Making essential and effective integrated care an Always Event

The Experience of Care Professional Lead at NHS England and NHS Improvement discusses why the Always Events methodology has led to improvements in patient experience:

Improving care experiences with people using services is often placed in the nice to do box.

This could be due to factors like lack of time, resources, or it just not being a priority. However, over the last four years we have spread the use of a model – the Always Events methodology – that has seen 135 NHS providers, supported by our Patient Experience Team, coproduce improvements in experience of care with great results.

This has now spread further, with Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs) starting to use this improvement approach in work across their systems.

The Always Events methodology, which is trademarked by the Institute for Healthcare Improvement, is a way to define those aspects of the care experience that should always occur when patients, their family members or other care partners, and service users interact with health care professionals.

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?”

Testing the methodology in the English healthcare system began in 2015 with just two organisations and now over 50% of providers are signed up to the programme. These providers have found that Always Events has enabled them to focus their quality improvements on what really matters to people and coproduce simple, cost effective, measurable and sustainable improvements because they are designed to work by people using services in partnership with staff at the point of care.

This has improved both the experience of care for the people using the services and for staff who can reconnect to their core purpose.

One example is the team at the Royal National Orthopaedic Hospital who asked families’ what mattered to them when they were attending the children’s out patient’s department.

They discovered that families could travel hundreds of miles and navigate the M25 but couldn’t find the department from the car park as the new inpatient unit had been built in the way. The staff thought expensive new signs would be the answer yet one of the children suggested bones painted on the floor to guide families to the department. Simple, effective ideas!

More recently there has been interest from health and care systems to look at how the Always Events methodology can support larger scale integration and transformation. For example, Joined Up Care Derbyshire are using the approach to implement their Community Frailty Model with their Place Alliances testing change ideas. They were drawn to ‘Always Events’ as a Quality Improvement methodology because of its particular focus on prioritising the voices of patients, carers and service users and front-line staff delivering care and services.

In the Greater Manchester Health and Social Care Partnership, they are co-producing improved experiences of social care in domiciliary care settings. One provider realised they were duplicating review meetings with social care, with people often having reviews with social workers in the morning and the domiciliary care provider in the afternoon. By doing the reviews together changes could be made immediately in response to the person’s needs rather than having to liaise with social care after the visit. This has improved the experience for everyone and saves time.

In Somerset, Always Events are being used to facilitate improved experiences of discharge from services, irrespective of who or where the service is provided. This has included acute, community, mental health and primary care providers together working in partnership with people who have lived experience.

Similarly, in South Tyneside a team of people with lived experience and health and social care providers wanted to increase use and reduce inequality of uptake of support that enables people to live well with one or more long term condition. They are using the Always Event methodology to understand what the barriers are to people utilising the education and rehabilitation services and what people want from these services.

We are committed to supporting the NHS in improving experiences of care through coproduction. There is a full package of support available from the Patient Experience Team at NHS England and NHS Improvement including an introduction to the methodology day, ongoing coaching calls and mentorship from an Always Event Buddy. Regional teams are also involved in supporting systems in using Always Events.

Helen Lee

Helen Lee is a qualified nurse with experience of working in both acute and community settings.

She is currently on secondment with NHS England and NHS Improvement leading the #AlwaysEvents ® programme.

Always Events are those aspects of care that are so important to people using services, their families and carers that they should always occur at every interaction with healthcare professionals and the health care delivery system.

Helen is passionate about people being at the heart of everything we do, quality improvement and co-producing improvements and Always Events are a fantastic way to bring these three things to life.

Follow Helen on Twitter: @helenlee321_lee

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