“Always Events” for patient-centred care

Glòria Galvez

What would we like to happen if we, our families or our friends had to be treated in a health centre? The details are important and, although some may seem minor, they will make the difference between having a good or a bad experience. The NHS England, in collaboration with the Picker Institute, the Institute for Healthcare Improvement (IHI) and the NHS Improvement, developed in 2015 a program to identify and ensure the achievement of these details that will be the ones that add value to the patient's experience. The program called Always Events,® as opposed to "never events", aims to translate the principles of attention centred on the person and family into concrete actions.

An Always Event is a manner or set of behaviours so relevant to the experience of the patient, users and families that should be guaranteed at all times since they provide the basis for the relationship between patients and professionals and represent the continuous commitment of the organization with a focus on the person and the family. The key concept is the co-design, where patients, caregivers and first-line professionals (who are the ones who know the best and the easiest and most affordable solution) participate in the definition of the most significant aspects of care for patients (in the following link you can find some examples of NHS Always Events).

Details such as ensuring that a patient receives a letter informing them of changes in the team of specialists who will assist them in the transition from one health device to another, including photographs and contact cards of the team, help people feel safe and cared for. Initiatives such as these make patients, on the one hand, feel good when their proposals have been taken into account and, on the other, that professionals commit themselves to person-centred care and reduce resistance to change.

Not all proposals can be considered an Always Event as they must meet four criteria: it’s important for patients, there is scientific evidence to show that it contributes to better care, it’s measurable and it’s sustainable. Standardized practices of quality care such as hand washing or treating the patient with respect and dignity are not Always Events.

Organizations that care about applying this method can use this toolkit which includes a practical guide on how to implement the four fundamental elements of an Always Event (leadership, patient and family association, professional commitment and measurement), in addition to two case studies of centres that have successfully launched it. For those who wish to expand the topic, the Picker Institute has published two results reports, the first in 2016 and the last in July 2018 with a summary of the program's progress and expansion.

All organizations should recognize their Always Events related to communication, shared decisions or the transition between different levels of care and be humble to recognize that we don't have all the keys, but that we must work side by side with the patients, from the beginning of the care process and in all its phases, integrating the improvement of quality, patient experience and person-centred care.