Making What Matters Most Matter: A Quality Improvement Project to Ask What Matters Most to Hospitalized Children

"What Matters Most" (WMM) refers to the core values, preferences, and priorities of an individual regarding their health care experience. Limited data exists on WMM to pediatric patients. The aim of this quality improvement (QI) project was to develop an additional tool for providing patient-centered care (PCC) by increasing the percentage of pediatric hospital medicine (PHM) patient encounters in which patients and/or caregivers were asked WMM from 9 to 75% in 5 months.

Following engagement of appropriate partners, WMM was assessed for eligible children within the first two days of admission. Using the Model for Improvement, this process was optimized through a series of Plan-Do-Study-Act (PDSA) cycles. Measures included the percentage of patients/caregivers asked WMM during admission (process), patient satisfaction and perception of PCC (outcome), and staff perception on time, impact on care, and satisfaction with the process (balancing).

The percentage of patients/caregivers asked WMM increased from 9 to 57% over the study period and was sustained at 41% 17 months later. The proportion of patients satisfied increased from a median of 78-86%, and 90% (n = 18) of sampled caregivers felt that being asked WMM positively impacted their child's care. While 94% (n = 31) of providers reported spending <5 minutes on asking WMM, only 56% (n = 24) were satisfied with the overall WMM process.

This project successfully increased WMM elicitation and demonstrated a positive trend in patient satisfaction over the corresponding timeframe with minimal additional perceived time burden by providers.