Always Events

The right behaviours always and everywhere

David McNallyNHS England

Action AreasAction Area 1: Helping people to stay independent,

maximising well-being and

improving health

Action Area 2: Working with

people to providea positive

experience of care

Action Area 3: Delivering high

quality careand measuring

impact

Action Area 4: Building and

strengtheningleadership

Action Area 5: Ensuring we have

the right staff,with the right

skills, in the right place

Action Area 6: Supporting

positive staff experience

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.

About the initiative• NHS England, in collaboration with Picker Institute Europe and the

Institute for Healthcare Improvement (IHI) have 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.

• The programme will run until April 2016 and will comprise 10 provider pilot sites in England. The purpose of the programme is to evaluate Always Events in these locations and assess the impact on improvement of quality in healthcare settings.

National approach + local determination

Recognition (local decision) -

transparent local feedback/ measurement

National tools– with patients & professionals

Local always events –

with patients & professionals

How are Always Events different to other initiatives?

• Always Events are not done ‘for’ patients – they are co-designed with patients, families and carers to ensure changes are happening in areas which really matter to service users.

• Always Events are not simply the opposite of Never Events – Never Events focus primarily on breaches in patient safety and operational issues. Always Events focus on making changes to standard working procedures and behaviours which have real impact on the quality of patient experience.

• They are not isolated, provider-specific initiatives – the programme is designed to foster learning between healthcare providers so innovative solutions can be easily disseminated.

Always Events at Lancashire Care

The New Quality Strategy 2015-2019 – Expected outcomes

Engaging staff – gaining momentum:• We are looking for a team who will be willing to participate in this exciting

and innovative national pilot of Always Events over the coming months • The team will receive support from the Quality Improvement and Experience

Team within LCFT, IHI and Picker • If you would like to nominate a team or discuss this further please contact

Helen Lee

Action Area 2: Working with

people to providea positive

experience of care

Making learning disability services better• The Learning Disability Services want to get better at what we do. Your ideas

are important and will help us get better at what we do. • We asked people that use the services about their ideas, what they liked

about the service and the things we could be better at.

What we did and how we did itWe asked 22 people about what they did with a staff member

and what they thought about work.

We met with people for an interview to get their ideas.

We showed each person a picture of the staff member to make sure they

remembered them.

What you told us you likedGood things staff members did:

• Helped people to feel relaxed so they could talk to them

• Explained things clearly and slowly

• Made eye contact, listened and wrote things down

• Gave their office number so people could contact them

• Gave people a choice about where they were seen

• Having someone to talk to

• Using drawing and pictures to help explain or understand things

• Getting on with the staff member

• Having privacy and feeling comfortable

• Being listened to and understood

• Learning skills and feeling more confident

• Practical support

What you told us you didn’t like:• Three people said they sometimes found it hard to understand the staff

member

• Some people found it hard to talk about difficult feelings

• Some people said they missed the staff member when they stopped seeing them.

What we will do to get better• Use simple language and questions

• Find out how people communicate best

• Plan endings well so people still feel supported

Tell us about your experience when you have stopped seeing your community nurse or therapist?

• I was really sad

• It was OK because someone else form the team came to see me

• It made me unhappy – she was my friend

• I had a telephone number of someone to contact

• I can’t think about them not coming to see me – I will always need help

• I was a bit worried but I started to see someone else

‘How can we make ending your support from Learning Disability Services better for you?’• A place or person to contact if we need help • A fridge magnet telling me who to contact (I lose pieces of paper and business

cards)• A photograph of the new person coming to see me• Warning in advance that my support will be ending and the person is leaving or

being replaced• Being told who you are going to see if the person you normally see is not

available • Keeping in touch with the service. Coffee mornings, catch up events• The person leaving introducing me to another worker I can contact

Tell us the best way to communicate with you?• Write it down and then read it to me • Don’t use doctor language• Use bigger type• Face to face• Sign language or symbols• Pictures• Talk slowly – don’t rush or talk too fast• Use kind respectful words• Give plenty of time to take things in • Ask me to repeat back so you know I have listened and understood • Have someone who knows me with me • Make sure you know how to communicate with me, sometimes what you say may make me worry • Make sure my support is available before you start the consultation • Find a quiet place to talk to me

How would we like our treatment to end?• Face to face

• With notice it is going to happen to give me time to think

• Photograph of the person on our letters so we know who you are talking about

• Contact number of a person we can speak to if we are worried (on a fridge magnet or key fob)

• Letters that are easy read with symbols and no difficult language

Contact Card

Letter

Process Flowchart

Always Event discharge tracking Commencing 1 July 2015

Name and NHS No

Date of Discharge

Nurse or Therapist

DateLetter and

contact card sent

Date of follow up telephone

call

Comments Record:

Any comments made

No response to call If planning to attend

‘Pop in and Chat’

Pop-in and chat invitation

Co-DesignAlways Event Wording

Were you given enough notice

about when you were going to be

discharged?

Were you told in enough time that you were ready

to move on?

We will always support you in transitions of

care

We will always support you in moving on in

care

Pop in and chat

Early days…Julie Clift: Clinical lead said:

‘Being involved in Always Events has enabled the learning disability service to

really respond to the needs of our service users in a meaningful way.

This is collaborative working at its very best. People with learning disabilities

know what they want from us as a heath provider. These little enhancements to the

way we work will have real meaningful impact on how our service users feel

about the care we provide’

Early days…Amanda Thornton: Clinical Director said:

We are working hard in Lancashire Care to learn from our experts – those who use our services.

Our teams working with and for people with Learning Disabilities were quick to seize the offer of involvement

in Always Events and quickly recognised with user input two service ‘touch points’ that needed

improvement. The ideas generated by those who use our services have been informed, innovative and have

frankly left us thinking ‘why didn’t we spot that’! We are delighted to be a part of the Always Events initiative and are learning lots that we can put into

practise elsewhere too. Thank you!