Why It Matters
What matters to you?
It’s a simple question that can deepen the connection between patients and caregivers. From California to Scotland, from Norway to Brazil, I’ve heard stories or witnessed its transformative potential.
In a 2012 New England Journal of Medicine article, Dr. Michael Barry and Susan Edgman-Levitan introduced the concept of asking, “What matters to you?” in addition to asking patients, “What’s the matter?” Since then, this change has been taking hold around the world, and is changing the balance of power between patients and care providers.
Why does this idea translate so well, in different languages and a range of care settings? First, when you ask someone, “What matters to you?” you’re compelled to see them as a whole person, and not a disease or an organ or a lab result. You understand that they may be under a lot of stress because they’re in a medical environment which may be foreign to them. You appreciate them as a unique individual who deserves respect.
For example, I was once walking through a long-term care home in Norway, and I noticed their white boards. In most organizations, the white boards have a picture of the patient, or the resident, and they list their age, their diagnosis, their DNR status, their physician, etc. They’re often very clinical.
But seeing these white boards filled me with joy. I saw pictures of the residents, the names they like to be called, their ages, and what matters to them.
On the white board for one elderly gentlemen, for example, it said, “I want two glasses of scotch at 5:00 PM every night.” One woman’s board declared, “NEVER,” in capital letters, “take me out of my room without my makeup and my hair done.” Some people have photos of their grandkids or of the favorite trips they ever took.
The interactions in this long-term care home are between human beings, not just between clinicians and patients. Learning about a resident’s tastes and preferences, or about their families and life experiences, changes how people interact with them. The balance of power goes from “I’m taking care of you” to “Let’s partner together.”
Reminding Us Why We Got Into Health Care
The biggest surprise for me about asking “What matters to you?” is how health care providers have responded. I knew it would improve the patient experience, but I didn’t anticipate how much asking this question could restore joy and meaning to the lives of staff members.
We’re running so fast and dealing with so much complexity in today’s world. But when you stop and have a real conversation, it can mean so much. It can remind you of why you wanted a career in health care in the first place.
I was giving a “What matters to you?” talk a few years ago, and I said, “When you go back to work, the next time you walk into a patient’s room, take a moment and ask what matters to them.” There was a pediatric nurse in the audience, Jen Rodgers, from Royal Alexandra Hospital in Paisley, Scotland. She took up my challenge. She went back to work, asked, “What matters to you?” and gave each child admitted to her unit a piece of construction paper and some art supplies.
Jen asked the boys and girls to share their first name, their age, and to draw or write what matters to them. They listed things like, “I like having the call button in my hand so I can get help when I need it,” and, “I like when the doctor calls me by name,” or, “Please knock before coming in.” Paying attention to the simple things they wrote restored a sense of self to these kids. Displayed over their beds, their posters were an immediate way for everyone entering their rooms to find a way to connect with them as individuals.
Seeing the difference it was making in her patient’s lives, Jen took the idea and worked on how to implement it reliably for every patient. Then Geraldine Marsh, who works in a geriatrics unit, heard about Jen’s work and started using it with her patients. There’s a new hospital in Scotland, and every bed has a place to display what matters to each patient.
The idea keeps spreading. Led by people like Anders Vege of the Norwegian Knowledge Centre for the Health Services, Norway started “What matters to you?” Day in 2014. On June 6, 2016, the global “What matters to you?” Day generated 20 million tweets and engaged 500 organizations around the world. So, in a few years, it’s gone from Jen Rodgers and Geraldine Marsh’s patients to all of the patients in a new hospital to thousands of participants because it resonates with patients, and adds meaning and purpose to people’s professional lives.
Going Beyond Improving the Patient Experience
Asking “What matters to you?” started as a way to enhance the care experience for patients, but it can also address the cost reduction and population health aspects of the Triple Aim. For example, you may assume a patient wants aggressive treatment, but when you ask them what matters to them, you may find out that their priority is to go home. You discuss the pros and cons and risks of all the options, and it becomes clear that the patient wants to be comfortable at home with their family in the environment they know best.
Finding out what matters can also help address the burnout that is plaguing much of health care. Ask the next staff member you run into in the hall or in the break room, “What matters to you?” Take a moment to find out how they’re doing and what they’re dealing with as a person outside of the work environment. Connect as human beings and not just colleagues.
What I see around the world is that when people stop and ask the question, it’s changing how we see each other. It’s creating deeper meaning for both the health care professional and the patient.
Maureen Bisognano is IHI President Emerita and Senior Fellow.
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The Power of Simple Things: “What Matters to You?” Stories from Brazil