“The writer David Foster Wallace once told a parable about two young fish who meet an older fish who nods at them, and says, “Morning boys, how’s the water?” The two young fish swim on, and then eventually one of them looks over at the other and asks, “What the hell is water?” Sometimes the most obvious, important realities are the most challenging to recognize.
Organizational culture, like the water surrounding fish, is all around us, yet can be difficult to perceive from within. This culture or “imprinting”—defined as a system of shared assumptions, values, beliefs, and norms existing within an environment—creates a powerful undercurrent that shapes the practices of all health care providers and contributes to overuse within the health care system.”1
This section will focus on culture change as a general concept, introducing different frameworks and methods to understand and target culture, using high-value care as the salient example. We will identify how the current prevailing culture in medicine contributes to overuse and low-value care, will describe specific interventions that support culture change, and will define opportunities to ensure the delivery of high-value care to patients
