addressed practice and practitioner variation within their own organizations. Produced by an action group of California Health Care Foundation’s California Improvement Network, it is intended to help organizations get started in this work.

The Forest Through the Trees: Maximizing Value in an Evolving Healthcare System
This report from the Avalere Center for Payment & Delivery Innovation describes five key lessons that health care organizations can use to maximize value and quality. The lessons can help guide efforts to prioritize the work of transitioning to a value-based system.

Choosing Wisely® Employer Toolkit
Employers can use educational materials, tip sheets and other resources to educate their employees about harms associated with the overuse of health care services.


“How improving practice relationships among clinicians and nonclinicians can improve quality in primary care”
This literature review covers relationships within health care organizations, including relationships among clinical and nonclinical roles. It also describes strategies for improving relationships within health care organizations.

“Creating the exceptional patient experience in one academic health system”
University of Utah Health Care system led a seven-year initiative to deliver an exceptional patient experience. The article describes the process of culture change, factors that affected the organization’s ability to provide exceptional patient experience, and lessons learned.

Helping Doctors Choose Wisely: Three Innovative Principles for Health Care Organizations
This Health Affairs blog post describes three ways that health care organizations can cultivate an environment supporting efforts to reduce overuse and includes links to relevant articles and initiatives.

Training Physicians to Provide High-Value, Cost-Conscious Care: A Systematic Review
This systematic review describes how certain learning environments, organizational factors, and interventions can support physicians in reducing overused care.

“Getting Doctors to Make Better Decisions Will Take More than Money and Nudges”
This Harvard Business Review article describes the importance of organizational culture in supporting efforts to decrease medical overuse and increase evidence-based care.


“Overuse: when less is more… more or less”
This article proposes a conceptual framework for defining potential areas of overuse and developing a shared understanding of the reasons for reducing overuse. The framework is organized around three areas: 1. the tradeoff between benefits and harms; 2. the tradeoff between benefits and costs; and 3. consideration of patient preferences.

“Engaging doctors in the health care revolution”
This Harvard Business Review article offers a framework—based on the writings of economist and sociologist Max Weber—for engaging clinicians in redesigning health care. It describes four motivations driving social action in health care organizations: shared purpose, self-interest, respect, and tradition.

“Low-value care: an intractable global problem with no quick fix”
This editorial describes the challenges of reducing overuse and strategies to overcome these challenges, and it incorporates insight from the Taking Action on Overuse framework.


“Measuring low-value care in Medicare”
This JAMA Internal Medicine article describes 26 measures of low-value care developed using Medicare claims data, which assessed low-value service usage and the proportion of spending devoted to these services.

Choosing Wisely Claims-Based Technical Specifications
This Washington State Choosing Wisely Task Force document aims to promote discussion and refinement of measures of overuse and includes technical specifications for measures of overuse that correspond to recommendations from the Choosing Wisely® campaign.

“Using quality improvement to reduce continuous pulse oximetry use in children with wheezing”
This article describes Cincinnati Children’s Hospital Medical Center’s experience reducing the overuse of continuous pulse oximetry and how it defined and tracked measures to monitor its progress.

General Overuse Resources

When Less Is More: Issues of Overuse in Health Care
This Health Affairs blog post explores the growing problem of overuse and how it contributes to patient harm, and includes links to relevant articles and initiatives.

“Preventing overdiagnosis: how to stop harming the healthy”
This article examines the underlying causes of overdiagnosis, the potential harms of unnecessary tests and treatments, and strategies for reducing overuse.

In this New Yorker essay, surgeon Atul Gawande explores the problem of unnecessary medical care through data, personal stories, expert interviews, and policy analysis.

Overuse Case Scenarios: Summary of Findings
This summary features three overuse case scenarios that expand on how to address overuse in specific health care settings.

Quality Improvement in Overuse Tip Sheet
This tip sheet provides constructive advice on how to effectively communicate about overuse within the frame of quality improvement across health care roles.

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