I'm really interested to hear about how other people view/perceive/promote high value care.I'm fairly new to my unit, everyone prides themselves on being "cost aware". People hold each other accountable for the tiniest of extra costs. I've been counseled by more than one colleague since I arrived for things like forgetting to credit a patient back an IV catheter or unused oxygen tubing.But this is where the culture falls short. We do MRIs with anesthesia for patients who have never been in an MRI machine before in their lives. We don't even attempt po sedation or moderate sedation if they request anesthesia. This week I sedated an 86 year old man for a biopsy who was a DNR, had refused chemo, and was being discharged to hospice care. There went at least $5K plus unnecessary risk and pain, along with an extra day in the hospital and no one could tell me why we were doing it. We order pre-procedure tests and no one can explain why coags from last week aren't good enough before an angiogram when the patient isn't at risk for a bleed. All I get is "you have to have a PT/INR within 24 hours of an angio..." but no why. Hourly portable Chest Xrays on post-lung biopsies... why hourly? Why not just once in x hours and prn if symptomatic? "Because that's how we always do it"We order CMPs for patients who really just need a creatinine and GFR before a contrast study, send blood gases to lab when we have point of care tests that are faster and cheaper, order UAs on patients who only need an HCG, and the list really just keeps going.I was always taught "because it's ordered" is never the answer to "why?". Now, when we are over-spending trillions of dollars a year in US healthcare, that is the answer everyone gives me. So we all go out of our way to save the patient/hospital $10 for an IV catheter, but not $10k for an unnecessary procedure.Any thoughts or advice on even incremental steps towards raising mindfulness or educating?