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Always Events® in Primary Care

Dr Gregor Smith Senior Medical Officer Primary Care Scottish Government spoke at today’s Always Events® conference on:

• critically reviewing criteria for selecting ‘always events®’ and generating a candidate list examples based on the patient feedback data
• a step by step guide to learning from patients about what matters to them
• our experience in supporting organisations to develop their own primary care always events®

Abstract of Dr Smith's presentation:

1) Title:  Quality improvement and person-centredness:  developing and refining the ‘always event®’ concept for primary care

2) Authors: 
Paul Bowie1,2, Duncan McNab1,3, Julie Ferguson1, Carl de Wet1, Gregor Smith4,5, Marion MacLeod1, John McKay1 & Craig White6,7

1Department of Postgraduate GP Education, NHS Education for Scotland, UK; 
2Institute of Health and Wellbeing, University of Glasgow, UK; 
3NHS Ayrshire & Arran Health Board, UK; 
4NHS Lanarkshire Health Board, UK; 
5Primary Care Division, Population Health Improvement Directorate, Scottish Government, UK
6Healthcare Quality & Strategy Directorate, Scottish Government, UK 
7School of Health, Nursing and Midwifery, University of the West of Scotland, UK

4) Introduction: The Always Event® (AE) concept - originally developed by the US-based Picker Institute - offers a person-centred quality improvement (QI) approach that may further optimize different aspects of the patient’s experience across healthcare settings.  A simple example might be that a patient “always wants to know what happens next” after a clinical consultation.  In other words, AEs are those actions and behaviours of healthcare organisations, teams, professionals and staff that create a satisfactory experience for patients.   The AE concept is under-researched in terms of its feasibility, while there is limited knowledge on how to effectively link QI measures with the person-centredness agenda.  We aimed, therefore, to ascertain from patients what really matters to them on a personal level of such high importance that it should ‘always happen’ when they interact with healthcare professionals and staff groups.  Additionally, we also critically reviewed existing criteria for selecting AEs and generated a candidate list of AE examples based on the patient feedback data.  

5) Methods: A mixed methods study, informed by participatory design principles, involved Scottish general practice managers each conducting brief semi-structured interviews (n=5) and short cross-sectional questionnaire surveys (n=10) with convenience samples of patients identified as having a long term clinical condition (e.g. Type II Diabetes or Chronic Pulmonary Obstructive Disease) over a 1-week period in April 2014.  Collected data were thematically analysed by the study team before adapted criteria for determining AEs were applied to generate examples of candidate AEs which were linked to measureable behaviours and systems processes for QI purposes.

6) Results: 195 patients from 13 general practices were interviewed (n=65) or completed questionnaires (n=130).  Four themes of high importance to patients were identified from which examples of potential ‘always events®’ (n=8) were generated: 1. Emotional support, respect and kindness (e.g. ‘I want all practice team members to show genuine concern for me at all times’); 2. Clinical care management (e.g. ‘I want the correct treatment for my problem’); 3. Communication and information (e.g. ‘I want the clinician who sees me to know my medical history’); and 4. Access to, and continuity of, healthcare (e.g. ‘I want to arrange appointments around my family and work commitments’).  Each ‘always event®’ was linked to a system process or professional behaviour that could be measured to facilitate improvements in the quality of patient care.

7) Discussion: To our knowledge this study is the first known attempt to develop and refine the AE concept in the primary care context.  The outcomes strongly suggest that this method can translate to this setting i.e. practice managers were able to collect data from patients on what they ‘always want’ in terms of expectations and desires related to care quality in general practice.  Further evaluation of the utility of the process will be necessary.  However, there is strong implementation potential in the Scottish health service, while the approach will be of interest across care settings and internationally.  

8) Declaration of competing interests

Funded by NHS Education for Scotland

No competing interests

Dr Smith's full presentation is available for download at the end of this page.

Dr Gregor Smith is proud to be a GP and now combines roles as a Senior Medical Officer in the Scottish Government and medical director for Primary Care in NHS Lanarkshire. He is a Fellow of the Scottish Patient Safety Programme and is passionate about improvement and innovation in healthcare. 
He is currently involved in developing new models of care and a novel Scottish GMS contract that will help to realise the Scottish Government’s 2020 Vision of Health and Social Care. He chairs the group overseeing the Scottish Patient Safety Programme in Primary Care and continues to collaborate with NHS Education Scotland, Health Improvement Scotland and many other stakeholders on fresh approaches to improving patient care and public involvement. 
Expanding his enthusiasm for the model for improvement, he is yet to achieve anything close to reliability with his guitar technique but is beginning to move the dots in his attempt to complete a 140.6m swim/bike/run.

Related event of interest:

Improving Patient Experience & Experiences of Care
Tuesday 16 June 2015 
Hallam Conference Centre, London


Download: Gregor Smith full presentation

24 March 2015


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