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Through the lens of patients: a person-centred approach to quality improvement


As a result of competitive funding from The Health Foundation’s ‘Innovating for Improvement’ Programme, we have been working with care teams across NHSScotland to design and test the Always Events concept. In continuously driving improvements, the Always Events approach aims to support healthcare providers to view experiences through the eyes of patients, families and service users.  

Originally coined by the Picker Institute, an “Always Event” is defined as a clear, action-oriented, and pervasive practice or set of behaviors that provides: 

  • A foundation for partnering with patients and their families;  
  • Actions that will ensure optimal patient experiences and improved outcomes; and  
  • A unifying force for all that demonstrates an ongoing commitment to person- and family-centered care.”    

Always Events are considered so important to patients and families, such that healthcare providers are expected to perform them consistentlyThey are captured directly from patients and service users, and could form the basis of spreading improvements in health and care at individual, care team, organisational and system-wide levels.    

In the process of designing and testing the Always Events concept in Scotland we delivered three learning sessions with care teams.  The content included:  

  • an overview of the Always Events method 
  • person-centred approaches to Quality Improvement 
  • summaries of care team improvement projects  

Care teams actively engaged with patients and service users to identify important aspects of the patient experience fundamental to care.  They then developed these ideas into potential Always Event lists and quality improvement projects, for future integration into work practices or new care systems.  Among the care settings represented in the teams were a GP practice, a hospital Emergency Department and a maternity unit.   

The Emergency Department at Queen Elizabeth University Hospital (NHS Greater Glasgow and Clyde) produced a film as part of the project to support user experience expectationsYou can view the film here

committed to supporting such improvements in healthcare, patient safety and person-centred-care through ongoing research, development and delivery.   

Further information 

Institute for Healthcare Improvement. (2014). Always Events Getting Started Kit. Cambridge, MA.  

The Health Foundation. (2015). Designing and testing “always event” and person-centredness concepts in multiple care settings.  


Nancy El-Farargy,, NHS Education for Scotland