Always Events

Always Events® are those aspects of the patient experience that are so important to patients and families that health care providers must aim to perform them consistently and reliably for every patient, every time.

Always Events, initially conceived in the United States by the Picker Institute and now led by the Institute for Healthcare Improvement (IHI), laid the foundation for the development of IHI’s Always Events framework. This framework provides a strategy to help health care providers identify, develop, and achieve reliability in person- and family-centered care delivery processes.

IHI's Always Event Framework



An Always Event is a clear, action-oriented, and pervasive practice or set of behaviors that:

  • Provides a foundation for partnering with patients and their families;
  • Ensures optimal patient experience and improved outcomes; and
  • Serves as a unifying force for all that demonstrates an ongoing commitment to person- and family-centered care.

An Always Event must meet four criteria:

  1. Important: Patients and family members have identified the event as fundamental to improving their experience of care, and they predict that the event will have a meaningful impact when successfully implemented.
  2. Evidence-based: The event is known to contribute to the optimal care of and respect for patients and family members (either through research or quality improvement measurement over time).
  3. Measurable: The event is specific enough that it is possible to determine whether or not the process or behaviors occur reliably. This requirement is necessary to ensure that Always Events are not merely aspirational, but also quantifiable.
  4. Affordable and Sustainable: The event should be achievable and sustainable without substantial renovations, capital expenditures, or the purchase of new equipment or technology. This specification encourages organizations to focus on leveraging opportunities to improve the care experience through improvements in relationship-based care and in care processes.

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