NHS England’s Patient Safety Incident Response Framework (PSIRF) brings a significant opportunity to improve patient safety because it represents a shift away from the burdensome responsibility to investigate, report and follow up on large numbers of adverse events towards a more “propionate and compassionate “response. This will include in depth investigations into a smaller number of events, and the use of other highly effective learning response tools that shift the potential for learning and change to the wards and our staff. 

The After Action Review (AAR) is one of those tools and its potential to benefit NHS organisations of all types, are strong but rely on having fully trained AAR Conductors, to set the benchmark for best practice and act as Champions for the approach. Whilst the four question model of the AAR looks simple, ensuring every AAR is a psychologically safe and productive learning environment is a skilled and complex activity. 

Benefits of After Action Review in the NHS include: – 

1. An increase in the quality and speed of learning. Research studies from a number of sectors, have demonstrated significant improvements in safety and risk awareness because of AARs.  
2. The widening of topics to be reviewed for learning. Investigations take up to 80 hours by an investigator to complete. AARs can take just a few hours to prepare, conduct and report, so many more concerns about care and processes can be reviewed. AARs can be a signpost to additional exploration for quality and safety teams.
3. Increasing efficiency and productivity.  Even in the best performing teams, the AAR approach will ensure all are engaged in continuously improving processes and approaches to care.   
4. Improved staff resilience and well-being. Being heard and being included are key features of the AAR approach and are well documented as being protective factors for staff stress. 
5. Fit for purpose solutions are created to fit local needs. Learning through AAR empowers staff to be creative in identifying solutions for local issues, that actually work.  
6. Better quality conversations can take place between organisational boundaries, services and clinical teams, as the AAR approach provides a psychologically safe context in which to learn from problems and find solutions together. 
7. Team performance will improve – the evidence is clear on this. Teams that use AAR regularly can improve their performance by 20 to 25% when compared with control teams.
8. The involvement of service users, patients and families in AARs is significant, when organisations are ready and able to support high quality learning and a partnership approach to improvement. 
9. Leadership and talent development. Training as an AAR Conductor fosters the development of highly valuable leadership skills which are widely applicable outside the practice of AARs.  

Further reading

1. Applying the After Action Review for the PSIRF – some real life examples Here
2. Patient Safety Managers creating a buzz around After Action Review Here
3. Five Tips for the AAR Conductor Here
4. Accelerated learning through AAR Here