Always Events: Make the Patient the Focus

Always Events, developed in the United States by the Picker Institute and currently directed by the Institute for Healthcare Improvement (IHI), is defined by the aspects of care that always should be completed when patients, their family members, and partners come into contact with healthcare professionals and the healthcare institution.

Always Events focus on patient care aspects which are considered important enough by the patient and their family that care providers should always handle them well.

This blog describes what Always Events implies, how to recognize it, how to create it and how it compares to a Just Culture.

Always Event

The definition of Always Events has a lovely ring to it. Simply put, an Always Event is a promise to the patient. A promise to work together and to listen to them. The results of this promise must make the patient, their partners, family, and caretakers certain of four things:

1. What we are going to do today
2. What the next step is
3. What is expected of me
4. Someone will listen to me

The characteristics of an Always Event

An Always Event is characterised by clear, proactive actions and behaviours that:

• create a foundation for working together with patients, their partners and family members, and other possible caretakers;
• ensure the best possible experience for the patient and improved results;
• serve as a common thread for all parties involved and indicate a dedicated effort to personal and family-oriented care;
• broadens the meaning of healthcare services as a whole.

What Always Events are

• Reliable procedures and behaviours that ensure the best possible patient care.
• Agreed upon with patients, families, partners, and other caretakers.
• Integrated into a coherent, patient-oriented care strategy. 

What Always Events are not

• Proven healthcare practices (i.e. hand washing) or a generally applicable professional standard such as treating patients with dignity and respect.
• Improvements on procedures that are done ‘for’ the patient and their family.
• Temporary or improvised improvements. 

Where an Always Event distinguishes itself, is in the experiences of the patient, partner, family, and other caretakers that results in an indispensable improvement in the entire healthcare process. 

The four criteria for an Always Event

An Always Event must meet these four criteria:

1. Important: Patients, partners, family, and other caretakers have deemed it fundamental for the quality of the care provided and expect a positive effect when it is successfully implemented.
2. Proven: The Event has proven its value as a contribution to the best possible care and respectful interactions with patients, families, and other caretakers, whether through research or through improvement of quality over the long term.
3. Measurable: The Event is specific enough to determine that the procedures or behaviours established are reliable. This is a difficult requirement to quantify in Always Events and is rather ambitious.
4. Sustainable and affordable: The Event must be plausible and sustainable without substantial innovations, investments, or the purchase of new equipment. This requirement is primarily intended to have healthcare improvements looked at within the organisation by investing in healthcare processes and relationship-based care.

Always Events and Just Culture

Where Just Culture focuses on the organisation itself and the handling of human errors, Always Events focuses on the patient. By focusing on the positive aspects of healthcare, namely the aspects that a patient must always receive and should also be promised and agreed upon with the patient, partners, their family, and other caretakers, it is not only the healthcare quality and involvement of the caretakers that improves, but particularly the experience and safety of the patient.

You can read more about Just Culture in the e-book 'Just Culture, Theory and practice'.