Always Events: what’s your experience?

Daniel Allen talks to physiotherapist Claire Marshall about Always Events, which are designed to improve patients’ experience of NHS healthcare.

Do you know what matters to your patients – things, large or small, about the service you provide that make the difference? You might guess but have you ever actually asked them? At the heart of a service improvement programme gaining traction in the NHS is the establishment of partnerships with patients and their families to find out what kind of experience they want every time they use the service.
So far, this approach has largely been the domain of nurses but Claire Marshall, an experienced physiotherapy manager currently on secondment at NHS England, is looking to draw in other CSP members.
Ms Marshall is a professional lead in NHS England’s patient experience team. Her substantive post is at Frimley Healthcare NHS Trust in south west Surrey and it was there, as head of patient experience, that she became involved in the initiative known as Always Events.
Always Events is a quality improvement methodology, she explains. ‘It’s about the experiences that should always happen for patients because they are the things that are really important for them – and for frontline staff.’
Developed in the US and introduced to the NHS three years ago, the Always Events framework helps healthcare professionals to develop consistency and reliability in patient and family-centred care (see ‘What is an Always Event’ box below).
‘It’s often nurses who lead Always Events in their organisations,’ says Ms Marshall. ‘But since I came into post in August last year I’ve been really struck by the fact that we’re missing an opportunity for health professionals  and, from my perspective, physiotherapists to be engaged in a programme that’s about improving the experience of care for patients.’
She adds: ‘There’s no reason why this couldn’t be led by physiotherapists. One of the things we’re really good at is those relational aspects of care that patients value. 
‘It’s not about the process but the small things that make a huge difference to patients.’

Affordable and sustainable

A good place to start, Ms Marshall suggests, is with patients’ feedback (see ‘Always start with the feedback’ box, right).
Always Events began in England with two pilot sites. By late February, almost 100 organisations had signed up and are were aiming to demonstrate improvements in patients’ experiences by following the principles laid out in the Always Events toolkit.
Always Events must meet four criteria, being 
  • important to patients and family members, with meaningful impact when implemented
  • evidence-based
  • measurable
  • affordable and sustainable 
Engaging with patients
But aren’t such ‘events’ simply things that physiotherapists and other healthcare staff should be doing anyway, as part of routine practice? Yes, says Ms Marshall. ‘Working together with patients, families and carers should be part of what we’re doing every day and some areas do it really well. Others have improvements to make in using co-production in a meaningful way and not as a tick-box, engaging-with-patients exercise.’
She dismisses the suggestion that leading or participating in Always Events will add to the load that hard-pressed physiotherapists are already carrying. 
‘I think service improvement is a core skill for physiotherapists. And there are lots of people who can help you to engage with patients and ask those key questions. If you’re a foundation trust, there are governors. 
‘There are patient leaders and representatives, there are volunteers – organisations like Health Watch – that are more than happy to come and support the work because they see it as meaningful engagement with people.’   That said, there are challenges.
An evaluation of the Always Events pilot sites found four main ones:
  • maintaining momentum when key staff leave
  • recruiting service users and families/carers to co-design groups
  • evaluating the impact of Always Events activities
  • ensuring frontline staff are engaged in and supportive of Always Events activities 
Nonetheless, the report concludes that staff were positive about using the Always Events framework to undertake quality improvement work.

Shining a spotlight

Experience of Care Week, starting on 23 April, will bring opportunities to learn more about how physiotherapists can use Always Events to enhance the service offered to patients.
‘The whole point of Experience of Care Week is to shine a spotlight on the really great things that are happening at a local level,’ Ms Marshall says. 
‘It’s a chance for individuals and organisations to think about how they can demonstrate the impact they have on patient experience. It would be fantastic to see some physiotherapy staff stepping forward and leading this work in their organisations.’ 
CSP assistant director Sue Hayward-Giles said: ‘Improving patient experience is clearly important and I would encourage physios to get involved with this initiative. The aim is to enhance how we listen to patients and hear about what’s really important to them. 
‘By improving how we tailor our rehab and care programmes, we will engage and motivate individuals to stick to treatment plans and improve outcomes.’

What is an always event?

Developed by the Picker Institute in the US and now led by the Institute for Healthcare Improvement, an Always Event is defined as a clear, action-oriented and pervasive practice or set of behaviours that:
  • provides a foundation for partnering with patients and their families
  • ensures optimal patient experience and improved outcomes
  • serves as a unifying force that demonstrates an ongoing commitment to person and family-centred care
  • To watch an NHS England video on Always Events.

Always start with feedback

Patient feedback is a good place for physiotherapists to start when planning work around Always Events, Claire Marshall (pictured left) suggests. 

‘Think about all the different types of feedback open to you: Patient Advice and Liaison Service contacts, compliments, complaints, friends and family tests, local and national surveys, ward and team feedback.
‘Then think about themes and trends. What’s this telling us? Start talking to patients and staff about what really matters to them relating to the topic you have been looking at. 
An example might be discharge from hospital – but it could be anything that’s important to patients and staff. That’s the golden nugget for Always Events – it’s not a top-down approach. It really is about what matters to people and focusing on that.’

Further reading

Daniel Allen

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