Beyond the Care Plan

A Short History of a Four-Word Question That Changed Care

The question didn’t appear out of nowhere. It grew out of decades of work to move health and social care away from a strictly biomedical, task-driven model and toward something more human — care that starts with the person, not the diagnosis.

In 2012, Michael Barry and Susan Edgman-Levitan published a landmark article in The New England Journal of Medicine arguing for a deceptively simple shift in clinical conversations: instead of only asking “What is the matter?” clinicians should also ask “What matters to you?” It wasn’t just a communication technique. It was a reframing of the entire relationship between professional expertise and personal priorities — from “we decide what’s best” to “we decide together, anchored in what matters most to you.”

That same year, the concept was piloted in Norway and Scotland. By 2014, Norway had launched the first “What Matters to You?” Day — a national catalyst that accelerated global adoption. IHI’s Maureen Bisognano challenged the medical community to shift from “What’s the matter?” to “What matters to you?” during her 2014 IHI Forum keynote, sparking an international movement that has now spread to over 49 countries.

As adoption grew, leaders emphasized that the question alone wasn’t enough. The widely used framing “ask what matters, listen to what matters, do what matters” became essential. The movement’s power depends on translating what’s learned into decisions and action, especially when choices are high-stakes.

By 2022, “What Matters” had become one of the central pillars of Age-Friendly Health Systems — one of the 4Ms alongside Medication, Mobility, and Mentation. And in January 2025, The Beryl Institute announced a collaboration with WMTY.world to strengthen the movement’s global infrastructure. The question had gone from a two-page editorial to a recognized international framework. “What Matters to You?” Day is now observed worldwide on the first Tuesday in June each year.

The Question That Changes the Whole Care Experience

At its core, “What matters to you?” is a shared decision-making practice. It invites the person receiving care — and their family — into the center of the plan, not as passive recipients but as partners whose values, goals, and fears shape what happens next.

That sounds straightforward. In practice, it’s transformative.

When teams understand what matters to a resident and family early, they build shared direction. Communication becomes more purposeful. Care plans become more personal. And the relationship between the community and the family starts from a place of alignment rather than assumption.

When people feel understood, trust rises. When people feel unseen, conflict grows. The question is the entry point.

Why Senior Living Needs This Now

Senior living is experiencing a convergence of pressures: staffing shortages, rising family expectations, regulatory scrutiny, and the emotional weight of serving people during some of the most vulnerable seasons of their lives. In this environment, communication gaps don’t just cause frustration — they create risk.

The moments where this pressure is most acute are transitions in care: admission and move-in, changes in condition, falls and safety events, hospital returns, and end-of-life planning. These are the moments when families are forming judgments fast, when assumptions are taking root, and when the care team has the least time to slow down and ask.

And yet these are exactly the moments when one question — asked with skill and followed by action — can change the entire trajectory of the relationship.

The Hidden Risk Problem: Misalignment, Not Bad Care

Here is a pattern that every senior living leader, risk manager, and care team will recognize:

A fall happens. The clinical facts are manageable. But the family’s narrative is already running: “They weren’t watching her.” “We told them she was unsteady.” “Nobody called us for three hours.”

The complaint, the survey deficiency, or the claim is rarely about the clinical event itself. It’s about the family’s story — that they weren’t heard, weren’t informed, and weren’t treated as partners in care.

Most conflict in senior living isn’t caused by bad people or bad care. It’s caused by a story the family tells themselves about what happened — and by the fact that no one understood that story early enough to address it.

This is the misalignment problem. And “What matters to you?” is one of the most powerful tools available to prevent it. When teams know what a family is watching for, what safety means to them personally, what the resident fears losing, and what dignity looks like for this specific person — the entire risk profile changes.

Communication improves. Documentation improves. And families who feel heard are far less likely to escalate, even when hard things happen.

How to Ask It Well in Senior Living

This is where most conversations about WMTY fall short. The question sounds simple. In practice, it’s one of the hardest conversations a care team will have.

Research on WMTY implementation has surfaced consistent challenges: staff often experience the question as “big,” “risky,” or hard to ask without context. Teams worry about creating expectations they can’t meet. Time pressure and system constraints can cause the question to collapse into a task-oriented checkbox rather than a meaningful conversation about values and goals.

That tension is real, and it’s exactly why framing matters.

A practical reframe that works

“In this next season of care, what matters most to you so we can plan together?”

That one shift — “this next season” — changes the dynamic. It makes the conversation concrete and time-bound. It gives the team a frame. And it tells the family: we’re not promising everything forever. We’re promising to plan with you, right now.

The skill behind the question

Ask in calm moments, not only during crises. Listen for meaning, not just tasks — what the person values, fears, and hopes for. Document the answer where the whole team can see it. Act on it in the care plan and daily routines. Close the loop — show the resident and family what you heard and what you did.

This is the discipline that turns a question into a practice — and a practice into culture.

Where to Operationalize It

WMTY is not a program that runs alongside care. It’s a practice that gets embedded into the moments that matter most. Here’s where it belongs in senior living:

Admission and move-in

This is where the foundation is set. Asking what matters during the admission process — not just collecting medical history and preferences, but understanding values, fears, and expectations — creates shared direction from day one. Guide Path’s Resident & Family Insight Survey is designed to capture exactly this: the priorities that shape how a family evaluates care long after the paperwork is done.

Care conferences

Care conferences are often task-driven reviews of clinical data. Adding a “what matters” check-in recenters the conversation around the person. It gives families a voice in the room and gives teams a reference point for whether the plan still reflects what the resident and family actually care about.

Change in condition and falls

These are communication crossroads. Families are evaluating trust in real time. Asking what matters — before jumping to clinical next steps — signals that the team sees the person, not just the event. It also provides critical context for documentation: a record that shows the community heard the family’s concerns and responded to them.

Family communication rhythms

WMTY shouldn’t only happen at formal touchpoints. When teams build a rhythm of checking in — “Is what matters to you still the same, or has something shifted?” — they catch expectation drift before it becomes conflict. What mattered at admission may not be what matters three months in.

QAPI learning loops

Quality Assurance and Performance Improvement programs can integrate WMTY data as a leading indicator. When communities track whether they’re asking the question, documenting the answer, and closing the loop, they create a measurable, defensible practice that connects person-centered care to quality outcomes.

The Leadership Piece: Making It a Culture Practice

WMTY doesn’t become culture because someone puts a poster on the wall. It becomes culture when leaders model it, resource it, and hold it as a standard.

That means asking staff what matters to them, too. When leaders create space for workforce conversations — “What matters to you about doing your work well? What gets in the way? What support would change your day?” — the entire organizational culture shifts. Staff feel respected. Turnover slows. Communication steadies. And the care experience stabilizes in ways no policy manual can replicate.

This is why GuidePath’s certification pathway includes both resident and family expectations alignment and workforce communication practices. Culture change only holds when both sides feel heard.

Culture change that sticks requires both sides of the conversation. Ask residents and families what matters. Ask staff what matters. Then connect both to how the community actually operates.

June Initiative: Voices of What Matters

This June, GuidePath is launching “Voices of What Matters” — a series of short stories from residents, families, caregivers, and leaders sharing what matters most to them in aging and care.

The series will feature real voices from across senior living, with a specific focus on transitions in care: the moments where expectations form, trust is tested, and communication makes or breaks the relationship.

GuidePath will also be hosting a practical webinar for operators, risk leaders, and care teams on how to build WMTY into a real, repeatable practice — including how to frame the question, where to embed it, and how to connect the answers to care planning, documentation, and communication habits.

“What Matters to You?” Day is observed worldwide on the first Tuesday in June. GuidePath is proud to be part of this global movement — and to bring it to life in senior living with the structure and tools that make it actionable.

An Invitation

The “What Matters to You?” movement has shown us something profound: when care starts with the person’s values, goals, and fears — not just their diagnosis and risk profile — outcomes change. Trust strengthens. Conflict decreases. And the people doing the hard work of caregiving feel more connected to why they do it.

But the question alone isn’t enough. Senior living needs the training, the tools, and the systems to turn a powerful question into an everyday discipline. That’s what GuidePath was built to provide.

If this resonates, follow Guide Path this June.
Watch the “Voices of What Matters” series this June.
Join the webinar, Wednesday, June 3rd, 1PM CST.
And share your own story.

We’ll start with the same question we’ve been asking all along: What matters most to you?