As we have talked to people all over the world about their “what matters to you?” conversations we have noticed some interesting themes. One of the most common things people notice is that small things seem to make a really big difference. Of course, this is not a new phenomenon and we have perhaps often experienced this ourselves or heard it said by others. But why do apparently small, simple things often have such a powerful impact in health and care experiences? “She smiled as she spoke to me…”; “He always remembered that I like my tea in china mug…”; “They always brought me my tablets after 10am because that’s when I take them at home…”. How is it that such apparently inconsequential things seem to have a disproportionate positive impact on the emotional and physical well-being of people receiving care and support?
When Austrian psychiatrist Viktor Frankl was incarcerated in a concentration camp during the second world war because of his Jewish heritage he experienced and witnessed unimaginable suffering and pain. When he wrote about these events later in life
one of his many reflections was that the greater the suffering he was experiencing, the more a simple act of kindness was amplified. Small acts of kindness that would have passed barely noticed in normal life suddenly had enormous impact, generating feelings of hope and being valued as a human-being, to surge through his body. A morsel of mouldy bread flicked his way by a guard, a scrap of lice-infested blanket shared by a fellow prisoner, suddenly became endowed with transformative power!
Frankl’s hypothesis is that the greater the suffering of an individual, the greater the impact of an act of simple kindness, no matter how small it may seem to the benefactor. This perhaps goes some way towards explaining why entering into a conversation with a person and understanding what really matters to them, and then doing something about it, can be such a powerful intervention. The people we come into contact with each day are often dealing with great challenges in their lives, challenges which often come with intense physical or emotional suffering and pain. A conversation focused on the things that are really important to a person in such circumstances, no matter how small and trivial these things might seem to us, has the power to generate hope, a feeling of being a person of value and the power to transform. Even if sometimes we are at a loss to know what to do we shouldn’t forget the power of listening as an act of kindness in its own right – to know you have been heard and feel that someone really cares isn’t nothing! Small things matter.
Frankl, V. Man’s search for meaning. Beacon Press (1966) Originally published 1946
Anders Vege - Norway
Blog 5 - How WMTY-day started. From heart to hands
In 2014 we started two learning networks in Norway. We wanted to create better and more health promoting pathways for elderly and people with long term conditions. We had two interventions:
- Implementing a system approach by a successful pathway pilot in Norway, "Patient Trajectory for Home-dwelling elders"
- Changing direction in healthcare. Moving from asking "What’s the matter?" to "What matters to you?" This was inspired by my dear friend and mentor Maureen Bisognano.
The first reaction on the interventions was inspiring. The pathway appealed to the heads and asking "What matters to you?" moved hearts. 10% of all Norwegian municipalities participated.
The improvement teams came to the second session of the learning networks with frustration. Making health professionals ask "What matters to you?" was difficult. Health care professionals are educated and trained with small "What’s the matter-questions" and that gives us a picture of a diagnose or lost functions. Flipping to the other questions is hard training so we asked the improvement teams, do you think it would help to create a "What matters to you" day?
That gave energy and creativity for a change of direction. In 2014 we had about 30 municipalities participating. We invited them to ask for free badges with WMTY on, and share stories on our Facebook group "gode pasientforløp". The message was clear: do whatever creates energy and build a new conversation with your patients and users. And so, this amazing movement had started. The number of participants have grown year by year in Norway. This year we have activity in more than half of the Norwegian health care. And it’s all in the local hands of health professionals in municipalities and hospitals.
In the beginning a lot of health professionals were afraid of asking. They said "we cannot meet the needs they will put on our shoulders". Time has shown this to be wrong, just as in "shared decision making", the answer is often modest and about the need of being independent and being able to live home as long as possible. And that creates a climate for focusing on health promotion and training on everyday activities, to live home as long as possible. This is why "What matters to you" day matters so much. It opens our eyes for better health and better coping. Now some municipalities sais "in the beginning we were afraid of asking, and now we are afraid if we have not asked".
The Health and Care Department leads the board for our program. And we are so fortuned that our health minister, Bent Hoie, has promoted our WMTY day from the very beginning. Here in the middle with the former minister of elderly and public health, Aase Michaelsen. The program is organized by KS, membership organization for municipalities, and The Norwegian Institute of Public Health. Kristin Tveitnes (KS), to the left, does incredible work in communications for our program.
We in Norway wish you all a powerful and health promoting "What matters to you-day".
Anders Vege - Norway
Blog 6 - When "What matters to you?" becomes really personal
Two years ago my dear friend Shaun Maher from Scotland invited me to share my personal "What matters to me-message". I thought for a little while and found in my heart the true answer to the big question.
The question can find its way to the very deep of our heart, as well as being related to the practicalities of our daily life.
My three kids are off course the deepest answer to this question. Their daily life and coping changes everything. From joy to deep worries and the other way around. The love of my life is the best anchor for this roller coaster. My mother used to be an anchor too.
After she developed dementia we kind of had to switch roles. But the contact continued to be strong and our meetings were filled with her
wisdom and the way she managed to see the light in even the darkest days. It became clear to me when Shaun asked. Walking all the way through this pathway with my mom was what mattered to me. I often talked to her about my work. Meeting health professionals in Norway and talk about moving from asking "What’s the matter?" to "What matters to you?". One day I talked about this change in health care she responded intuitively and took both her hands to her stomach and said;
"Ohhh, I could feel this here. The first you said made me feel very little. But in the other question it was space enough for all of me."
Without knowing it, I think she nailed the differences of those two questions. "What’s the matter?" is perfect to find and set an illness, a diagnose. But those kind of questions have never been ment to find a whole person, and can therefore not be used to create person centered care.
I heard Maureen Bisognano from Institute of Healthcare Improvement, Boston speaking in Paris April 2014. My mentor and dear friend inspired me deeply, and we created a "What matters to you-day" in Norway two months later. One of the municipalities that joined the first "What matters to you-day" was my hometown. My mother recieved
health care in that town and the very same question inspired the services she recieved. Four years later the question was not "a day in June-question" in my hometown. In january 2018 she spent her last six days of life at Sandefjord medical center. And she was cared for by nurses wearing the wmty-badge every day at work. It was on their uniform, in their heart and in their hands.I don’t think "What matters to you?" can become as personal as it did those six days. So I could be her son and hold her hand.
I made a wmty-memo for her carers and it started with: Mom has 7 children, many grandchildren, and great-grandchildren. To mention the name of her children will comfort her: Ulf, Aashild, Kristin, Gunnar, Erik, Anders and Ingunn. Name everyone of them and say they love her deeply.
I wish you the best for your personal "What matters to you-day"