title: Taking action on overuse: Creating the culture for change.
abstract: BACKGROUND
  Unnecessary care contributes to high costs and places patients at risk of harm. While most providers support reducing low-value care, changing established practice patterns is difficult and requires active engagement in sustained behavioral, organizational, and cultural change. Here we describe an action-planning framework to engage providers in reducing overused services.
  
  
  METHODS
  The framework is informed by a comprehensive review of social science theory and literature, published reports of successful and unsuccessful efforts to reduce low-value care, and interviews with innovators of value-based care initiatives in twenty-three health care organizations across the United States. A multi-stakeholder advisory committee provided feedback on the framework and guidance on optimizing it for use in practice.
  
  
  RESULTS
  The framework describes four conditions necessary for change: prioritize addressing low-value care; build a culture of trust, innovation and improvement; establish shared language and purpose; and commit resources to measurements. These conditions foster productive sense-making conversations between providers, between providers and patients, and among members of the health care team about the potential for harm from overuse and reflection on current frequency of use. Through these conversations providers, patients and team members think together as a group, learn how to coordinate individual behaviors, and jointly develop possibilities for coordinated action around specific areas of overuse.
  
  
  CONCLUSIONS
  Organizational efforts to engage providers in value-based care focused on creating conditions for productive sense-making conversations that lead to change.
  
  
  CONCLUSIONS
  Organizations can use this framework to enhance and strengthen provider engagement efforts to do less of what potentially harms and more of what truly helps patients.
authors.affiliation: MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA, United States. Electronic address: parchman.m@ghc.org.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parchman
authors.affiliation: MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA, United States.
authors.forename: Nora B
authors.initials: NB
authors.lastname: Henrikson
authors.affiliation: MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA, United States.
authors.forename: Paula R
authors.initials: PR
authors.lastname: Blasi
authors.affiliation: MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA, United States.
authors.forename: Diana S
authors.initials: DS
authors.lastname: Buist
authors.affiliation: MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Penfold
authors.affiliation: MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Austin
authors.affiliation: Robert Wood Johnson Foundation, Princeton, NJ, United States.
authors.forename: Emily H
authors.initials: EH
authors.lastname: Ganos
mesh_terms: D006801:Humans; D007857:Leadership; D015279:Organizational Culture; D009936:Organizational Innovation / Q000191:economics*; D018802:Patient-Centered Care / Q000379:methods; D011209:Power, Psychological; D014481:United States; D019564:Unnecessary Procedures / Q000191:economics*