Meeting patients’ individual needs using the Always Events Programme

For healthcare professionals, being able to meet patients’ individual needs can be a challenge. These could be perceived as minor things, such as a seamless transfer of care of a frail elderly patient from one health setting to another, or ensuring that a patient with eye problems can read the prescription label on their medicines properly. But it is often the finer details in a patient’s care journey that shape how they view their care and the healthcare system. So it is important that healthcare professionals and workers get this right every time.

For the past decade, the NHS national patient experience surveys have consistently identified human relationships and communication falling short of patients’ expectations. The Institute for Healthcare Improvement (IHI), a not-for-profit organisation helping to lead the improvement of healthcare, and the Picker Institute Europe, an international charity in the field of person-centred care, are working in partnership with NHS England to look at how the NHS organisations in England can develop consistent ways to meet the individual needs of patients, ensuring care is patient centred and delivered in partnership with them and those close to them. And thus the Always Events framework, initially conceived in the United States, was developed for use in the NHS.

This framework provides a strategy to help healthcare providers identify, develop, and achieve reliability in person and family-centred care delivery processes.

Always Events are aspects of the patient experience that are deemed so important to patients and family members that healthcare providers must aim to perform them consistently for every individual, every time.

The programme aims to focus on what matters to the patient and to meet their needs. Nurses, doctors, pharmacists, healthcare staff, and community health providers seek to understand the comprehensive needs and goals of the patients they serve. Yet, in the busy world of clinical care, there are innumerable situations where what really matters to patients and their family members is not understood or addressed.

NHS England, IHI and the Picker Institute Europe have been working with provider organisations within England to test out the Always Events programme and have recently delivered phase II of the project by enrolling eight other organisations on to the project. These NHS providers will test out a toolkit on how to develop Always Events within the NHS, which will then be published in spring 2016.

Blackpool Teaching Hospitals NHS Foundation Trust has been working with patients who have received inpatient stroke treatment and have developed an Always Event to ensure their discharge is safe. This has included work with all patient representatives and staff groups, including pharmacy staff, to develop a tool to prompt patient and carers to understand further the discharge process and encourage them to record questions they wish to ask the relevant professional.

The tool is used to confirm patient understanding of medication instructions by asking patients to repeat the instructions using their own words and is not aimed to test patients’ knowledge but to test how well the ward discharge coordinator has explained the medicines — when to take them, their side effects — as well as being able to answer any questions that the patient or their carer may have.

Continuous measurement and monitoring of the programme will guide leaders to understand to what extent the activities and outcomes were sustained and how to overcome specific barriers to sustaining a change in the patient experience.

NHS England has started supporting organisations to develop and to continue to nurture and support the compassionate care that is at the core of our professions and the NHS and, using Always Events, we are forging new ways to raise the bar on our collective performance and improve the quality of care of patients.

Paul Jebb

Experience of Care Professional Lead

NHS England