Why It Matters
Photo by Etienne Girardet | Unsplash
Asking patients “What matters to you?” (WMTY) was pioneered by Dr. Michael Barry and Susan Edgman-Levitan to flip the traditional “What’s the matter with you?” focus of many shared decision-making conversations to make them more patient-centered. They made the case for understanding a patient’s motivations and hopes so care teams could use patients’ own words to personalize and improve the care experience.
Listening to patient voices is important to support shared decision-making, deliver ideal experiences, and facilitate optimal outcomes. Getting to the root of what matters most to patients, and capturing this information at the point of care, allows for an almost immediate return of data that can help guide health care providers’ actions.
Recognizing that improving access to care is one way to improve health equity, the Bone and Joint Center at UPMC Magee-Womens Hospital standardized asking WMTY to better understand patients’ needs and wants and the barriers they face to receiving comprehensive whole-person care. As a result, we now have data to help us more equitably improve access to care.
The team developed a survey to collect quantitative and qualitative data from patients about their distance from the clinics, mode of transportation used to get there, race, ethnicity, barriers to telemedicine use, and interest in additional services. Our data was collected digitally in high-volume orthopaedic, midlife health, pain management, and women’s health clinics. Our data overwhelmingly indicated that patients wanted complementary services that include midlife health care, pain management, weight management, nutrition services, and physical therapy to augment their bone and joint treatment plans. Our data also indicated that patients wanted care both digitally and in-person. However, it is often only those with reliable transportation, dependable childcare, flexible work schedules, and other resources and funds for additional associated costs who can benefit from these additional visits and cover associated copays.
Through our data collection, we have learned that improving access to care is a significant problem. Access to care is more than the ability to receive an appointment and includes affordability, availability, (geographic) accessibility, accommodation, and acceptability. Much of the relationship between access and health equity can be explained through insurance coverage in the United States. Most US health insurance is employer-sponsored, meaning that populations with higher rates of unemployment often have no insurance or are underinsured. These unemployment rates are directly tied to structural racism, including public policies and institutional practices that limit educational opportunities and contribute to cyclical poverty. The inability to access affordable care can translate to patients in underrepresented groups forgoing preventative care or chronic illness management, which then leads to more health inequities and costs to the health care system.
The Bone and Joint Center used this opportunity for improvement as the impetus to create a new center that could be a “one-stop shop” focused on collaborative and coordinated care to help patients achieve optimal bone and joint health. Available through both digital platforms and a physical location, the Center for Bone and Joint Health began as a pilot in April 2021.
Despite the continuing COVID-19 pandemic, the Center continues to grow its patient population. How? We believe this is because our care team — from the intake coordinator to the advanced practice providers — incorporates motivational interviewing techniques into conversations at every touch point. For example, advanced practice providers ask questions like these during the patient’s first one-hour intake call:
- Picture yourself one year from now. What will you ideally be able to do that you cannot do now?
- What about your health do you want to improve over the next several months? Examples may include sleep better, eat healthier, and increase mobility.
The advanced practice provider also takes time to evaluate a patient's mental health and food security to understand potential barriers to health and provide interventions.
After analyzing this baseline data, we learned that many patients lived 30 minutes to one hour away from UPMC Magee-Womens Hospital and arrived by public transit or were driven by a family member. The Center for Bone and Joint Health helps to address these access issues by providing telehealth and combining services in one visit.
Learning what matters to patients and what motivates them to make progress allows us to provide individualized and coordinated care. Asking WMTY sparked innovation that resulted in a new clinical pathway to promote health equity and provide highly collaborative coordinated care. This simple framework provided a platform for patients to express their needs and wants to achieve an ideal care experience. The care team showed that they were listening by taking action.
Tips for Having and Processing What Matters To You Conversations
Preparing to ask WMTY can help staff feel more at ease when having meaningful and organic conversations. A collection of WMTY supporters and practitioners contributed to a list of tips to operationalize asking WMTY in a variety of settings:
The top patient-reported requests gathered from our WMTY qualitative surveying and analysis include wanting to be:
- Included
- Respected
- Heard
- Clearly communicated with
- Given a plan
- In control
Patient responses can further be categorized into the WMTY matrix below developed by the WMTY practitioners from around the world.
Our colleagues from the Royal Free London NHS Foundation Trust have found that patient requests are often easy to meet and can jumpstart improvement projects. For example, they have found they could categorize 54 percent of patient requests as “simple and meaningful,” 25 percent as “collaboration required,” 16 percent as “more complicated,” and only 11 percent as “most complex.” In addition, in our experience, using tools such as motivational interviewing can help determine that what may initially seem like a more complex request can be further understood as simple and meaningful.
Getting Started
One of the best ways to get started asking WMTY is to practice. Ask your colleagues, friends, and family about what matters most to them to get comfortable before asking a patient. Like other improvement techniques, there is no perfect time to start, so don’t wait. Take inspiration from the many champions around the world to learn how they have turned patient (and employee) responses into improvement projects.
Hannah Hamlin is a project consultant with goShadow and 2023 Master of Healthcare Administration candidate at The Ohio State University.
You may also be interested in:
What Matters To You resources from around the world, goShadow, the Montefiore Hudson-Valley Collaborative, and the Institute for Healthcare Improvement.