On Tuesday, June 6, “What matters to you?” Day was celebrated globally. The observance first began in Norway in 2014 and became more widespread after Healthcare Improvement Scotland got involved. The day is intended to build support for more meaningful conversations between health care providers, social workers and the people, families and caregivers who receive such services. I think this is a wonderful effort, yet I couldn’t help but wonder why we devote only one day to recognizing the importance of asking our patients what matters to them?
In 2001, the Institute of Medicine, now known as the National Academy of Medicine, defined patient-centered care as “care that is respectful of and responsive to individual patient preferences, needs, and values” and that ensures “patient values guide all clinical decisions.” Providing patient-centered care is important because it results in better outcomes for patients and greater patient satisfaction with the care they receive. With the patient’s voice at the center of their care team, it also helps assure the patient and family that members of the health care team are all talking to one another, and everyone knows what everyone else is doing. Additionally, it promotes shared decision-making, which emphasizes the importance of clinicians and patients working together to produce the best outcomes possible. In short, it helps the team deliver care that is focused on what matters most to the patient.
In an article published in Becker’s Hospital Review, Maureen Bisognano, president emerita and senior fellow of the Institute for Healthcare Improvement, explains, “What you’ll find is that what matters deeply to people often is different from what we might clinically diagnose them, but it expands our view, our sense of what is really important in these peoples’ lives.”
This concept was explored by Michael Barry, MD, in an article on shared decision-making published in the New England Journal of Medicine in 2012. He explains, “For some decisions, there is one clearly superior path, and patient preferences play little or no role — a fractured hip needs repair, acute appendicitis necessitates surgery and bacterial meningitis requires antibiotics,” for example. “For most medical decisions,” he continues, “more than one reasonable path forward exists (including the option of doing nothing, when appropriate), and different paths entail different combinations of possible therapeutic effects and side effects.” In such cases, patient involvement in decision-making adds substantial value.
In the namesake campaign launched by Healthcare Improvement Scotland last year, several examples of things that matter to patients were highlighted:
- “I like to receive the medication that manages my Alzheimer’s at the time I always take it at home, rather than at drug rounds.”
- “It’s really important to me that my granddaughter is involved in any discussions about my support. She’s the main person in my life!”
- “Getting outside is really important to me. When I’m having a difficult day, getting outside helps me to find space to think more clearly.”
Most of you will recall the direction of Sir William Osler to treat the patient, not the disease. Dr. Berry says, “If we can view the health care experience through the patient’s eyes, we will become more responsive to patients’ needs and, thereby, better clinicians.” The question of “what matters” can be approached in a variety of ways, such as:
- “What are the things that are important to you at the moment?”
- “What are some of the things you would like to achieve as a result of this support?”
- “When you have a good day, what are the things that make it good?”
It is said that this approach to conversing with patients helps us build a relationship with them, allowing us to better understand the person in the context of their own life and the things that are most important to them. Because diversity is one of our core values at UTMB, we try to recognize and understand the many different backgrounds, beliefs, traditions and preferences of our patients. With this crucial insight, we are in a much better position to work with our patients to find the best way forward for them, and we are in a much better position to provide them with the very Best Care.
When was the last time you asked a patient, “What matters most to you?” What was the outcome? Please send me your stories.