After-action review

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An after action review (AAR) is a structured review or de-brief (debriefing) process for analyzing what happened, why it happened, and how it can be done better by the participants and those responsible for the project or event.[1] AARs in the formal sense were originally developed by the U.S. Army.[2] Formal AARs are used by all US military services and by many other non-US organizations.[3] Their use has extended to business as a knowledge management tool and a way to build a culture of accountability.[4]

In England’s National Health Service, AAR is increasingly used as a learning tool to promote patient safety[5] and improve care, as outlined by Walker et al 2012.[6] In the UK and Europe other healthcare organisations, including pharmaceutical and medical technology businesses such as BD, are beginning to roll out their own AAR programmes. Specialist AAR training and facilitation consultancies are becoming established to service the demand.[7]

An AAR occurs within a cycle of establishing the leader's intent, planning, preparation, action and review.[8] An AAR is distinct from a de-brief in that it begins with a clear comparison of intended versus actual results achieved.[1] An AAR is distinct from a post-mortem in its tight focus on participants' own actions; learning from the review is taken forward by the participants.[9] Recommendations for others are not produced. AARs in larger operations can be cascaded in order to keep each level of the organization focused on its own performance within a particular event or project.[9]

Formal AAR meetings are normally run by a facilitator or trained 'AAR Conductor', and can be chronological reviews or tightly focused on a few key issues selected by the team leader.[9] Short cycle informal AARs are typically run by a team leader or assistant and are very quick.[9]

After action reviews in the military[]

There are basically two types of military AARs—formal and informal. Formal AARs require more detailed planning, preparation, and resources. They are normally scheduled and conducted as a part of external and internal evaluations.[10] Informal AARs require less planning and preparation than formal AARs and are often on-the-spot reviews of soldier and collective training performance at crew, squad, or platoon level.[11]

Formal[]

Formal AARs are normally conducted at company level and above.[12] However, when a training event is focused at squad or platoon level, and resources are available, a formal AAR may be conducted to gain maximum training benefit.[13] Externally evaluated lane training, small-unit ARTEPs, and tank and BFV gunnery tables are prime examples. Informal crew, squad, and platoon AARs are held prior to company and higher-echelon AARs.[14]

The AAR facilitator (evaluator or controller) provides a mission and task overview and leads a discussion of events and activities that focuses on the objectives.[15] The discussion with leaders and soldiers should orient on the use of terrain integration of key BOS (Battlefield Operating Systems), and leader actions.[Department of the Army Publications 1] The discussion should also examine the weapons systems and doctrine used by the enemy during the exercise. At the close, the AAR leader summarizes comments from the observers, covering strengths and weaknesses discussed during the AAR and what the unit needs to do to fix the weaknesses.[16]

An observer/controller-trainer conducts a formal after-action review to assist a reserve unit capture lessons learned from their exercise

Informal[]

Informal AARs are usually conducted for soldier and crew-, squad-, and platoon-level training or when resources are not available to conduct a formal review.[13] They are often held for lower echelons prior to a formal company- or higher-level AAR, though they may be conducted at company level. Informal AARs are extremely important since they involve all soldiers and leaders in the participating unit.[14] The formal company AARs for the training event depend on these thorough, informal reviews.[17] These are sometimes referred to as a "hotwash".[12]

Informal AARs are conducted similar to formal AARs and may be done for large or small units. They may be scheduled, or leaders may do on-the-spot reviews during the training.[18] Discussion comments could be recorded to use in follow-on AARs or to apply immediately the lessons learned as the exercise is repeated.[2]

After action reviews in the NHS[]

In 2008 a group of senior leaders within University College London Hospitals NHS Foundation Trust acted on the realization that bullying and blaming behaviours were impacting on safe and effective care. They commissioned the UCLH Education service to tackle the problem, and AAR was chosen as the tool to use.

“Healthcare is dominated by the extreme, the unknown and the very improbable with high impact consequences, conditions that demand leadership, and yet we spend our time focusing on what we know and what we can control. Educating staff on the use of After Action Review enables team working and cues behaviours through allowing an emotional mastery of the moment and learning after doing”. Late Professor Aidan Hallighan UCLH Director of Education[19]

“AARs are applicable to almost any event, clinical or otherwise, and whilst the emphasis is on learning after less than perfect events, AARs after successful experiences can also provide rich benefits. Prerequisite to the success of a formal AAR are a few key ingredients, including a trained ‘conductor’, a suitable safe private environment, allocated time and the assumption of equality of everybody present. Every AAR follows the same structure with the conductor getting agreement for the ground rules at the outset and ensuring everyone is clear about the specific purpose of the AAR and the four apparently simple questions to be used.”[6]

AAR is actively used in a number of NHS organisations including Cambridge University Hospitals, Bedfordshire Hospitals and NEL Healthcare Consulting and has been recommended as an approach to be used in the new NHS Patient Safety Incident Response Framework, which “moves away from reactive and hard-to-define thresholds for ‘Serious Incident’ investigation and towards a proactive approach to learning from incidents.”[20]

See also[]

References[]

  1. ^ a b Cronin, Gerard; Andrews, Steven (2 June 2009). "After action reviews: a new model for learning: Gerard Cronin and Steven Andrews explain why after action reviews are an ideal model for healthcare professionals to analyse and learn from events". Emergency Nurse. 17 (3): 32–35. doi:10.7748/en2009.06.17.3.32.c7090. PMID 19552332. ProQuest 218273304.
  2. ^ a b Morrison, John E.; Meliza, Larry L. (1 July 1999). "Foundations of the After Action Review Process". DTIC ADA368651. {{cite journal}}: Cite journal requires |journal= (help)
  3. ^ Sawyer, Taylor Lee; Deering, Shad (December 2013). "Adaptation of the US Army's After-Action Review for Simulation Debriefing in Healthcare". Simulation in Healthcare. 8 (6): 388–397. doi:10.1097/SIH.0b013e31829ac85c. PMID 24096913. S2CID 35341227.
  4. ^ Levy, Moria (19 July 2011). "Knowledge retention: minimizing organizational business loss". Journal of Knowledge Management. 15 (4): 582–600. doi:10.1108/13673271111151974.
  5. ^ "How can After Action Review (AAR) improve patient safety?".
  6. ^ a b Walker, Judy; Andrews, Steve; Grewcock, Dave; Halligan, Aidan (July 2012). "Life in the slow lane: making hospitals safer, slowly but surely". Journal of the Royal Society of Medicine. 105 (7): 283–287. doi:10.1258/jrsm.2012.120093. PMC 3407393. PMID 22843646.
  7. ^ E.g. iTS AAR
  8. ^ Baird, Lloyd; Holland, Phil; Deacon, Sandra (March 1999). "Learning from action: Imbedding more learning into the performance fast enough to make a difference". Organizational Dynamics. 27 (4): 19–32. doi:10.1016/S0090-2616(99)90027-X.
  9. ^ a b c d Beatty, Carol Anne (2016). "The How of Change". Managing Change: The Easy, Hard and Tough Work. ISBN 978-0-88886-568-7.
  10. ^ "FM 25-101 Appendix G After Action Reviews". www.au.af.mil. Retrieved 2019-04-19.
  11. ^ "The After-Action Review". www.au.af.mil. Retrieved 2019-04-19.
  12. ^ a b Mastiglio, Thomas; Wilkinson, Jeffrey; Jones, Phillip N.; Bliss, James P.; Barnett, John S. (1 June 2011). "Current Practice and Theoretical Foundations of the After Action Review". S2CID 107779092. DTIC ADA544543. {{cite journal}}: Cite journal requires |journal= (help)
  13. ^ a b ArmyStudyGuide.com (2006). U.S. Army Board Study Guide. Foster City, California: QuinStreet, Inc. ISBN 0-9776750-0-9.
  14. ^ a b Salter, Margaret S.; Klein, Gerald E. (1 January 2007). "After Action Reviews: Current Observations and Recommendations". DTIC ADA463410. {{cite journal}}: Cite journal requires |journal= (help)
  15. ^ Pike, John (2019). "After Action Reviews". Global Security. Retrieved 12 April 2019.
  16. ^ Combined Arms Center - Training (December 2013). "The Leader's Guide to After-Action Reviews (AAR)" (PDF). Unit Training Management (UTM). Retrieved 11 April 2019.
  17. ^ A leader's guide to lane training. Headquarters, Dept. of the Army. 1998. OCLC 41407250.
  18. ^ The Infantry Rifle Platoon and Squad (PDF). March 2007.[page needed]
  19. ^ Halligan, Aidan (October 2011). "Patient safety: culture eats strategy for breakfast". British Journal of Hospital Medicine. 72 (10): 548–549. doi:10.12968/hmed.2011.72.10.548. PMID 22041722.
  20. ^ https://www.england.nhs.uk/wp-content/uploads/2020/08/200312_Introductory_version_of_Patient_Safety_Incident_Response_Framework_FINAL.pdf
  1. ^ Mosley, Troy. "Operational Terms and Graphics". FM 101-5-1. Department of the Army. Retrieved 6 February 2013.

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