In health care, more isn’t always better. We know what to do less of, but how?

Our ‘Taking Action on Overuse’ framework helps organizations build a culture where care teams take ownership for reducing low value care. But what does that look like?

by Michael Parchman, MD, MPH, Director, The MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute

“Low-value health care” is a term that’s subject to many interpretations, but we define it as health care for which the potential for harm exceeds the possible benefit. Examples include:

• high-end imaging for acute low-back pain,
• long-term opioid use for chronic pain, and
• antibiotics for viral upper respiratory infections.

Low-value care not only increases overall health care costs, but can also cause patient harm. Reducing this type of care requires that health care organizations engage providers and teams in the challenging work of sustained cultural, organizational, and behavior change.

We created and are testing the Taking Action on Overuse framework to help organizations change the culture of how medicine is practiced by engaging providers and teams to actively reduce low-value care. The framework identifies evidence-based strategies for obtaining buy-in, motivating behavior changes, and providing the necessary support and infrastructure for health care providers to engage and lead their peers in making changes that can improve the value of health care.

As we refine and develop the framework, we’re also building tools and resources from real-world lessons we’re learning from three partner health care organizations that represent different settings.

Our research of medical overuse-reduction efforts across the country has illuminated 3 common indicators of success that represent care teams taking ownership, including:

• Conversations about overuse and enacting solutions
  This indicator involves care teams engaging in conversations about the potential for harm from overuse and how often overuse occurs. These conversations sometimes include patient stories about harm that resulted from overuse. They occur in a non-threatening environment where teams exchange ideas about actions they can take to reduce overuse. Leadership can help by stressing the importance of these conversations, creating time dedicated to discussing overuse, emphasizing blame-free discussions, and stressing that voices from every level of the care team are welcome to participate. Read more about building a culture of trust, innovation, and improvement.
• Resources dedicated to consistent measurement of overuse
  Care teams that have taken ownership around overuse regularly meet to review trusted measures of over-used services that are transparent at the provider or team level. Leadership has committed resources for the collection, analysis, and distribution of actionable data that care teams can use to inform their reduction efforts. Read more about committing resources to measurement.
• Reducing overuse as part of professional identity
  Invested care teams consider providing the right level of care as part of how they define themselves as health care professionals and they proactively seek opportunities to address low-value care wherever it might occur.

Taking Action on Overuse is an evolving framework for health care organizations to engage their care teams in reducing low-value, unnecessary care and to make those efforts last. It identifies evidence-based strategies for obtaining buy-in, motivating behavior change, and providing the necessary support and infrastructure for health care providers to engage and lead their peers in making the changes that improve the value of health care.

We know that culture change is hard. It’s challenging work. There are no easy answers, but we are beginning to learn HOW to engage in this important work. We invite you to share feedback about your experiences with reducing overuse and to keep up with our latest work by subscribing to the Taking Action on Overuse mailing list.

Dr. Michael Parchman directs The MacColl Center for Health Care Innovation at Kaiser Permanente Washington Health Research Institute. His research focuses largely on improving chronic illness care in primary care clinics by approaching them as complex adaptive systems. A family medicine physician, Dr. Parchman previously served the Agency for Healthcare Research and Quality as the director of Practice-Based Research Network Initiative and senior advisor for primary care. He has a joint appointment at the Department of Family Medicine and the Department of Health Services Research at the University of Washington and is a collaborator in their Institute of Translational Health Science.

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