Creating a Culture of High Value Care at Massachusetts General Hospital

Three in four physicians stated that unnecessary tests and procedures contribute to the high cost of health care in the United States, according to a survey conducted by PerryUndem Research/Communication. In recent years, medical societies and health care professionals alike have begun to speak out on the overutilization of tests and its harmful effects on health. Nilay Patel, MD, an internal medicine resident at Massachusetts General Hospital (MGH), understands that we must shift away from our “more is better” culture. That shift can start by equipping residents with the proper knowledge, skills, and tools to promote a culture of high-value care among their patients.

Cost-Value of Patient Care

Patel partnered with his faculty advisor, Ryan Thompson, MD, to investigate MGH residents’ knowledge of the relationship between cost and value due to residency program curriculum, and their consideration of cost–value during daily patient activities. The results were startling: Only 35 percent of residents felt that the current curriculum prepared them to consider the cost–value of patient care during delivery; fewer than 50 percent of residents considered cost–value of procedures and tests on a daily basis.
“These results verified that there was a need for a new, innovative curriculum to train internal medicine residents at MGH in the delivery of high-value care,” said Patel.

“Approximately one-third of MGH internal medicine residents are involved directly in quality improvement initiatives. However, their involvement typically is sitting on a committee with faculty. Through this project, our goal was to change the culture of high-value care by implementing a quality improvement initiative that was primarily peer-driven, and allowed residents to obtain constant feedback while applying their knowledge and skills.”

As a 2014 Clinical Care Innovation Challenge Pilot Award recipient, a program sponsored by the Association of American Medical Colleges, Patel led the development and implementation of a multifaceted, high-value care curriculum for internal medicine residents. The curriculum was disseminated in three phases: awareness, education, and application. The awareness campaign engaged residents by highlighting internally generated goals relevant to the residents’ daily patient care, which were displayed in resident work areas. It drew inspiration from the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign.

Massachusetts General Hospital Poster Campaign

Value Dashboard

Seeking an innovative approach to measurement during the application phase, Patel constructed the Value Dashboard, a feedback mechanism that provides residents with monthly qualitative and quantitative assessments on high-value care metrics.

Quantitative feedback is reported as compliance rates with the internally generated goals, while the qualitative reports show the results from resident surveys administered throughout the year that assess perceived competency in recognizing and providing high-value care.

“The Value Dashboard is a novel approach that did more than just provide feedback to residents and data to the team,” said Thompson. “It helped in the facilitation of peer-to-peer learning and mentorship. Additionally, the experience of this quality improvement project gave residents a sense of responsibility in the project’s success, which added more value to their daily work.”

Patel designed the curriculum to serve as a model for other residency programs with an interest in expanding their quality improvement programming. MGH continues to change the culture of high-value care among internal medicine residents at MGH and other institutions through this curriculum.

Nilay Patel, MD, was a recipient of the 2014 Association of American Medical Colleges Clinical Care Innovation Challenge Award. If you are interested in obtaining more information about this project, another CCIC project, or the awards program, please email The application period for the 2016 Clinical Care Innovation Challenge Awards will open on Tuesday, October 13, 2015.