Why "What Matters to You?" Matters

Dr Tim Williams (Director Peak Health Coaching)

Behaviour Change does not start with Health Coaching

I got into coaching by accident!

Back when I started as a GP over 20 years ago, I found people with chronic pain, really difficult to deal with (they probably found me difficult too!).  In fact, just seeing their name on my list was enough to make my heart sink.  I had nothing to offer, nothing that worked well at all.  So, I got a job in a local pain clinic – this, I thought, would be the answer; get more confident, learn new skills, have more to offer my patients.

Sadly, the pain clinic was by no means, the answer for everyone either, but while I worked there, I had a ‘penny drop’ moment, which was, “The people who did well, were those who realised that they had a contribution to make.”  In fact, they did well, whatever else I did.  So, I knew then, even at this early part of my career, that my job was not just diagnosing, referring, and prescribing, but much more about tapping into that internal resource that people had to look after themselves, (as far as they were able).  I didn’t know it at the time, but this is a coaching mindset, that ‘the person in front of me has the most important contribution to make and often has the solutions to their own problems.’

I haphazardly made my way through the first decade or so of general practice, with a few forays into NLP, then I came across coaching and thought “This is what I’ve been trying to do all these years, but now I know what it is and I have a framework to use, I can do it more consciously, more deliberately and hopefully, more skilfully.”

When we train health care colleagues in health coaching, we often hear the same back from them – it’s not that we don’t know this stuff, it’s understanding what it is and the power it has, when used well.  That’s what we want to deliver on our health coaching training – practical skills, that people can apply in the right context, with the right people and to breathe new life into the practice of healthcare. 

Where’s our starting point?

For me it started with a change in mindset from a ‘fixer’ (sorting, solving, saving) to appreciating the role the patient had to look after themselves and supporting them to do that.  But that is not all. Coaching starts with understanding “what matters”.  I can coach people, for many appointments, but if our conversations are not, at some point, about what really matters, it is a waste of everyone’s time.  I want to make a difference and I know I’m not alone in this.  Making a meaningful difference in the lives of the people we work with, starts by understanding what really matters to them.  The only way to know that, for sure, is to ask.

Think for a moment - “What matters to you?” 

This is a big question and I expect you need to take a moment to think about it.  In fact, if we were meeting in person and relative strangers, it is perhaps tricky for you to answer, ‘straight off the bat’.  It is also possibly challenging because you don’t feel ‘safe’ enough to share what really, really matters to someone you barely know.  You might therefore give me an answer that you think I want to hear like “my health”, (I was a doctor after all). However, there may be much more that sits above this, in terms of importance for you, right now, and for very good reasons.

Being Connected and Feeling Safe

Getting to what “really matters”, I think, starts with people feeling connected and ‘safe’ enough to share it.  This can progress to “what matters” and then, and only then, can we get into meaningful coaching or treatment. (see diagram)

Many people working in the health and social care sector are experts in connecting and building rapport and do this easily and seemingly with little effort – it’s just how they are.  Warm-hearted, welcoming, and generous and skilled with their attention, whatever other pulls they have on their time (and there will be many!). Some of us, will need to practice this essential ‘connecting’ skill more – sometimes deliberately and consciously, until it becomes a bit more of ‘how we are’, rather than ‘what we do’.

I am not, of course, talking about all interactions and all situations, but most of the work we do in the NHS is long-term care, where this seems particularly pertinent. For example, raising a person’s awareness of what matters to them and how their long-term condition is affecting that, can be a powerful motivator for a change towards more self-management.   Decisions about continuing treatment or end of life care, would be other good examples. 

As part of our usual work, how many of us can truly say that we know what matters to the person we are treating/caring for/supporting?  In the absence of knowing, we will make assumptions, or a ‘best guess’, about what we might want in that same situation.  The ‘problem’ with us all being unique, is that this assumption or ‘guess-work’, will often fall short of the reality.

Version one is better than version none.

In my experience, although some colleagues find this straightforward and have been doing it in some form for some time, many find a “What matters to you?” conversation challenging.  But don’t let that stop us giving it a go!  And then let us hone our approach, as an essential skill and a cornerstone of the way we work with our fellow human beings.  As Celeste Headlee says in her TED talk on having better conversations “Talk to people, listen to people and be prepared to be amazed.”   

And, if helping someone feel connected and ‘safe’, is as far as it goes in our initial interactions with them, let’s be content with that, as an amazing and essential starting point, full of possibilities.