QI in Action: Improving Compliance with Shared Decision-making at Fremantle Hospital

We spotlight Evonne Fong and Dale Mitchell’s project aimed to improve understanding and communication of patient goals of care and preferences.

The ACHS Improvement Academy’s Quality Improvement Lead (QIL) Program supports healthcare professionals in implementing data-driven improvement initiatives within their organisations.       

QIL Graduates, Evonne Fong and Dale Mitchell worked on a project titled, ‘Improving Compliance with Shared Decision-making at Fremantle Hospital,’ focusing on strengthening patient engagement and ensuring patients are actively involved in decisions about their care through more consistent clinical practices and processes. 
 

Project Background 

Following the 2022 accreditation assessment, Fremantle Hospital identified opportunities to improve the consistency and visibility of shared decision-making practices across inpatient areas. It was determined that there was a greater need to ensure that discussions about patient goals, preferences, and engagement were systematically documented in care plans and communicated during clinical handovers. 

The project team set a clear aim to implement a process to support shared decision-making and ensure there is documented evidence for all inpatients by April 2025. 

Putting Patients at the Centre 

The initiative was inspired by the What Matters to You movement, which began in Norway in 2014 and encourages healthcare staff to ask patients a simple but powerful question: What matters to you? 

These conversations help clinicians better understand patients’ goals and priorities, recognising them as experts in their own needs. Research shows that engaging patients in this way can strengthen trust and improve both the safety and quality of care. 


Understanding the Issues 

The project began by clearly defining the problem, establishing a shared understanding of its impact on patients, staff and the organisation. This foundation enabled the team to align around a common purpose and priority for improvement. Using these insights, the team collaboratively developed a focused aim alongside a set of targeted change ideas to guide the improvement effort. 

Implementing and Testing Change 

The initial intervention involved introducing What Matters to You whiteboards in patient rooms. These were designed to capture patient goals and preferences, making them visible to staff during care planning and clinical handovers. 

To support implementation, staff education and communication strategies were introduced. Feedback was gathered through staff surveys, consumer interviews and audits to evaluate how effectively the whiteboards were being used in practice. 

 

Figure 1. Intervention: What Matters to You board design 

Early findings indicated low compliance and limited staff engagement. Consumers were also unclear about the purpose of the boards, highlighting a gap between intention and implementation. 

In response, the team adapted their approach, shifting to a more integrated, multi-pronged strategy that embedded the What Matters to You concept across multiple points in the patient journey. 

A key change was the introduction of a What Matters to You patient form, completed at admission. This provided patients with a simple and comfortable way to share their priorities, enabling clinicians to more effectively incorporate these into care planning. The approach was reinforced through ongoing staff education, clinical handovers and meaningful patient conversations. 

Positive Early Results 

The patient form has shown encouraging results, with good levels of completion and positive feedback from both staff and consumers. Patients appreciated the ability to complete the form while in bed, and staff reported that it was easy to integrate into admission processes. 

Importantly, the form also acts as a prompt for clinicians to initiate meaningful conversations about patient goals and preferences. 

Looking ahead, the What Matters to You patient form will be introduced to additional wards at Fremantle Hospital, with plans to expand the initiative to Fiona Stanley Hospital. A ward implementation guide is being developed to support consistent adoption. 

By embedding the simple question “What matters to you?” into routine practice, Fremantle Hospital is taking meaningful steps to strengthen patient-centred care and ensure that healthcare decisions reflect what matters most to patients. 
 

Explore projects from QIL Program Graduates    
You can read more projects like this in the QIL Projects Summary booklet undertaken by QIL 2024 participants over the course of our 9-month program.    

This years program is underway contact us to see if the program is right for you and when the best time to enroll is improvementacademy@achs.org.au