After Action Reviews

The trust was generating learning through various routes; including incidents, serious incidents, complaints, claims, audits, etc. However there was a gap in enabling the identification of timely reactive learning, and the inclusion of staff directly involved in incidents/events in the generation of learning. Below we conduct an After Action Review (AAR) on the implementation of AARs and the trust wide rollout using the four key questions that an AAR is centred around.

WHAT WAS EXPECTED?

We would have champions for the approach and people who promote it

It becomes fully embedded with a Train the Trainer approach

The approach is widely recognized and valued not just a nice to have

It is a positive multi-disciplinary approach where people feel welcome and feel able to be open

Our departments champion it

It is a positive and inclusive approach

We are able to create psychological safety in AARs

We will achieve a cohort of trained AAR Conductors who use it formally and that it becomes something that people start to use informally as well, to structure conversations

We improve the patient experience and safety because our staff are engaged in AAR and feel it is valuable

AAR would be a timely and reactive learning tool.

The AAR approach compliments the new Patient Safety Incident Response Framework (PSRIF) as one of their recognised tools for learning.

WHAT ACTUALLY HAPPENED?

Quality Governance Learning Assurance Coordinators were recruited to lead the AAR process and implementation.

A cohort of conductors have been trained with dates scheduled to train further conductors. 7 trust staff members have been trained as trainers. There was initial anxiety amongst some staff attending AARs.

AARs were implemented in selected departments initially to trial the process and AARs are now utilised regularly within the Maternity and Paediatric departments.

Learning points have come out of every AAR held which bridge across individual learning, process improvements and trust wide learning.

The time between the incident/event and an AAR being held varies significantly and are not always as timely/reactive as hoped. Some cases go to AAR within a matter of days, other times it can take a number of weeks.

AARs are frequently suggested/recommended by members of the executive team, as well as departmental leads in areas where AAR is well established.

AARs often have to be cancelled and rescheduled due to staff availability/staffing pressures.

AAR can often be seen as alternative to a Serious Incident instead of a complimentary method for identifying learning.

WHY WAS THERE A DIFFERENCE?WHAT DID WE LEARN FROM THIS?

Some AARs were held prior to the official trust wide launch so staff were unaware of what an AAR was.

Rollout and staff recognition of AARs is a slow and continual process as staff familiarity increases.

Staff will not be fully familiar and on board with the process of an AAR until they have either attended one, or trained as a conductor.

Staffing constraints and availability, particularly during the pandemic, has meant there can be difficulties in staff being released to attend an AAR.

A very successful training package meant that staff were very supportive of AARs after completing the conductor training.

Newly trained conductors felt anxious about conducting their first AARs. Clarity about where this new process sat within/alongside other existing processes.

Staff were unfamiliar with the new Patient Safety Incident Response Framework (PSIRF) and its recommendation for the use of AAR as a forum for learning from incidents/events.

The high proportion of AAR attendees have felt able to speak freely within the forum. Having a dedicated resource and trust leads in the form of the Learning Assurance Coordinators.

AARs can be a successful forum for identifying learning from incidents/events. Development of standardised staff guides and documentation paperwork.

A brief guide on AARs is now shared alongside the meeting invitations to familiarise staff with what an AAR entails prior to attending.

Supporting newly trained conductors and enabling them to observe an AAR being conducted within the hospital setting prior to leading their own.

AAR conductors are needed within every department to increase the opportunity for onthe-spot reactive AARs and to ensure each service takes ownership of AARs within their own area.

Produce a formal strategy for the ongoing implementation and embedding of the AAR process.

Increased trust wide communications to promote and champion AARs; including sharing learning points from AARs within the quarterly patient safety newsletter, creating a short week.

Raising the awareness of the new PSIRF amongst staff using existing trust communication routes.

Adapting the AAR training package to suit the needs of our Trust staff, including developing a clinical scenario to simulate an AAR in the hospital setting.

Our enthusiasm for AAR is catching.