Asking “what matters to you?” may seem like an obvious opening when caring for a patient, but it is only in the last decade that health care institutions and providers have asked this common-sense question, according to Maureen Bisognano, President Emerita and Senior Fellow, Institute for Healthcare Improvement (IHI).
Ms. Bisognano was the featured speaker at the third UHF Quality Leaders Forum on September 22. She discussed the “What Matters to You” (WMTY) campaign, an international person-centered care movement that has spread to over 48 countries including the US, inspired in part by a paradigm-shifting 2012 article in The New England Journal of Medicine, Shared Decision Making—The Pinnacle of Patient-Centered Care by Michael J. Barry, M.D. and Susan Edgman-Levitan, P.A. The authors made the case for engaging patients and families as partners in their care and outlined the importance of asking patients not “What’s the matter?” but “What matters to you?”
Maureen Bisognano, Institute for Healthcare Improvement
WMTY is a simple yet powerful concept that can create deeper and more personal engagements with patients and their families, she said, leading to a better understanding of what a patient wants from their health care and the foundation for genuine partnerships between patients and providers. To underscore its impact, Ms. Bisognano shared her own experience with her brother, who was diagnosed with non-Hodgkins lymphoma at age 19 and died a year later. Toward the end of his life, as he lay in a hospital, a physician asked him what mattered most to him in terms of his treatment. His answer: “I want to go home.” The doctor immediately helped him out to his sister’s car. She drove him home, where he was surrounded by friends, family, and familiar surroundings in his final weeks.
“That changed my view of what caring for a patient means,” Ms. Bisognano said.
The IHI signed on to the campaign in 2012; since then, Ms. Bisognano has traveled throughout the United States and 48 countries spreading the word. She shares the experiences of health care providers and organizations that have rallied around the “What Matters to You” model, as well as stories of patients and caregivers talking about what it means to have the question asked of them.
Ms. Bisognano offered multiple examples of how the movement has transformed departments and entire hospitals. Implementation typically starts informally, sometimes with just one or a few people in a health care institution asking WMTY, and initially leads to small process changes. But WMTY can spread quickly and readily be scaled to an organization-wide approach to care. “You can’t approach this like usual quality improvement work,” she said. “Rather than being imposed from the top down, it needs to be allowed to spread organically, by word of mouth.” As more and more staff see the positive impacts on quality, they usually embrace the concept, she added.
Ms. Bisognano also explained how the WMTY movement can improve health equity by calling attention to the social needs that can affect a patient’s health and well-being. In fact, she noted, “We can’t get to equity without asking that question.” She gave the example of an elderly veteran with cancer in South Carolina who had been hospitalized for three weeks while receiving chemotherapy. After returning home, he called 911 because he had no food in his home, and no family to bring him any—something no one on the hospital staff had thought to ask about. “What kind of equity do we have if we're sending someone home without food? We have to right our system and open up conversations about the true drivers of health,” she said.
More information and guides on the “What Matters to You” campaign can be found on the IHI website.
The Quality Leaders Forum, organized in collaboration with Greater New York Hospital Association (GNYHA), includes alumni from the UHF/GNYHA Clinical Quality Fellowship Program and honorees from UHF’s Tribute to Excellence in Health Care. Members are invited to network and discuss current issues in health care quality with nationally recognized quality leaders and to pursue opportunities for sharing best practices.
Past Forum summaries can be found here. The next Forum will be held on December 1, 2021 at 8 am. The invited speaker is Dr. Helen Bevan, a leader of large scale change in the British National Health Service for more than 20 years.
UHF is grateful to Elaine and David Gould, whose generosity supports the Quality Leaders Forum.