Article Title

Taking Action on Overuse: Implementing an Action-Planning Framework to Engage Providers

Publication Date



health care costs/resource use, dissemination and implementation of innovations, patient safety


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 23 health care organizations across the United States. A multistakeholder advisory committee provided feedback on the framework and guidance on optimizing it for use in practice.

Results: The framework (www.takingactiononoveruse.org/framework/) describes four conditions necessary for accelerating change: prioritize addressing low-value care; build a culture of trust, innovation and improvement; establish shared language and purpose; and commit resources to measurements. When these conditions are present, they catalyze 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 and plans for coordinated action around specific areas of overuse. Key changes used by innovative health care organizations to create conditions for change and foster sense-making conversations are described along with examples of activities used to implement these changes. Early work with health care systems to utilize the framework in three settings will be described: an outpatient specialty care clinic, an acute care inpatient setting and a statewide regional cooperative.

Conclusion: Organizational efforts to engage providers in value-based care are focused on creating conditions for productive sense-making conversations that lead to change. 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.




June 21st, 2017


August 10th, 2017