• Healthcare quality improvement
• Quality improvement
• Continuing education, continuing professional development

As healthcare costs continue to rise globally, policy makers and researchers have focused on inefficiencies in healthcare delivery. In the USA, the combination of high costs and disappointing outcomes associated with a fragmented delivery system has generated the idea that substantial reductions in spending are possible without sacrificing patient care. Indeed, we know that high spending often fails to produce optimal outcomes and therefore, reductions in spending should be achievable with no detrimental effects on quality.

The evidence that less can sometimes be more is all around us. Front-line providers know all too well the human and financial costs of aggressive treatment of terminally ill patients who might otherwise prefer a palliative approach. Redundant testing due to inadequate care coordination and lack of information sharing is another example. Preventable adverse events exemplify how poor-quality care can drive up costs and harm patients at the same time. From these instances, a new mantra has emerged among many health policy leaders: less is better. Intensity is bad.

What is clinical intensity? It is often described as the tendency to do more: perform more procedures, admit more patients, consult more specialists and prescribe more medications.1 Why does level of intensity appear to vary widely across institutions? Some have suggested that variation in clinical intensity is due to differences in the underlying patient population, although others have argued that patient factors matter very little. Detailed work by researchers at Dartmouth has suggested that both medical intensity and its variation among providers are fundamentally inefficient …