Putting the care back into healthcare: What Matters to You?

A new campaign aims to make compassion central to the healthcare experiences of older people 

Care and compassion are core tenets of healthcare and the public expects care that is competent, compassionate and caring. However, in the past decade a number of reports suggest that this is not the reality of many older people’s healthcare experience. 

On admission and throughout the acute hospital stay, healthcare professionals focus on the medical model of care, which revolves around the patient’s physical status. The emphasis is ‘what’s the matter with you?’ 

While the presenting health issue is a concern to patients, their experience of hospital care is measured by the level of dignity, compassion and respect with which they are treated. Problems can arise when rapid treatment, fast turnover and shorter lengths of stay are prioritised at the expense of compassion. 

Systematic approach

Until we synthesise these elements of care and deliver them in equal measure on a consistent basis, we will fail to meet the needs of frail older people and their families. We must find a way to allow these two paradigms – physical and emotional – of care to flourish and coexist. The literature suggests that the most positive experiences of care occur when staff know what matters to the patient. However, this type of information is often shared in an ad hoc manner, during conversation or handover. 

A systematic approach is required if we want to understand what patients consider to be meaningful and valuable. What Matters to You? (WMTY?) is an approach developed in NHS Greater Glasgow and Clyde by Royal Hospital for Children chief nurse Jennifer Rodgers and adapted for older people’s services by improvement adviser Geraldine Marsh.

It was adapted in Ireland where it is underpinned by a bespoke education programme, which supports staff to have WMTY? conversations. 

Informing care

WMTY? promotes compassionate, relationship-centred care, where staff routinely ask patients what is important to them during their time in hospital. This information is recorded, with the patient’s permission, on the WMTY? board and can be used to inform the patient’s care plan. The WMTY? board can be kept at the bedside, at the back of the bed or in a place determined by the patient, for ease of access by all healthcare professionals. 

Information captured in this way provides staff with unique knowledge of the person, which promotes relationship-centred, compassionate care and means that staff are enabled to relate to the patient as a person, rather than concentrating on their diagnosis and past medical history. 

Vital sign

President emeritus of the Institute for Healthcare Improvement Don Berwick stated on Twitter that WMTY? is the most important question healthcare professionals can ask patients because it sets the compass of care in the right direction. 

Scottish Government national clinical director of healthcare quality and strategy Jason Leitch describes WMTY? as the 'new vital sign', which should be checked along with the others. 

Staff report that the information captured in WMTY? conversations is helpful to patient care as it builds rapport and establishes relationships. When staff ask what matters, hear what matters and do what matters it releases time to care. Interviews with patients suggest they think it is a positive initiative, especially for older people with cognitive and communication issues. 

Find out more

• What Matters to You? in Scotland
• YouTube: Setting the compass of care in the right direction. Nursing & Midwifery conference 2018

About the author

Deirdre Lang is the director of nursing, National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin 

@DeirdrelangLang