What matters to you? day 2017

The 6 June 2017 is ‘What matters to you?’ day. There is increasing evidence that a more holistic, person-centred approach to healthcare provision can improve the patient’s experience and clinical outcomes. One simple step towards this is by finding out what actually matters, or what is actually important to patients. This aligns closely with the Scottish Government’s 2020 Vision and associated initiatives such as ‘Our Voice’. Originating in Norway, ‘What matters to you?’ day is an initiative to promote person-centred care. After hearing of the success in Norway, the idea was taken on by Health Improvement Scotland and the Scottish Government’s person-centred care team in 2016.

Part of my job is to analyse all of the feedback that the Scottish Ambulance Service receives, good and bad. Whilst there are a wide variety of themes, what does stand out for me is that when patients compliment our staff, they often emphasise how they felt listened to, how the staff put them at ease or that they took the time to explain things and involve them in the decisions about their care. This has certainly been highlighted in a number of Care Opinion stories. Sadly, but not surprisingly, our negative feedback often reflects the opposite, where we have not communicated with well with our patients and not listened to them or their concerns.

As part of our preparations for ‘what matters to you?’ day 2017, and with the support of patient experience colleagues in NHS Lothian, I decided to spend some time speaking to patients who had been taken by ambulance to an Emergency Department. This proved to be an extremely insightful experience and highlighted that what matters to patients is not always what we think it will be.

The first patient I spoke to had collapsed on his way to work and had regained consciousness with a crowd of people standing over him. He was then quickly assessed by an ambulance crew before being taken to hospital. When I spoke to him he was feeling better but was still unsure what had happened to him and was waiting to see a doctor. This must have been an extremely frightening experience and he was definitely not expecting to be lying in a hospital cubicle that morning waiting for the results of the various tests. Despite this, what actually mattered to him and what was most important at that moment was his wife and children. He was reflecting on a recent argument with his wife, and what the impact of this would have been on her and his children if he had not recovered from his collapse.

Another patient who had been brought in to hospital after falling and sustaining a head injury was concerned about the waiting times. She had heard horror stories in the press this really worried her.

I spoke to an elderly man who had a recent history of back and leg pain. That morning his pain had suddenly increased and he was unable to walk. He explained to me that over the past couple of months he had received a number of tests but so far had not been given a diagnosis. When I asked what mattered to him he explained that his doctor and a specialist had told him what was not wrong with him but no one was able to tell him what was causing the pain. For him, knowing that nothing serious appeared to be wrong was not enough. He was extremely frustrated by this.

Another elderly patient that I spoke to had been brought into hospital with severe back pain. He had a number of chronic medical conditions and lived alone. He had received treatment and was waiting to be discharged. What had mattered to him when the ambulance crew were with him was having his pain managed but now he was extremely worried about going home. He was very frightened about what he would do if the pain returned and he was unable to summon help.

I had a chat with a patient who had made the brave decision to try and stop taking recreational drugs but with little support. An event in his personal life had led him to the decision to stop using drugs but when I spoke to him he had suffered chest pains and hallucinations. Interestingly, what mattered to him was not his situation at that moment or the fact that he was receiving treatment in hospital. His main concern was his work and what was going to happen with his job.

I spoke to a lady who had fallen in the street and was waiting for an x-ray of what was probably quite a nasty break to her arm. She was full of admiration for the ambulance and hospital staff. What was mattered to her was that we have emergency services and accident and emergency departments that can be relied upon when they are needed.

What appeared to be a recurring theme throughout the day was that what mattered to the patients was not always what I expected it would be. They were not so concerned about what had specifically happened to them on that day to bring them to hospital but most patients highlighted a variety of less obvious but extremely important concerns or things that were important to them. This was fascinating and could be due to the fact that most of the patients had already been treated or had had their treatment started by the ambulance and hospital staff. Perhaps having had time to reflect on what had happened may have influenced this. I know that in similar work that we have undertaken on ambulances, what is often important to patients is just getting through the current situation they are in, for example, just getting their pain managed.

Whatever the reasons, what was important was that asking patients what mattered to them provided a much greater understanding of what really was important to that individual patient. This simple enquiry has the potential to have a really positive impact on the immediate and ongoing care of our patients and in my view is of essence of person-centred care. I intend to share my findings with my colleagues with a view to replicating this approach on a larger scale.