Always Events®

Always Events® are defined as “those aspects of the patient and family experience that should always occur when patients interact with healthcare professionals and the health care delivery system”. NHS England, in collaboration with Picker Institute Europe the Institute for Healthcare Improvement (IHI) and NHS Improvement have been leading an initiative for developing, implementing, and spreading an approach to reliably integrate Always Events® into routine frontline services

Always Events® is a co-production quality improvement methodology which seeks to understand what really matters to patients, people who use services, their families and carers and then co-design changes to improve experience of care. Genuine partnerships between patients, service users, care providers, and clinicians are the foundation for co-designing and implementing reliable solutions that transform care experiences with the goal being an “Always Experience.” The creation of an Always Events® is a practical methodology for achieving this goal by asking patients and people who use services “What matters to you?” in addition to “What’s the matter?”

Working together, the four organisations developed a programme to pilot and test the Always Events® framework and create a toolkit to support implementation of Always Events® within the NHS in England. The programme began in 2015 and involved 10 provider pilot sites across England. Helen Lee, Head of Quality Improvement and Patient Experience at Lancashire Care NHS Foundation Trust who was part of the pilot programme shares;

we have successfully implemented Always Events for people with learning disabilities and are now spreading the approach across the organisation.

We now have more than 100 provider organisations actively working with us to codesign Always Events, and met the 2018 NHS Mandate deliverable of 100 trusts by 31 March. The 2020 goal in the NHS Mandate is to ensure that ‘patients, their families and carers are involved, through co- production, in defining what matters most in the quality of experience of services and assessing and improving the quality of NHS services’.

Always Events national programme

A jointly written letter by Jane Cummings, Chief Nursing Officer at NHS England and Ruth May, Executive Director of Nursing at NHS Improvement, as been issued to Chief Nurses in NHS provider organisations.

Both Ruth and Jane are keen to see the majority of NHS provider trusts using co-production with patients and families to undertake their quality improvement work, and ensure patients have the best possible experience of care.

Always Events toolkit

The toolkit was a result of NHS England, Institute for Healthcare Improvement and Picker (Europe) working with the initial 10 provider organisations and was published in December 2016.

This toolkit is for any organisation wanting to implement an Always Event using the Always Event methodology.

Evaluation of Always Events

Here is the first report of the Evaluation of Always Events® Pilot Programme carried out by Picker Institute (Europe) published September 2016.

A further evaluation report has been published and can be found on the Picker website: Always Events® Evaluation Phase 4: Scale-up and spread – July 2018.

Always Events film

A short (5 minute) film has been produced which shows clips of interviews with both staff and people who use services who have been involved in codesigning, testing and implementing Always Events.

Always Events and learning disabilities

There are a growing number of providers of services to people with a learning disability who are codesgining Always Events with good success. Lancashire Care NHS Foundation Trust were one of the first trusts to undertake Always Events with people using the services of one of the community learning disability teams. Their vision was “We will always be supported in moving on in care.” A number of changes were implemented in collaboration with both staff and people using the service and feedback was extremely positive with 80% of people discharged from the learning disability team saying they felt supported when they were discharged.