Always Event Co-production Quality Improvement Methodology

LTP Priority: Quality Improvement: Always Events

Population Intervention Triangle: Segments (link to Section 1 PHE PBA): Service

Type of Interventions: Always Event Co-production Quality Improvement Methodology

Major driver of health inequalities in your area of work

Involving people in the codesign and coproduction of services and associated quality improvements ensures that the services are designed using the underpinning principle of what matters to people, by the people, for the people. Services and improvements will then be designed to meet people’s needs.

The CQC report Quality improvement in hospital trusts (2018) describes coproduction with patients and staff as a central element in undertaking effective QI and key to aligning QI and experience:

  • ‘Putting the patient at the centre of the QI journey sharpens the focus on delivering high-quality patient care and aligning improvement activity to outcomes and experience for patients. To deliver this, patients must be involved and enabled as true and equal partners for QI.’
  • There are several trusts that are further along the journey to embedding improvement culture, where effective improvement-focused leadership has engaged, empowered and enabled staff, patients and carers in improving services. We have seen this approach reflected in achieving outstanding ratings.
  • ‘We have found tremendous synergy when patients, carers, people using services and the public are meaningfully involved and incorporated into QI, alongside an engaged, empowered and enabled workforce.’
  • ‘We have heard of the journey these organizations take, transitioning from consulting patients on service developments and improvement work, to building true partnership for QI with meaningful patient and public involvement. In co-production, patients are actively and meaningfully involved. In looking at systems design and improvement, they define what matters. This is different to traditional forms of consultation.’

A further driver is two NHS Mandate overall 2020 Patient Experience goals:

  • With NHS Improvement, improve the percentage of NHS Staff who report that patient and service user feedback is used to make informed improvement decisions (staff survey question 22c);
  • 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 improving the quality of NHS services (a 2017/18 deliverable to rollout always events in 100 providers was met).

By coproducing services and quality improvements with vulnerable groups, barriers to access can be overcome and health inequalities reduced.

Target groups

Deprivation, Inclusion health group, Protected characteristics.


Always Events


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?”

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 and NHS Improvement, in collaboration with Picker Institute Europe and The Institute for Healthcare Improvement have been leading an initiative for developing, implementing, and spreading an approach to reliably integrate Always Events® into routine frontline services.

The Always Event Framework provides commissioners with a robust coproduction quality improvement methodology which can be used to work with vulnerable groups to reduce health inequalities and unwarranted variation. There is evidence of the success of this approach from the 125 provider organisations now engaged in the programme. We have also begun to work with Integrated Care Systems to use the methodology, for example, Joined up Derbyshire are using the methodology to coproduce services in relation to their community frailty model.

There is a free programme of support available to people including a 1-day training day and subsequent monthly coaching sessions and mentoring support available from the national team.


NHS England webpage with an overview of Always Events, a short video, the link to the toolkit and 2 Picker Europe evaluation reports.

Marshall, Claire; Zambeaux, Angela; Ainley, Esther; McNally, David; King, Jenny Miss; Wolfenden, Lorraine; and Lee, Helen (2019) “NHS England Always Events® program: Developing a national model for co-productionPatient Experience Journal: Vol. 6 : Iss.1, Article 19.

The CQC report Quality improvement in hospital trusts (2018).

We have examples of Always Events being coproduced to improve experiences of people with a learning disability and the impact his has had e.g. supporting people moving on in care and being diacharged from community learning disability services.