Always Events Overview

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A National Organizing Principle for Improving the Delivery of Patient-Centered Care


Picker Institute is dedicated to enhancing the delivery of patient-centered care across the health care continuum.  Based upon a review of existing efforts to measure and improve patient-centered care, Picker has determined that an organizing principle focused on the concept of Always Events℠ can be implemented to drive the system to become more patient-centered.   In contrast to the well known “Never Events” that refer to incidents that should never happen in the delivery of care, patient-focused Always Events℠ are aspects of the patient and family experience that should always occur when patients interact with health care professionals and the delivery system.

After an in-depth exploration of the Always Events℠ concept with patients, providers, and national leaders representing consumer, health care industry, and government perspectives, Picker has convened a National Steering Committee to guide a strategy to move this organizing principle into the mainstream of health care delivery, through the implementation of specific initiatives and demonstration projects using Always Events℠ at the national, community, and organizational level.

Guiding Themes

Based on input from focus groups with patients, families, and frontline caregivers, Picker has identified two key thematic areas of focus for Always Events℠:

  • Communication: The interactions and exchange of information between patients and providers, as well as among the team of providers responsible for a patient’s care, must involve the patient in an appropriate patient-centered way, and
  • Care transitions: Patients need an appropriate level of communication when moving from one provider or health care setting to another (for example, from primary care doctor to specialist, from hospital to home, long term care or rehabilitation facility, and emergency department to inpatient unit).

Within these core areas, Picker has further identified four criteria that should guide the selection of Always Events℠

  • Significant: Patients have identified the experience as important;
  • Evidence-based: The experience is known to be related to the optimal care of and respect for the patient;
  • Measurable: The experience is specific enough that it is possible to accurately and reliably determine whether or not it occurred; and
  • Affordable: The experience can be achieved by any organization without substantial renovations, capital expenditures or the purchase of new equipment or technology.

In order to provide further definition to  Always Events℠ the National Steering Committee (NSC) has proposed that a short “starter list” of not more than 10 specific “always events” be compiled consistent with the above thematic areas and criteria.  The starter list will be developed in consultation with the NSC and other leaders involved in the exploratory phase of the initiative.

Demonstration Projects

In order to demonstrate the value of implementing Always Events℠ in practice, Picker has issued a Request for Proposals (RFP) to encourage and support a range of projects at the national, community, and organizational level.  Challenge Grants of up to $50,000 (Picker share) over one year will be awarded to applicants that propose to focus on the use and dissemination of the Always Events℠ concept consistent with the guiding themes and overall goals of the effort.

Demonstration projects will be selected to achieve a mix of strategies for promoting Always Events℠ including consumer engagement, quality improvement, and payment rewards and incentives.  For example, a community-based coalition may propose to focus on a healthcare related consumer engagement initiative to promote public awareness of certain communications experiences that should always happen during a medical encounter.  Or a hospital may propose to focus on a campaign to encourage staff to always provide clear discharge instructions to patients leaving the hospital.

Applicants will be asked to describe the specific activities they will undertake to promote implementation of their proposed Always Events℠ how the Always Events℠ will be measured or evaluated, how the success of their initiative will be determined, how the effort will be extended after the end of the grant in the grantee’s own setting, and how the results will be disseminated to others.  Picker Institute has issued an RFP and a number of applicants have been invited to submit full proposals on or before January 17, 2011. The National Steering Committee will participate in the review and selection of projects.

Collaborative Learning Network

Once the demonstration projects are selected, Picker will support a collaborative exchange of information among the projects through periodic conference calls, webinars, and listserv communications.  This learning network will be a source of tools and strategies for achieving the selected  Always Events℠ Picker also will support the development of key messages and media tools, including establishing a presence in online social networks, to provide communications support for the various demonstration projects.

At the conclusion of the two-year demonstration program, Picker will produce:  1) a summary of lessons learned and a “how-to” guide for future adopters of Always Events℠ and 2) a synthesis of the tools and strategies used to promote and achieve the specific Always Events℠ selected for focus in the demonstration projects.  The demonstration program is expected to result in replicable models for adoption and use by others on a national scale.

Leadership Provided By:

Lucile Hanscom, Picker Institute, Executive Director

Picker Board of Directors

National Steering Committee

Dale Shaller, MPA, Shaller Consulting Group

Carrie Brady, JD, MA, Independent Consultant

Hannah Honor Hanscom, BSN, RN, Picker Institute Grants Coordinator

As of January 1, 2013, the Institute for Healthcare Improvement will provide leadership for the Always Events program. They can be contacted via email at or via phone at (617)­ ­301-4800.


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