Risk is not only clinical. It’s relational.
When we think about claims in healthcare, we tend to think about clinical events — a fall, a medication error, a missed diagnosis. And those events matter. But in our experience, the claims that escalate the fastest and cost the most don’t start with a clinical failure alone. They start with a relational one.
A family who felt shut out of decisions. A patient whose priorities were never asked about, let alone reflected in the care plan. A team that made sound clinical choices but never communicated the reasoning in a way the people involved could understand or trust.
The clinical event is often the trigger. But the gap between what a person valued and what a team assumed is what turns an adverse outcome into a grievance, and a grievance into litigation.
This is the space we work in every day. And it’s why a global healthcare movement built around a single question has caught our attention as a claims management and risk strategy tool:
“What matters to you?”
How disputes form: assumptions + silence + fear
There’s a pattern we see across healthcare settings — hospitals, post-acute care, senior living, clinical practices. It looks like this:
A patient or resident enters a care setting. The team assesses clinical needs, builds a plan, and executes. But the person’s actual priorities — what they value, what they’re afraid of, what outcome they’d consider a success — are never explicitly surfaced. The team assumes. The family assumes. And as long as things go well, those assumptions stay invisible.
Then something goes wrong. A change in condition. A fall. An unexpected outcome. And suddenly the gap between what the team was working toward and what the family expected is exposed — not as a misunderstanding, but as a betrayal.
Research confirms this pattern. Studies show that poor clinician-patient communication is a significant motivator for patients seeking legal counsel. Patients and families pursue litigation not only for compensation, but to understand what happened, to ensure it doesn’t happen again, and to feel that someone is being held accountable. When they feel unheard before an adverse event, they’re far more likely to feel abandoned after one.
Fear compounds this on the provider side. Healthcare organizations have operated for decades in a deny-and-defend posture — afraid that openness will invite litigation, that communication will complicate claims, that acknowledging a gap will be treated as an admission of fault. That fear has suppressed exploration of better alternatives. It has cost organizations financially and emotionally.
The question “What matters to you?” disrupts this cycle at its origin point — before the adverse event, before the grievance, before the claim.
Why WMTY is a defensible practice (when done well)
The “What Matters to You?” movement didn’t start as a risk strategy. It started as a shared decision-making framework.
In 2012, Michael Barry and Susan Edgman-Levitan published a landmark piece in The New England Journal of Medicine arguing that clinicians should ask not only “What is the matter?” but also “What matters to you?” The article framed this as the core of shared decision-making — a practice in which both the clinician and the patient share information, the clinician offers options and describes risks and benefits, and the patient expresses preferences and values. Each participant is armed with a better understanding, and shares responsibility in the decision about how to proceed.
That origin matters for risk. Shared decision-making has a robust evidence base. A Cochrane review of 86 randomized trials found that using decision aids led to increased patient knowledge, more accurate risk perceptions, greater alignment between decisions and patient values, and reduced decisional conflict.
When an organization can demonstrate that it systematically asked what mattered to a patient, documented the answer, and reflected it in care planning and communication, it creates a defensible record. Not because the question is a legal shield — but because it produces the kind of aligned, transparent, well-documented care that is inherently harder to challenge.
The movement has since grown to over 49 countries and become embedded in the Age-Friendly Health Systems 4Ms framework (What Matters, Medication, Mentation, Mobility) — one of the most widely recognized quality frameworks in healthcare. The discipline behind it has been distilled into a three-part practice: ask what matters, listen to what matters, do what matters.
That last part is where the risk value lives. Asking without follow-through is performative. Asking with documented follow-through is a defensible practice.
The operational reality: teams need training because WMTY is complex in practice.
None of this works if WMTY is treated as a script or a checkbox.
Research on healthcare providers implementing WMTY in real-world settings has surfaced important challenges. Staff often find the question difficult to ask without context or confidence. Teams worry about creating expectations they cannot meet — that asking what matters will imply they can deliver anything a patient wants. Time pressure causes the question to collapse into task-oriented goals rather than meaningful personal priorities. And without organizational support, even well-intentioned staff default to the functional and clinical rather than the relational.
These are not reasons to avoid WMTY. They are reasons to invest in structured implementation — training, framing, practice, and frameworks that make the question repeatable, documented, and tied to care decisions.
The Montefiore Hudson Valley Collaborative, which has implemented WMTY across a diverse network of provider organizations, has found that the most effective approach is to treat WMTY as a movement, not a metric. Organizations that fixated on quantitative measures — counting how many WMTY forms were completed — tended to squash the momentum. Organizations that collected stories, celebrated the impact, and let the practice spread organically through staff experience built durable cultural change.
This is an important insight for any organization thinking about WMTY as a risk tool: the risk value comes from the relational quality of the practice, not from its volume. One well-asked, well-documented, well-followed-through WMTY conversation at a critical transition point is worth more than a hundred forms filled in at intake.
Where WMTY reduces exposure
In our claims management work, we see the same high-risk moments across healthcare settings. These are the inflection points where misalignment between a care team and a patient or family is most likely to take root — and most likely to become a claim later. They are also the moments where WMTY has the greatest impact.
Transitions in care. When a patient moves between settings — from hospital to home, from acute care to post-acute, from independent living to a higher level of care — the risk of misalignment spikes. New teams inherit care plans they didn’t build. Families receive information from multiple sources. Priorities get lost in the handoff. Asking “What matters to you?” at every transition point creates continuity of understanding, not just continuity of clinical data.
Documentation alignment. One of the most common vulnerabilities we see in claims is a disconnect between what a care plan says and what a family understood. When WMTY is documented — when the patient’s stated priorities are reflected in the record and referenced in clinical decisions — it creates alignment that is visible to anyone reviewing the chart, whether that’s a surveyor, a risk manager, or a plaintiff’s attorney. Documentation that reflects a person’s values is categorically different from documentation that only reflects clinical tasks.
Family meetings. Goals-of-care conversations and family meetings are among the highest-stakes interactions in healthcare. When these conversations happen without a clear understanding of what matters to the patient, they frequently become adversarial — families advocate for what they think the patient would want, teams advocate for what they believe is clinically appropriate, and neither side has a shared foundation. When WMTY has been asked and documented earlier in the relationship, family meetings can begin from a place of alignment rather than negotiation.
Complaint response tone. When a complaint or grievance is filed, the organization’s response sets the trajectory for everything that follows. If a care team can reference what mattered to the patient and demonstrate how that informed the care plan, the response carries a fundamentally different weight. It’s the difference between “We followed our protocol” and “We understood what mattered to your mother, and here’s how we worked to honor that.” One is defensive. The other is credible.
Practical “risk-smart” WMTY language
For organizations considering how to begin, we recommend starting where the risk is highest — not everywhere at once.
A pilot might look like this: identify one or two high-risk transition points in your care delivery (admission and change-in-condition conversations are strong starting places). Train a small team — not just on how to ask the question, but on how to listen, how to document what they hear in a way that connects to care planning, and how to communicate it across shifts and disciplines.
The language doesn’t need to be clinical. In fact, the less clinical, the better. Effective WMTY conversations might sound like:
“Before we talk about next steps, can you help me understand what’s most important to you right now?”
“When you think about what a good outcome looks like, what comes to mind?”
“Is there anything you’re worried about that we haven’t talked about yet?”
“What would you want us to know about your mom if we could only know one thing?”
The goal is not to collect a data point. The goal is to surface what a person values so that the care team can align around it — and document that alignment in a way that creates both trust and a defensible record.
Over time, this becomes cultural rather than procedural. The Montefiore Hudson Valley Collaborative found that as WMTY took hold, staff and leadership began naturally using the language — not because it was required, but because it changed how they connected with the people they served.
That cultural shift is, ultimately, the most powerful risk strategy there is. When people feel understood, they are less likely to escalate. When care teams operate from shared understanding, they make better decisions. And when organizations can demonstrate a pattern of asking, listening, and doing what matters, they build the kind of credibility that reduces exposure across every dimension — regulatory, reputational, and legal.
June is What Matters to You? month. We’ll be sharing more throughout the month about how WMTY shows up in practice and why we believe it belongs in every organization’s risk strategy.
If you or your team have any questions about WMTY, reach out to us for a conversation.