Always Events The right behaviours always and everywhere Lorraine Wolfenden 11 th May 2017
What are Always Events? Always Events are aspects of the care experience that are so important to patients, service users and carers that health care providers must perform them consistently for every patient, every time. Successfully delivering the Always Event programme provides: A foundation for partnering with patients, service users and their carers; Actions that will ensure optimal care experiences and improved outcomes; and A unifying force for all that demonstrates an ongoing commitment to person and family centred care.
Always Events 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 delivery system. Always Events is a trade marked product owned by the Institute of Healthcare Improvement. It was originally developed by the Picker Institute Inc in the USA
Criteria for Always Events Important: Patients and families have identified the event as fundamental to their care Evidence-based: The event is known to be related to the optimal care of and respect for patients and families Measurable: The event is specific enough that it is possible to accurately and reliably determine whether or not it occurs Affordable: The event can be achieved without substantial capital expense
Always Events are Reliable processes or behaviors that ensure optimal patient and family member experiences of care Co-designed with patients and family members (done with ) Integrated into overall person- and family-centered care strategies Always Events are not Evidence-based practices (e.g. hand-washing) or professional standards of practice (e.g. patients are treated with dignity and respect) that should always occur to ensure safe, high-quality care Improvement in processes that are done for patients and family members An isolated organizational QI initiative or local improvement Always Events Toolkit, p. 10
Doing To Doing For Doing With Always Events Where are you in your journey?
The Five Aims of Always Events 1. Raise the bar on both provider and patient expectations 2. Introduce a new organising principle to help galvanise action and accountability 3. Demonstrate how the Always Events concepts can be implemented in practice 4. Widely disseminate Always Events strategies for national replication 5. Energize and expand the movement toward a more patient- and family-centered health care system
About the initiative NHS England, Picker Institute Europe and the Institute for Healthcare Improvement (IHI) developed a programme to pilot and test the Always Events Framework and create guidelines and a toolkit for implementing Always Events within the NHS in England. https:///ourwork/pe/always-events/ Tested in 10 provider pilot sites in England. The purpose of the programme has been to evaluate Always Events in these locations and assess the impact on improvement of quality in healthcare settings. Now rolling out to a wide range of settings and organisations
Pilot Sites in NHS England Always Events Programme Pilot Sites and Area of Focus for the Always Events Blackpool Teaching Hospitals NHS FT (phase 1) Lancashire Care NHS Trust (phase 1) Aintree University Hospital NHS FT Ashford and St Peters NHS FT Stroke Ward: Patients always know what to do when they get home or, if not, they know who to contact. Learning Disability Services: We will always support you in moving on in care. Medicine Ward and Major Trauma Ward: Open visitation for family members Dementia-Friendly Medical Ward: What matters to you and your carer? Calderdale and Huddersfield NHS FT East Kent Community Trust The Royal Marsden NHS FT Southampton NHS FT Taunton and Somerset NHS FT University Hospitals Morecambe Bay NHS FT Outpatient Vascular Clinic or Orthopaedic Clinic: Patients understand clinical condition and treatment plans; Clinical team understands what matters to patients Neurology Rehabilitation Unit in a Community Hospital: Co-design of personalized care plans Haematology Clinic: Patients get the right information at the right time Medical Ward: Involvement of patients and family members in planning for discharge Pre-natal Care by Community Midwives: Create and implement individualized care plans based on what matters to mothers, fathers and family members Post-partum Ward: Customize immediate post-natal care for the entire family and prepare for discharge
I understand how to take my medications and I know how to care for myself at home. I will always have support when moving on in care The staff always understand what matters to me. We will always engage dementia patients and their carers in meaningful, two-way communications. I have access to the father and other loved ones to support me and my baby in the immediate period after the baby is born.
Always Events and NHS England Priorities Compassion in Practice - Action Area 2 working with people to provide a positive experience of care NHS Five Year Forward View 2014 sets out new shared vision for future of the NHS Leading Change Adding Value (2016) A Framework for Nursing, Midwifery and Care Staff commitment 5 We will work in partnership with individuals, their families and others important to them? NHS Mandate
Matrix of Change Ideas Easy to Implement High Impact Low Impact Difficult to Implement
Event Co-Design an Always Event Reliably Implement Standard Work Over Time Understand What Matters to Patients? in Pilot Unit or Program Create an Aim Statement and Begin to Co-Design an Always Event Test Specific Change Ideas for the Always Event PLAN Communicate New Specified/Standard Work Processes to Clinicians and Staff DO Teach, Coach and Support Implementation Always Specify Details of Successful Changes for the Always Event STUDY/ACT Observe, Reflect & Redesign Standard Work as Needed to Increase Reliability
Where are we now. We now have almost 50 new organisations working towards co-designing and implementing an Always Event These include Acute Hospitals, Community, Learning Disabilities, Mental Health, Maternity, Ambulance Trusts, Children's, substance misuse Working with NHS Improvement
How can Always Events Support Frailty?...
l.wolfenden@nhs.net @lorrainewolfen1