6- Creating the Conditions for Change

MODULE 8 | Section 6 of 11

Creating the Conditions for Change

A group from the MacColl Center for Health Care Innovation convened patients, providers, and health care leaders to develop an action-planning framework for addressing overuse in health care. “The model is based on observations that providers, care teams and patients can change practice together to reduce low-value care if conditions for change are present as presented in the first level of the framework. These conditions make it possible to have the sense-making conversations depicted in the second level of the framework, where assumptions are challenged, the potential for harm created by overuse is recognized, and data on current measures of overuse are examined.”1

CREATE CONDITIONS FOR CHANGE

Select each card to learn more about each part of the framework

Select each card to learn more about each part of the framework

PRIORITIZE THE NEED TO REDUCE LOW-VALUE CARE

“Successful organizations consistently communicate the importance of addressing low-value care through both words and actions.

  • Examples of actions include scheduling protected time to meet for provider-only and team conversations,
  • attendance of leadership at case conferences on overuse,
  • soliciting ideas from providers and staff about opportunities to reduce low-value services,
  • public recognition of provider-led initiatives to reduce over-use,
  • engaging patients through patient-facing tools and resources about overuse, and
  • including patients in planning low-value care activities.”
BUILD A CULTURE OF TRUST, INNOVATION AND IMPROVEMENT

“Conversations about potentially harmful or overused services are more productive when all parties involved trust each other and are committed to improving the safety and effectiveness of the care they provide. In a culture of trust, conversations are non-judgmental and non-punitive, innovators are welcomed, and all share a vision of delivering care that is safe and effective. Leaders and clinical champions create trust with transparent, inclusive management decisions. Providers, teams, and patients change culture through the expression of their concerns, values and needs, and through grassroots initiatives by clinical champions such as devoting time during traditional “grand rounds” to discuss case examples of overuse.”

ESTABLISH A SHARED PURPOSE AND LANGUAGE

“Conversations about overuse of low-value care may be new and reflect many different perspectives and disciplines. A shared understanding of the language used in conversations about low-value care can make them more productive. For example, discussions of the concept of “value” are perfectly acceptable in some settings, while in others the potential for harm or actual examples of overuse-related harm resonate more with providers and patients than discussions about value. Framing patient financial burden as a harm can also be a successful strategy to increase engagement. Harm can also be described at the population level as the overuse of a service can make it less accessible for patients who truly need it. Framing overuse as potential harm engages providers by appealing to their professionalism and commitment to care for each individual patient and ‘do no harm.’”

COMMIT RESOURCES TO MEASUREMENT

“Providers often underestimate how often they deliver a specific service or may be unaware of how their ordering behavior compares with their peers. Recent reports on the use of low-value services at the provider level are essential for conversations and action. Many indicated the importance of providing transparent provider-level data on measures of use and its role in improving trust within peer discussions. Organizations interviewed in the environmental scan dedicated additional resources to develop and validate trusted and transparent measures of current overuse as well as training on how to take action based on the data.”

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“Organizations will generally try to create needed change without addressing, budgeting for, or having the patience for culture change. God bless them if they are successful; the vast majority won’t be. Leaders can’t create a culture, but they MUST create the conditions for a great one to emerge.”
Bob Wachter MD, Chair of Medicine
University of California at San Francisco

REFERENCES

  1. 1- Parchman ML, Henrikson NB, Blasi PR, et al. Taking action on overuse: creating the culture for changeHealth C: J Del Science Inno. 2017;5(4):199-203.

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