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Asking patients “what matters to you” to personalise health and care
On this 2021 ‘What matters to you day’, I ask all clinicians, system leaders and healthcare workers to consider how they can introduce one simple question into healthcare practice – “what matters to you?”
People’s circumstances, values, and preferences really matter in the decision-making, design and delivery of their individual health and care. Despite over two decades of scientific evidence showing this way of working is effective, we know from patient experience measures and data on health inequalities that exist in England, that this approach of “what matters to you” is not universally adopted.
As we restore services and recover from the COVID-19 pandemic, it’s critical we adopt this style of communicating with the people and populations we support. This is the very first step to introducing Personalised Care – a key commitment for delivering health and high quality for all, as outlined in the NHS Long Term Plan. It gives people the same choice and control over their mental and physical health that they expect in other aspects of their life, ensuring better experiences and improved health and wellbeing.
I became a physiotherapist because I love helping people live their best life. I empower, support and coach them with different clinical interventions, largely including physical activity and exercise. My personal values drove my behaviour as a clinician in how I consulted with patients and their families. This taught me to value being a “fixer for” – and also a “facilitator with” – patients so they were enabled to help plan their care. At times, I didn’t always get the balance of fixer and facilitator right. I got it “more right” when I asked “what matters to you” alongside “what’s the matter with you”.
Let me give you an example. I was treating Anthony who had fractured his calcaneum (the large bone forming the heel). Anthony was homeless and alcohol dependent. Supporting him to weight bear and stop using crutches as part of his orthopaedic recovery and rehabilitation required working very differently on his care planning and care delivery due to what motivated him to change, and frankly, what was within his control to change. The evidence-based part of my work flagged risks around his slow progress and developing complex regional pain syndrome. However, what mattered to Anthony in his rehabilitation planning was quite different to what matters to me as his clinician supporting and facilitating his return to mobility. His values and his personal context were critical in terms of how care planning was delivered.
As a clinician, I strive to deliver effective, evidence-based care and support I also want to deliver optimal value to the people, populations and systems I support, as well as fulfil what motivated me to a career in healthcare. In other words, delivering evidence-based medicine to optimise the outcomes that matter to an individual person, yet doing this in the context of the population health eco-system, integrated with the assets of the person as well as their community. The “What matters to you” approach, for me, was intrinsically a question that linked with what I was trying to achieve morally and ethically as a clinician, but also me as a human, doing my best to support others in the context of their whole lives.
And yet this does not mean adopting a consumeristic style of healthcare, but rather clinicians and patients working as equal partners to understand what is important to that person. Research shows this improves patient outcomes, improves experience of care, enhances clinician satisfaction and importantly, as a by-product, improves efficiency.
My call to action for you is this: for those who already embrace this approach, use this year’s “What matters to you day” as a chance to celebrate, share, and amplify your work to your peers. Describe its impact so that we, as a healthcare community, show that this is the way in which we transform, rebuild and recover our healthcare systems in 2021.
For those of you who have not yet tried “What Matters to You”, then in the words of Don Berwick and Maureen Bisognano from the Institute for Healthcare Improvement, “just try it” and share with me what you found – #WMTYD21
If you would like more information on personalised care, and in particular Shared Decision Making, for which which asking What Matters to You is the foundation, take a look at the NHS England and NHS Improvement website and the Personalised Care Institute training offer, hosted by the Royal College of GPs.