A1.2. After Action Review (AAR)

After Action Review (AAR) - evaluate all activities

What should I expect the outcomes to be of using the tool?

A record of main outcomes and improvement actions, as a short list of key lessons learned.

Tool/ method

AAR is a facilitated discussion that supports continuous improvement through prompting us to reflect on how successful we were at achieving our aim by comparing what actually happened with what was intended.

It can be used at key stages or after completing a task, event, activity or project to help us recognise when something needs improving.

The review is structured around the following questions:

The format can also act as a useful way to record and share learning events.

Why we may choose to use this tool/ method?

 

 

AAR is simple to use, it doesn't require a lot of equipment or advance preparation and can be held almost anywhere.

It is participative, so everyone can join in and it doesn't judge success or failure.

A flexible approach can be taken, so the discussion can be formal or informal, longer or shorter, depending on the complexity of the activity being reviewed.

How you might use this tool/ method?

AAR should be used on a regular basis and planned into key stages of a project, event or task, rather than waiting until things have gone wrong,

The review meeting should be held as soon as possible after an event so that people's memories are fresh and team members are still available.

It needn't take long meetings could last half-a-day, or even half-an-hour but all the key members of the team should be included. There is a need for openness and honesty so set some ground rules such as respect for others' views and set an expectation that everyone should take part.

A facilitator should be appointed to help create an open environment, promote discussion and draw out lessons learned. This can be a member of the team, but ideally it will be someone not directly involved so that they can remain objective but have a good understanding of the issues.

Structure your discussion as follows:

  1. Revisit the objectives in order to establish a common understanding of the activity: Ask the following questions…
  • What did we set out to achieve?
  • What actually happened?
  • Why were these differences?
  1. Reflect on the strengths and weaknesses….
  • What worked well? Why?
  • What could have been improved? How?
  1. Finally identify specific actions for improvement:
  • What would you do differently next time?

Tips:

  • A meeting space large enough for all the members of the team
  • Flipcharts and pens to record the key points and actions
  • If time is limited it may be helpful to distribute the questions in advance, responses can be collated and shared to stimulate discussion.
  • Write the questions on flipchart sheets before the meeting and stick these up around the room to focus participants' minds.
  • Keep asking "why?" to draw out the reasons behind the strengths and weaknesses and "how?" to identify specific actionable recommendations.

What next?

Consider how the lessons can be shared and how improvement actions can be implemented.

Examples/ case studies/ links to best practice/ evidence

 

An article describing how Univeristy college hospital used AAT to stimulate learning and improvement can be found at

http://www.ncbi.nlm.nih.gov/pubmed/19552332

After action reviews: a new model for learning. Emerg Nurse. 2009 Jun;17(3):32-5

Contact for further information

Suzanne Hamilton, Cumbria Partnership NHS Foundation Trust

Suzanne.Hamilton@cumbria.nhs.uk

 

 

Templates and visualisations:

 

CPS TOOLKIT

Toolkit overview
The purpose of this toolkit
What is the Cumbria Production System?
How can we transform our services?
Cumbria Production System - improvement principles
What improvement outcomes and results can we expect?
When should you use the tools?
Key tool templates and visualisations
Summary of tools
Module 1: Our approach to improvement
1.1 Plan, Do, Study, Act (PDSA)
1.2 After Action Review (AAR)
1.3 Data gathering and evidence and '5 whys'
1.4 Measuring for improvement
1.5 A3
Module 2: Seeing the issues and adding value for the people who use our services
2.1 Maximising value
2.2 Customer Journey Mapping (CJM)
2.3 Process mapping
2.4 Value Stream Mapping (VSM)
Module 3: Waste removal and standardisation
3.1 Waste, waste wheel, waste walk
3.2 Spaghetti diagrams
3.3 5S workplace organisation
Module 4: Flow, demand and standard operations
4.1 Demand analysis
Module 5: Taking people with us
5.1 Stakeholder analysis
Appendices
A. The tools in detail
Module 1: Our approach to improvement
A1.1 Plan, Do, Study, Act (PDSA)
A1.2 After Action Review (AAR)
A1.3 Data gathering and evidence and '5 whys'
A1.4 Measuring for improvement
A1.5 A3
Module 2: Seeing the issues and adding value for the people who use our services
A2.1 Maximising value
A2.2 Patient/ Customer Journey Mapping
A2.3 Process mapping
A2.4 Value Stream Mapping (VSM)
Module 3: Waste removal and standardisation
A3.1 Waste, waste wheel, waste walk
A3.2 Spaghetti diagrams
A3.3 5S workplace organisation
Module 4: Flow, demand and standard operations
A4.1 Demand analysis
Module 5: Taking people with us
A5.1 Stakeholder analysis
C. References and acknowledgements