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

Alexandra Stanford1, Nicholas Errico1, Rakshana Selvarajan1

  • 1Department of Pediatrics, Inova L.J. Murphy Children's Hospital, Falls Church, Va.

Academic Pediatrics
|July 2, 2026
PubMed

Insights

This quality improvement project increased asking pediatric patients and caregivers about "What Matters Most" (WMM) from 9% to 57%, improving patient satisfaction. The process was sustained, showing positive impacts on care with minimal time burden.

Area of Science:

  • Pediatric hospital medicine
  • Quality improvement initiatives
  • Patient-centered care

Background:

  • Limited data exists on understanding "What Matters Most" (WMM) for pediatric patients.
  • WMM encompasses individual values, preferences, and priorities in healthcare.
  • Patient-centered care (PCC) is crucial for effective pediatric healthcare.

Purpose of the Study:

  • To implement and assess a quality improvement (QI) project to increase the elicitation of WMM in pediatric hospital medicine (PHM).
  • The goal was to raise the percentage of PHM patient encounters where WMM was discussed from 9% to 75% within 5 months.
  • To evaluate the impact of WMM discussions on patient satisfaction and perception of PCC.

Main Methods:

  • Utilized the Model for Improvement framework with Plan-Do-Study-Act (PDSA) cycles for process optimization.
  • Assessed WMM for eligible pediatric patients within the first two days of admission.
  • Measured the percentage of patients/caregivers asked WMM (process), patient satisfaction (outcome), and staff perceptions (balancing).

Main Results:

  • The percentage of patients/caregivers asked WMM increased from 9% to 57% during the study period, sustained at 41% after 17 months.
  • Patient satisfaction increased from a median of 78% to 86%.
  • 90% of caregivers felt WMM discussions positively impacted their child's care, with providers reporting minimal time spent (<5 minutes).

Conclusions:

  • The QI project successfully enhanced the elicitation of WMM among pediatric patients.
  • A positive trend in patient satisfaction was observed concurrently with increased WMM discussions.
  • The process demonstrated minimal additional time burden for providers, supporting its integration into routine care.
Abstract

Keywords:
patient-centered carepediatricswhat matters most

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