What matters when asking, “what matters to you?” — perceptions and experiences of health care providers on involving older people in transitional care

Abstract

Background: Transitional care for older chronically ill people is an important area for healthcare quality improvement. A central goal is to involve older people more in transitional care and make care more patient-centered. Recently, asking, "What matters to you?" (WMTY) has become a popular way of approaching the implementation of patientcentered care. The aim of this study was to explore health care providers' perceptions and experiences regarding the question of WMTY in the context of improving transitional care for older, chronically ill persons. Methods: The data comprise semi-structured individual interviews with 20 health care providers (HCPs) who took part in a Norwegian quality improvement collaborative, three key informant interviews, and observations of meetings in the quality improvement collaborative. We used a thematic analysis approach. Results: Three interrelated themes emerged from the analysis: WMTY is a complex process that needs to be framed competently; framing WMTY as a functional approach; and framing WMTY as a relational approach. There was a tension between the functional and the relational approach. This tension seemed to be based in different understandings of the purpose of asking the WMTY question and the responsibility that comes with asking it. Conclusions: WMTY may appear as a simple question, but using it in everyday practice is a complex process, which requires professional competence. When seen in terms of a patient-centered goal process, the challenge of competently eliciting older people's personal goals and transferring these goals into professional action becomes evident. An important factor seems to be how HCPs regard the limits of their responsibility in relation to giving care within the larger frame of the patient's life project. Factors in the organizational and political context also seem to influence substantially how HCPs approach older patients with the WMTY question.

‘They Just Came with the Medication Dispenser’ – A Qualitative Study of Service User Involvement and Welfare Technology in Public Home Care Services

“…The ndings from our study show that the participants did not experience the use of GPS as monitoring, but as a safety measure. What service users see as important should be the guiding principle for services and interventions if genuine user involvement is to be achieved, rather than the attitude of the health professionals, as also supported by other studies (34,40,57). A feeling of being heard and listened to was seen as important by the participants in our study.…”

“…The service users' goals, needs, and capabilities should be the guiding principle for services and interventions if genuine user involvement is to be achieved (34,38). For this reason, this study should also be seen in light of the increased focus on patient-centred care in health services (39,40). Furthermore, user involvement is also about the relationship between health professionals and service users (41).…”

“…This highlights the need for user involvement by end-users in the procurement process if the home care service is to acquire new technology that actually meets service users' needs. Furthermore, other studies (5,40) point out that, health professionals have a responsibility to follow-up what service users experience as important.…”

“…Olsen el al. (40) pointed out that patient-centred care is essential for trust and cooperation, as well as for optimising health care. Making patient-centred user involvement the standard way of working among healthcare professionals is a matter of urgency in relation to putting the service user in focus.…”

‘They just came with the medication dispenser’- a qualitative study of elderly service users’ involvement and welfare technology in public home care services

“…Hestevik et al [53] argue that a paternalistic attitude on the part of health professionals in relation to how service users are included in the process and allowed to share their wishes and experiences can be a barrier to user involvement. In line with Olsen et al [39], a more patient-centred focus can contribute to user involvement in relation to service users' health-related needs and goals.…”