Facilitator's Guide

Rationale for this Module 

The purpose of this module is to help value champion fellows think about what strategies they will employ in their overuse reduction initiative. Many clinical champions are unsure of where to start and often feel like they are flying by the seat of their pants. The heart of this module is the TAO Change Package, where fellows can find practical examples of activities they might use as they rollout their overuse reduction initiative

How to Prepare for this Session

First, read the Taking Action on Overuse: Creating the Culture for Change assigned reading, then watch the TAO Model Talk Video on the website to get a good overview of the framework.

  • Read the other assigned readings with the discussion questions available. As you read, mark or highlight in the readings sentences or sections that are relevant to each discussion question.
  • Prepare for the small group activity by completing the exercise yourself. Use the TAO change package to identify what strategies were used to decrease the use of cardiac enzyme testing. Also ask yourself what strategies did they not use that you think might have been effective?

Suggested Agenda

  • Welcome and introductions (10 minutes)
  • Watch the TAO Model Talk Video (10 minutes)
  • Discussion of required readings (15 minutes)
  • Small group exercise: see below (15 minutes)
  • Reconvene: Putting it all together (10 minutes)

TAO Model Talk Video

This short video will provide the group with an overview of the Taking Action on Overuse Framework, how it was developed and examples of tis practical application

Probes for Discussion Questions about the Readings

  • What strategies in the TAO Change Package will you use first, and which ones might you try later? How will you sequence your activities and what are determinants of that sequencing?
  • How might the results of your stakeholder analysis inform the selection of strategies you use to engage colleagues in efforts to reduce an overused service?

Small Group Exercise

Give the class/group 3-5 minutes to read:  Decreasing the Use of Cardiac Enzyme Testing

  • Citation: Alvin MD, Jaffe AS, Ziegelstein RC, Trost JC. Eliminating Creatine Kinase–Myocardial Band Testing in Suspected Acute Coronary Syndrome: A Value-Based Quality Improvement. JAMA Intern Med. 2017;177(10):1508–1512. doi:10.1001/jamainternmed.2017.3597)

Here are some discussion questions for the group/class to consider:

  • What key changes or activities did they employ, and which domain of the TAO framework do they map to?
  • Why do you think they selected more than one strategy to implement?
  • When you examine the TAO change package, are there other strategies or key activities you might choose to de-implement cardiac enzyme testing and why?


  • Ask each group to name one key change or activity they found in this article and what they thought the rationale was for selecting that key change or activity.

Last modified: Tuesday, 18 May 2021, 3:54 PM