After Action Reviews
What is an After Action Review?
After Action Review (AAR) is a highly adaptable and useful approach, originally developed by the US Army. It can be used effectively for learning from positive or challenging actions, for example, a situation where the outcomes fell short of expectations.
A Before Action Review (BAR) uses the same techniques and can help a team to assess the knowledge and experience they already have to inform the planning stages of a new project.
AARs are promoted as one of the key learning tools in the NHS England guidance: responding proportionately to patient safety incidents (PDF), which is part of the new Patient Safety Incident Response Framework (PSIFR).
How does it work?
A trained AAR conductor takes a group directly involved in the action through a set of ground rules so that everyone can contribute equally, without blame, and in an environment to learn together. The conductor asks four questions: what was expected before the activity or project, what actually happened, why was there a difference, and what can be learnt?
How can we help you?
TPHC are experts in independent AARs and BARs. We offer:
- Expert conductors: TPHC has a pool of skilled AAR and BAR conductors able to run bespoke sessions for teams and organisations.
- After Action Review Conductor Development training: this is a one-day training course that equips participants to become confident and competent AAR conductors. It introduces the principles and underpinning theories of AAR, with real-life examples. It also provides a safe and nurturing space for participants to practise the approach with feedback for continuous improvement.
- Conductor development: for trained AAR conductors and organisations who are looking to advance their skills and quality of their AAR practice, we offer bespoke support. This is through Action Learning Sets, reflective practice and active mentoring.
- Organisational development to embed AAR practice: our AAR expertise can help organisations to capitalise on the energy AAR creates in your organisation. TPHC can help you design sustainability in your approach with tailored support and coaching programmes. This could be creating a community of practice of AAR conductors in your organisation or embedding this practice along other learning tools.
What are the benefits of AARs?
Regular AARs make a significant contribution to team resilience and performance and are a key tool in creating a sustainable improvement culture.
The AAR approach works to:
- Build strong effective multi-professional teams
- Deliver swift, smart solutions to problems
- Structure open, honest and productive conversations
- Provide a supportive operating environment for teams in which to reflect and learn
- Increase psychological safety.
Teams that use AAR routinely have the ability to reflect and learn together. This builds excellent problem solving, flexible thinking and capacity for continuous improvement.
This is why AARs are promoted as one of the key learning tools in the NHS England guidance: responding proportionately to patient safety incidents (PDF), which is part of the new Patient Safety Incident Response Framework (PSIFR).
What do our customers say?
‘Having worked with TPHC for the past year I can’t thank them enough for the support and guidance they have given in developing the initial cohorts of AAR conductors here at CUH. As part of our ‘Just Culture’ workstream, we wanted to provide staff with an opportunity to learn together, in a psychologically safe way, that was evidence-based and proven.
By working with TPHC, the team have given us the tools and framework to develop a supportive culture, not only for the leams wanting to undertake AARs, but also for the newly trained AAR conductors. This is just the first phase of the work as we develop an AAR Academy at the Trust, and we are excited to continue working together. Themes of learning have already been shared across teams in the Trust, and the confidence it has brought Conductors has been shared with me personally. TPCH have been responsive to our changing needs, which has proved invaluable when undertaking a medium to long term improvement programme of work.’
Deputy Chief Nurse, NHS Foundation Trust
“The practice session was so valuable to be able to practice in a safe space”
“Training was delivered by experts in their field, which was well delivered, the methods were conducive to various learning needs and styles. I have learnt more than I expected”
How do they work in practice?
We’ve helped a range of organisations and leaders to improve performance and delivery:
AAR Conductor Development Programme, Cambridge University Hospitals NHS Foundation Trust, 2019-20
Working with the Deputy Chief Nurse and Patient Safety Team, TPHC designed and delivered a comprehensive AAR conductor development programme. This was part of a Trust-wide initiative to put learning into action and support patient safety.
We trained 112 staff to become AAR conductors and supported their development. We carefully planned the approach for the training, prepared promotional and communications materials and advice to support the CUH strategy. Finally, we designed a detailed evaluation pre and post training, based on key project KPIs and impact reports.
Impact: The newly trained conductors successfully facilitated AARs across the Trust, which brought actionable learnings and improvements to services. When COVID-19 hit in March 2020, the trained conductors were able to support and share learnings quickly, and our team were recommissioned to support conductors (virtually) through reflective practice.
AAR Conductor Development Programme, East Suffolk and North Essex NHS Foundation Trust, 2021-24
Working with the Chief and Deputy Chief Nurse and Patient Safety Team, TPHC has designed and delivered a comprehensive AAR conductor development programme.
We trained over 330 staff to become AAR conductors as well as planning the approach and preparing communications materials and advice to support sustainability.
We helped our client understand the positive impact of AAR on the Patient Safety Incident Response Framework and provided evaluation, recommendations and actions for sustaining the AAR community and the quality of AAR practice in the Trust.
Impact: AAR practice in the Trust has increased, with success stories of the outcomes of AARs spreading organically across the organisation. The community of practice is becoming self-sustained with the Patient Safety Team running a centralised allocation system for AAR requests and conductors. We are currently completing an evaluation as well as hosting an away day for the AAR community of practice.
Secure school learning review and lessons learned, NHS England, Youth Custody Service, 2021
Three years into the development of one of the government’s flagship projects, the design and opening of the first secure school, TPHC was commissioned to design and deliver a learning review. The review would enable the team to take stock, constructively reflect in a safe space, capture key successes and learnings and turn those into actionable insights for the rest of the project. TPHC designed a mixed-method approach, including one BAR and four AARs with key stakeholders to reflect and learn on key focus areas.
Impact: The report set out key lessons learned, themes and actions to take forward. These have now been implemented and England’s first secure school will open this year.
Talk to us to find out more
If you are interested in hearing more about how AARs or BARs can help your organisation to meet its challenges, improve performance and delivery, please contact us for an informal chat.
email us at:rf-tr.tphc-communication@nhs.net.