Posted by: ayrshirehealth | April 9, 2014

Always events by @craigwhitephd

Making it happen reliably

One of the concepts that unify quality improvement programmes across Scotland is the emphasis on testing and learning to identify what leads to improved safety, effectiveness and person-centredness of care. This learning can then inform work that is focused on ensuring that this happens every time that it needs to – spreading this across a team, ward, area or health system in a way that makes sure it happens reliably.SPSP

We have learned a great deal about using this model to improve patient safety and are now beginning to explore the ways in which we can improve person-centred care experiences.

Patient Safety Essentials

The Scottish Patient Safety Programme has supported staff across the country to identify what should always happen to make sure that care is as safe as it possibly can be. We now have a series of patient safety essentials in Scotland – the things that should always happen to ensure people are safe from healthcare and avoidable harm is prevented:

  • Hands will be washed before touching a patient, before clean procedures, after fluid exposure risk, after touching a patient or their immediate surroundings.
  • Health and care system leaders will walk round clinical and care facilities.
  • There will be pauses and briefings for all of the team before surgery
  • On every ward, every day a short briefing will take place to highlight any patient or equipment safety issues for the day or shift.
  • Every patient in an Intensive Care Unit will have a set of daily goals agreed and documented in the case notes.
  • VAP, CVC and PVC bundles will be used to prevent avoidable infections
  • Early Warning Scoring will be used consistently to identify patients who may need closer monitoring or more intensive treatment.

How long will it be before we have our list of Care Experience Essentials?

Always Events

This week I have been thinking about ‘always events’ and how this concept might help with some of the Scottish Government’s policy commitments to person-centred care. Always eventsThe Picker Institute (now closed but see for details of the arrangements that have been made for it’s pioneering work to continue) developed the concept of ‘Always Events’ as a key organizing principle for person-centred care improvement work. ‘Always events’ are events that are informed by the desires and preferences of people who are using services, and are events that people would like to happen, that have a positive impact on care experiences. When this is demonstrated they are then designed into care processes so that they happen all of the time.

‘Be consistently person-centred in word and deed’

Being consistently person-centred is the first of five critical behaviours that form the high impact leadership behaviours outlined in the IHI White Paper ‘High-Impact Leadership’ (

IHI Leadership essentialsScotland is fortunate to have many strong leadership messages about person-centredness. We are also in the enviable position in Scotland, as not only do we have a clear governmental policy commitment to person-centred care, we have a Scottish Parliament that recognises the importance of this area. On 5th November 2013 the motion was agreed that:

“…the Parliament recognises the importance of person-centred healthcare in delivering the best health outcomes possible; supports measures to ensure that individuals are supported to be active partners in their own care; agrees that all parts of the healthcare system should be focused on the patient, and that should include both community and hospital care….”

We are also so fortunate to have the support infrastructure in place to support learning and improvement. The Person-Centred Health and Care Collaborative ( and the People Powered Health and Wellbeing Programme ( ) are both focused on helping people across the country to identify the learning and change actions that will transform care experiences.

The Will is there and the ideas are coming…

The will to improve care experience and shift the balance of power for all of us accessing health and social care is, I believe, greater than ever. The ideas are now beginning to develop and tests are being implemented that will inform the reliable execution of changes in care process that are needed to make care more person-centred (see IHI’s White Paper on Seven Leadership Leverage Points for Organisation –Level Improvement in Health Care for more on will, ideas and execution: ).

Some colleagues wonder what all the fuss is about and believe that they are as person-centred as they need to be (when in fact many of our actions are more system and profession focused than we realise). How many of us can say that we really understand:

  • What someone’s most pressing need is (which is not the same as what we think it is)?
  • What is most important for the people we are caring for?
  • What do people value most?
  • What is the most meaningful way for me to relate and connect in providing care and responding to need?

Learning from the ‘constructively disgruntled’

I participated in the first of a series of events hosted by the Institute for Healthcare Improvement last week – Martha Hayward reminded us that ‘Always Events’ are often based on matters relating to communication, physical comfort, emotional support, transition and continuity of care and co-ordination of care. IHIThese are so often the areas where system performance and reliability is not as we would wish – leading to complaints and stories of poor care experiences. Always events could provide us with one of the ways to reduce these failures of care experience? What could you learn from people who are constructively disgruntled by suboptimal care experiences? Patient OpinionReview the last 3 complaints received and see what changes might improve care process for others. Visit to see what people are saying (good and bad) about your services – this might generate some ideas for ‘Always Events’?

Another powerful way of thinking about improvement work in this area is to consider principles for person-centred care, developed by Audrey Birt and colleagues emphasising the importance of ‘People in relationship’ (see I have listed these principles below as headings; with some ideas about the sort of questions that you could ask people to start to link your improvement work with them.


Ask ‘What could I do to help better understand how it feels for you today?”. Then do it and ask about the impact.

Trust, respect and empathy

Get people to rate how much they feel that they can trust you to meet their needs, respect their situation and empathise with their experience – then ask them what you can do to improve this?

Equality, mutuality and individuality

Ask ‘What would I need to do to improve the way I relate and connect with you?’ ‘Is there something that I could do to better take account of you and your personal situation?’

Flexible and empowering culture and system

Ask ‘What would need to happen more for you to feel the levels of control you would like to have’?

Help generate ideas to test and learn from ….

It is an exciting time to be involved in this work. I am eager to prompt ongoing dialogue on these issues across the country. I am particularly keen to hear from people with their ideas of ‘Always Events’.

Please consider taking some time to share your thinking with me at:

and circulate the details to colleagues, family and friends too.

This week’s blog was by @craigwhitephd (Craig White) Divisional Clinical Lead, The Quality Unit, Scottish Government Health and Social Care Directorates & Honorary Professor of Applied Psychology at the University of the West of Scotland.


T: @craigwhitephd




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