Implementing "What Matters to You" in a Geriatric Care Pathway – a Researcher-In-Residence study:

Background To help people with frailty develop adaptive strategies to maintain their sense of identity, integrity, and wellbeing, health and care services must respect what is important to them. Training healthcare practitioners to ask frail patients “What Matters to You” (WMTY) instead of “What is the matter with you?” at every clinical encounter is expected to enable person-centred care (PCC) and provide these benefits. Asking WMTY may reduce formal complaints, improve health outcomes, and staff wellbeing, promote more efficient healthcare delivery, and reduce service costs. However, there is a lack of clarity regarding what 'mattering' is and barriers to effectively implementing WMTY. This paper explores the barriers and facilitators to implementing WMTY and its capacity to enhance meaning in life. Methods This Researcher-In-Residence (RiR) study embedded a researcher with clinical teams to facilitate learning and iterative feedback on WMTY implementation. All teams showed a willingness to integrate WMTY into their workflows. The researcher made handwritten notes with a participant observation tool in eight different locations (e.g., acute wards and community teams) and two matrons’ meetings; the observations were conducted for approximately 39 hours over nine months. The NASSS-CAT and Com/b frameworks facilitated qualitative data analysis. Results The study identifies that an every-encounter WMTY approach creates significance in the healthcare system rather than just aligning care plans with objects that matter to patients (e.g., loved ones, hobbies, home). It highlights that poor interoperability of hospital records hampers WMTY's effectiveness in guiding care plans. Additionally, illness-related challenging behaviours in reactive care settings may render WMTY inappropriate, necessitating tailored judgement calls based on patient and staff abilities. Conclusion Working culture and professional values may not always support PCC. Systems need better data capture to support a spectrum of structured person-centred conversations, from immediate functional goals to abstract discussions on Meaning in Life (MIL).