Why It Matters
Sometimes staff aren’t sure they want to hear what patients have to say if they ask “What matters to you?”
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Dealing with Doubts about Asking “What Matters to You?”

By IHI Multimedia Team | Thursday, October 27, 2016

What-mattersRecognizing that empathy and compassion are just as important as medical interventions, the team from Associação Congregação de Santa Catarina (ACSC) accepted an invitation from Health Improvement Scotland to participate on June 6th in What Matters to You Day.

The goal was to have meaningful conversations. Instead of just asking “What´s the matter?” we challenged our health care providers to ask patients and families “What matters to you?”

The majority of our health and social care facilities — approximately 20 — joined in. We received over 200 reports about conversations initiated by nurses, nurse technicians, social workers, nutritionists, rehab/occupational therapists, and doctors.

The reactions to these conversations — from the staff as well as the patients and their families — sometimes surprised us. We learned lessons both big and small that will stay with us long after this event.

Moving Past Uncertainty

Staff expressed uncertainty before they started these conversations. They were concerned about what could happen if they had an open dialogue with patients and families. They were afraid of receiving complaints or unachievable demands. None of us — patients, families, and staff — were used to having discussions like this.

Once conversations began, however, fear soon dissipated and was replaced by a strong determination to help patients have a better day.

“I was feeling insecure, not knowing exactly how to pose the ‘What matters to you?’ question. . . . I decided to share with the patient how I was feeling. He helped me and from that moment on, we established a trusting and open relationship and the conversation went smoothly.”

— Marco Antonio, social worker, OS Santa Catarina/ primary care facility, São Paulo/SP)

“At first, I felt uncaring, and insensitive. How could I have not noticed these needs before as hundreds of people passed through here, suffering the anxiety of being admitted to a hospital, intubated, having cannulas inserted in their veins, and not even knowing why? How could I have not noticed people spending sleepless nights, when the solution was to let them use their home blanket? [It made me] very sad . . . But then, witnessing the small but consistent results like the smile on a patient’s face after receiving a ‘good morning’ from the care team, or having egg for lunch instead of chicken, or hearing that what mattered to one patient was that there was love in our work environment brought me joy and hope because there is still time to improve.”

— Marcelo Anacleto, nurse manager, Hospital Madre Regina Protman, Santa Teresa/ES)

What We Learned

We identified five common themes — representing broad categories of what matters — among the responses we heard from our patients and their families:

  1. Being with family and friends, solidarity, and faith
  2. Empathy and good interpersonal relationships with health care professionals (“A simple greeting or smile can be so powerful!”)
  3. Pets
  4. Meals (“Our inability to take into account our patients food preferences surprised me. Why do we assume we know what they like to eat?”)
  5. Personal care, including hair washing and styling, makeup, bathing, etc.) (“These simple details can make a person feel better about himself or herself.”)

What we heard is helping us determine useful directions for improvements, including two actions:

  • An improvement project will explore better ways to ask the “What matters to you?” question and to initiate meaningful conversations. Two intensive care units will serve as pilot sites.
  • One of our hospitals is going to include asking “What matters to you?” as a new “vital sign” on their daily goals board in patients’ rooms.

Organizations might have concerns about asking “What matters to you?” After all, you can’t know exactly how people will respond. We hope, however, that by sharing our positive experience, we can encourage others to ask their patients this very important question.

Camila Sardenberg, Camila Lorenz, Eliana Argolo, Camila Lajolo, and Fernando Ferragino organized What Matters to You Day at Associação Congregação de Santa Catarina.

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