What is an “Always Event”? Barbara Balik, RN; IHI Senior Faculty, Common Fire Healthcare Consulting “Always Events” were developed by the Picker Institute. The idea was that they were really a counter or a balance to the “Never Events” that we’re familiar with in health care. If I were going to describe what an “Always Event” or an “always experience” is, it’s a promise to patients. If you think of having a conversation with a six- or seven-year-old about a promise, that’s a big deal. Always events or always experiences are a big deal. They’re our promise to partner with patients to do things consistently, to do it always. That’s where it started. It’s got four criteria. When you’re thinking of putting one together and being consistent with it, being always, first and foremost, it’s important, and if you remember no other criteria, it’s important and it’s important to patients and their families. That’s the first and primary screen for it. It may be important to us as health care professionals, but first and foremost, it’s important to patients and families. The only way you understand that is by being in conversation with them, spending time, and most importantly, listening to what’s important to them. I was working with a patient faculty yesterday, and she said the most important thing to her in this long history of very complicated chronic conditions was that somebody finally listened to her, and that was a turning point in her health care. The other criteria are evidence-based, measurable, and sustainable. The whole idea is you don’t wait until you build a new clinic or you have very expensive infrastructure to develop, it’s what can be done today. Some of the examples that we’ve learned from patients from always experiences are, “I always know what’s going to happen next.” Next could be in the next 20 minutes or the next six months, depending on what the condition is that the person’s living with. Another one is, “I know what I’m supposed to do.” If I’m in the hospital and I’m going home or I’m leaving a clinic appointment, I know what I’m supposed to do or as patient faculty yesterday said, “Someone listens to me.” In ten interviews that a colleague did recently with patients about what was important to them and their clinic experience, loud and clear came through, “Someone listens to me, and you hear me.” When it first started, when the Picker Institute and their National Advisory Group that I was a part of started developing it, it was again, a balance to the “Never Events.” An affirmative approach to “Never Events,” so that’s where the term “events” came. “Events” fit probably more specifically with “Never Events.” When you think of wrong-site surgery, that’s an event. Whereas we move into “always,” I think that language is going to emerge from “events,” which makes it sound like it’s just here, into “experiences,” which is ongoing. While the umbrella may say “Always Events,” I think people can keep in mind what that looks like in its broadest sense.