IHI created this roadmap to assist healthcare providers in using “Always Events” as a tool to improve patient-centered care. It outlines the four phases of “Always Events” and key elements - leadership, patient and family partnership, team engagement and measurement - needed for successful change. Phase 1: Identifying an Always Event; Phase 2: Developing and Implementing the Program; Phase 3: Evaluating the Program; Phase 4: Sustaining the Momentum.