1. Always Events
Thematic analysis

2. Steps Collect data Analyse data to identify themes
Agree on Always Events
Step 4
Does Always Event fulfil criteria?
Step 5
Design Quality Improvement project based on Always Event

3. Questionnaire
What do you feel is so important that it should ALWAYS happen when you have contact with __________________? (name of unit/department) 1 2 3

4. Number of responses needed
Data saturation

5. Combines responses
“All staff should be polite and pleasant towards patients”
“Prefer to see same GP every time and if given bloods want to know exactly what the results are...”
“Someone shows genuine concern for any matter that I present with”
“That I can get through on the phone to reception quickly.”
“The appreciation by reception staff that patients (more often than not) actually do need some consultation with someone whom they find approachable and whose diagnoses and judgement they trust”
“I want the correct treatment for my problem”
“That we are able to access a doctor or practice nurse ‘on the day’ for important problems...”
“It matters a lot to me that I receive good care which I do, as this allows me to continue working and doing the many things I do”
“Being treated as an individual – not next in line, but don’t feel this is a problem”
“That you can ask the GP anything you need to and to understand what they say because they are saying it using words and language you understand. That they talk to you, not look at the book or computer…”
“It should be friendly and efficient and I should always be No.1”
“It [care] is given to me by people who are properly qualified and understand my needs”
“I feel that when I leave the surgery that I have had a positive outcome e.g. any questions that I had have been answered and even more importantly that I have been listened to”
“The ability to book appointments in advance with a GP of my choice and at a time convenient to me”
“That I should be able to see the nurse/doctor I always see and have confidence in...”
Read and re- read data – immerse yourself in data

6. Code responses
“All staff should be polite and pleasant towards patients”
“Prefer to see same GP every time and if given bloods want to know exactly what the results are...”
“Someone shows genuine concern for any matter that I present with”
“That I can get through on the phone to reception quickly.”
“The appreciation by reception staff that patients (more often than not) actually do need some consultation with someone whom they find approachable and whose diagnoses and judgement they trust”
“I want the correct treatment for my problem”
“That we are able to access a doctor or practice nurse ‘on the day’ for important problems...”
“It matters a lot to me that I receive good care which I do, as this allows me to continue working and doing the many things I do”
“Being treated as an individual – not next in line, but don’t feel this is a problem”
“That you can ask the GP anything you need to and to understand what they say because they are saying it using words and language you understand. That they talk to you, not look at the book or computer…”
“It should be friendly and efficient and I should always be No.1”
“It [care] is given to me by people who are properly qualified and understand my needs”
“I feel that when I leave the surgery that I have had a positive outcome e.g. any questions that I had have been answered and even more importantly that I have been listened to”
“The ability to book appointments in advance with a GP of my choice and at a time convenient to me”
“That I should be able to see the nurse/doctor I always see and have confidence in...”
2nd person - agreement

7. Arrange in themes
“It should be friendly and efficient and I should always be No.1”
“All staff should be polite and pleasant towards patients”
“Being treated as an individual – not next in line, but don’t feel this is a problem”
“Someone shows genuine concern for any matter that I present with”
“I want the correct treatment for my problem”
“It [care] is given to me by people who are properly qualified and understand my needs”
“It matters a lot to me that I receive good care which I do, as this allows me to continue working and doing the many things I do”
“That you can ask the GP anything you need to and to understand what they say because they are saying it using words and language you understand. That they talk to you, not look at the book or computer…”
“The appreciation by reception staff that patients (more often than not) actually do need some consultation with someone whom they find approachable and whose diagnoses and judgement they trust”
“I feel that when I leave the surgery that I have had a positive outcome e.g. any questions that I had have been answered and even more importantly that I have been listened to”
“That I can get through on the phone to reception quickly.”
“The ability to book appointments in advance with a GP of my choice and at a time convenient to me”
“That we are able to access a doctor or practice nurse ‘on the day’ for important problems...”
“Prefer to see same GP every time and if given bloods want to know exactly what the results are...”
“That I should be able to see the nurse/doctor I always see and have confidence in...”

8. Themes - example Access to, and continuity of, healthcare
“That I can get through on the phone to reception quickly.”
“The ability to book appointments in advance with a GP of my choice and at a time convenient to me”
“Prefer to see same GP every time and if given bloods want to know exactly what the results are...”

9. Create Always Events
Generate Always Event that summarises theme (or part of the theme) and uses the patient’s own words
Candidate Always Event:
“I want to be able to get through on the telephone to reception quickly”

10. Does candidate Always Event fit the criteria?
Always Event Criteria: 1.
Is any healthcare interaction, process or outcome that is judged by patients, carers or relatives to be a highly important determinant of care quality and experience 2.
Is unambiguous and specific to enable reliable measurement 3.
Is consistently deliverable to applicable patient groups by all relevant health care organisations, teams and individuals; AND 4.
Is feasible as part of routine health care delivery

11. Design Quality Improvement Project
Always Event:
“I want to be able to get through on the telephone to reception quickly”
Measure:
Patients will speak to a member of staff within two minutes of phoning. (Practice has electronic call handling system)
Standard (target)
90% of patients will speak to a member of staff within two minutes of calling.

12. Team involvement Discussion with frontline staff
Agreement on measure and standard (target)
Discussion regarding how to interrogate call handling system to collect data
Agreement to look at weekly data (could easily use much smaller sample sizes)

13. Baseline data collection
In one week:
1168 calls
561 (48%) answered within 2 minutes

14. Implement change Discussed handling of calls :
House visits
Prescription requests
Test results
Streamed to appropriate caller – alteration to call handling system

15. 2nd data collection 1232 calls
690 calls (56%) answered within 2 minutes

16. Change Busiest at 8:30am to 10:00am on Monday, Tuesday and Wednesday
One staff member agreed to change hours

17. 3rd data collection 1067 calls
898 calls (84%) answered within 2 minutes

18. Implement change
Online appointment booking

19. 4th data collection 1221 calls
1050 calls (86%) answered within 2 minutes

20. Presentation of data
Standard = 90%

21. Your turn! Review your responses from patients Assign codes to quotes
Identify one theme from your data
Generate a candidate Always Event within that theme
Apply the criteria (in packs) to determine if it is an Always Event

22. Going forward NES project support Evaluation BMJ Quality licences
Publication

23. BMJ Quality Platform http://quality.bmj.com/

24. BMJ Quality Resources

25. BMJ Quality Improvement Reports http://qir.bmj.com/