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HealthJanuary 12, 2021

Improving performance with after-action reviews

By: Sarah Handzel, BSN, RN
As healthcare centers continue to respond to the Covid-19 pandemic, nurse leaders are consistently seeking ways to improve patient care, streamline workflow processes, and promote staff engagement and continuing education. One such method, the after-action review (AAR), is a tool that can be used to review and evaluate a facility’s planning and implementation processes for major public health events, including patient surges.

AARs were initially developed by the United States military as a way to review and evaluate mission outcomes. Now, many governmental and private agencies use AARs to help improve responses to all types of emergencies that impact large numbers of people, such as hurricanes or bombings. Nurse leaders in any healthcare facility can use AARs to evaluate organizational response to any event, learning what response methods worked well and what can be improved upon in future events.

AAR objectives and features

According to the World Health Organization1, AARs are completed with four specific objectives in mind:

  1. Review the actions undertaken at each phase of the event to help identify actions that worked well, as well as those that worked less well and why.
  2. Demonstrate the functionality of a facility’s capacities in preparing for, detecting, and responding to public health events.
  3. Identify the corrective actions needed to institutionalize any lessons which emerge from the management of such events.
  4. Address the challenges made evident through the AAR.

A recent article in the journal Nursing Management2 lists several of the features of an effective AAR, which include:

  • Holding an informal or formal AAR
  • Being inclusive
  • Avoiding finger-pointing
  • Sticking to the facts and actions that occurred
  • Identifying lessons learned
  • Facilitating an open and honest discussion

Initiating an after-action review

To successfully complete an AAR, nurse leaders must approach the process as a structured method to evaluate any event which impacts large numbers of people, including patients and healthcare workers. AARs may be formal or informal processes, and a team of people who were directly involved in the event should be present.

Each after action review should proceed according to the following steps:

  • Step 1: planning. Ideally, AARs should be completed immediately following the event. A small group should plan the AAR, deciding how formal the process should be and which stakeholders should be included. In some cases, outside facilitators may be necessary to aid discussion, since they are neutral parties to the event.
  • Step 2: doing. Each participant should have a voice in the AAR. In general, each participant should reflect and share their thoughts on four specific questions: what was planned and expected, what really happened, what went well and why, and what would each person do differently and how.
  • Step 3: documenting outcomes. From meeting notes, nurse leaders may compile all feedback into a summary document. Additionally, leaders should plan to follow up on any suggestions or actions which may facilitate change and promote improvements to processes.

An after-action review is a simple tool that can help nurse leaders identify problems at the organizational level, determine which changes may need to occur, and find ways to make those changes. Like other review processes, AARs can help healthcare organizations improve performance while also providing a platform for any and all stakeholders to participate.

Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
  1. “After Action Review.” World Health Organization, World Health Organization, 13 Oct. 2020, who.int/ihr/procedures/after-action-review/en/.
  2. Goodyear, Caryl PhD, CCRN-K, NEA-BC, FAAN. “After-Action Review: A Critical Tool for Leaders to Get to the next Normal.” NursingCenter, 2020, nursingcenter.com/journalarticle?Article_ID=5730250.
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