Consumer engagement at the heart of integration - Embedding the "What matters to you" question

Who is it for? What Matters to You (WMTY)? is an international movement that was inspired by a shared decision journal article in 2012. Asking clients WMTY involves three steps: Ask, Listen and Do what matters. WMTY conversations help healthcare teams understand what is “most important” to patients, leading to better care partnerships and improved patient experience. Whilst this seems like 3 simple steps, embedding this into everyday practice requires cultural shift. We share our experience of this process that would be of interest to clinicians and leaders wanting to embed this question into clinical practice. Who did you involve and engage with? Team leaders and Diabetes Nurses were involved in the planning and design of the improvement methodology. Diabetes Nurses and clients were engaged in the evaluation phases of the improvement cycle. Information from the evaluation informed the next planning and design phase. What did you do? We completed rolling ‘Plan, Do, Study, Act’ (PDSA) cycles to embed this question into a Chronic disease clinic within a Community Health Service. Testing and evaluating this at a team level with regular feedback from the clients and clinicians enabled us to embed our learnings and adapt to retest in the next PDSA phase. Outcome measures included clinical care measures and those relating to partnering in care including asking the clients if they were engaged in their care as much as they wanted to be, if they had access to the support needed to manage and monitor their condition, and documentation of the patient being asked about WMTY. What results did you get? Initially 20% of clients were being asked WMTY which increased to 100%. Improvement cycles focused and evolved on each of the three steps of the WMTY process. First step was how to ask the question and timing of the question within a clinical session. Clinicians identified that there was a need to build rapport prior to asking the question. Through collaboration it was identified that clinicians had narrowed the question to “What matters most about your clinical care”. Phase two focused on broadening the question and ensuring clinicians felt comfortable to hear and respond to non-clinical elements that were most important to patients, rather than focusing purely on clinical elements of care. The final stage of implementation was the ‘do what matters. Once clinicians knew what was most important to patients it was embedding what matters into goal and care planning processes and referring to service providers to enable integrated and holistic care. What is the learning for the international audience? The learnings are to partner in care requires education and cultural shift by clinicians to enable clinicians to feel skilled and capable to respond to clients’ needs both within and outside their clinical scope of practice. Working at an individual and team level is critical to embedding success for partnering in care. What are the next steps? Next steps are sharing learnings with other areas of Community Health to embed this question across the service.