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In many cases in academic medicine, teaching a concept is important but education is not necessarily the most effective way to create real improvement. Sometimes, it is more effective to create hard changes in the systems & processes that underlie our care delivery. For example, it may be more effective to simply make it impossible to order a very low utility test, or to create barriers to ordering testing, rather than focusing solely on teaching the reasons why it is not worth ordering that test. What are effective or innovative examples you've seen or implemented to improve high value care that go beyond teaching?