Why It Matters
There are care processes and behaviors that should always occur to ensure safe, high-quality care.
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What Are Always Events?

By Patricia Rutherford | Wednesday, July 8, 2015

Clinicians and staff in all clinical settings seek to understand and provide compassionate care to meet the comprehensive needs, values, and preferences of the patients they serve. Yet, in the busy world of clinical care, there are too many situations where what really matters to patients and their family members is not understood or adequately addressed.

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 Events 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.

Many in health care refer to The National Quality Forum’s Serious Reportable Events as “never events.” Few would disagree that incidents such as performing surgery on the wrong site or a death caused by a medication error are not only tragic and harmful, but they should never happen. Conversely, there are care processes and behaviors that should always occur – reliable implementation of evidence-based care and the adoption of professional standards of practice – to ensure safe, high-quality care.

A key distinction of an Always Event is that patients and family members have identified the event as fundamental to improving their experience of care. A fundamental principle in co-designing Always Events is to move from “doing for patients” to “doing with patients.”


Always Events are aspects of the patient experience that are so important to patients and family members that health care providers must aim to perform them consistently for every individual, every time. 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.

Some examples of Always Events aimed at improving care transitions and discharge are Always Use Teach Back, an initiative created by the Iowa Health System (now UnityPoint Health), and the SMART Discharge Protocol developed by Anne Arundel Medical Center (see the related tools posted on IHI.org).

IHI’s Always Events framework holds promise as an approach to accelerate improvement efforts aimed at enhancing patients’ and family members’ experiences of care. The goal of the process is an “Always Experience.” Effectively using the framework is a practical methodology for achieving this goal.

For more about Always Events, check out these resources:

Always Events Toolkit

Video: What Is an Always Event?

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