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Acad Med. 2017 May;92(5):598-601. doi: 10.1097/ACM.0000000000001485.

Swimming Upstream: Creating a Culture of High-Value Care.

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R. Gupta is a VA/UCLA Robert Wood Johnson Clinical Scholar, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, director, outreach and evaluation and director, Teaching Value in Healthcare Learning Network, Costs of Care, Boston, Massachusetts.C. Moriates is assistant dean for healthcare value and associate professor of internal medicine, Dell Medical School at The University of Texas at Austin, and director of implementation, Costs of Care, Boston, Massachusetts.


As health system leaders strategize the best ways to encourage the transition toward value-based health care, the underlying culture-defined as a system of shared assumptions, values, beliefs, and norms existing within an environment-continues to shape clinician practice patterns. The current prevailing medical culture contributes to overtesting, overtreatment, and health care waste. Choosing Wisely lists, appropriateness criteria, and guidelines codify best practices, but academic medicine as a whole must recognize that faculty and trainees are all largely still operating within the same cultural climate. Addressing this culture, on both local and national levels, is imperative for engaging clinicians in reforms and creating sustained changes that will deliver on the promise of better health care value. This Perspective outlines four steps for health system leaders to understand, cultivate, and maintain cultural changes toward value-based care: (1) Build the will for change through engaging frontline providers and communicating patient-centered motivations for health care value; (2) create necessary infrastructure to support value improvement efforts; (3) expose physicians to value-based payment structures; and (4) demonstrate leadership commitment and visibility to shared goals. The authors support their recommendations with concrete examples from emerging models and leaders across the country.

[Indexed for MEDLINE]

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