Unlocking Continuous Improvement: The Power of After Action Reviews in the NHS

I recently read an interview with Dave Cooper, a former US Navy SEAL who played a key role in the planning and preparation for the mission to capture Osama Bin Laden. In the interview he explains the pivotal role After Action Reviews (AAR’s) played in ensuring the mission was a success.

Over the last year I’ve worked with NHS Trusts, delivering training on the new Patient Safety Incident Response Framework (PSIRF) which introduces a number of tools, one of which is AAR’s. Whilst I’d seen how they can play a role, Dave Cooper’s interview made clear just how transformative an effective AAR can be in transforming processes and outcomes.

Why After Action Reviews?

AARs are not just about identifying what went wrong, but also celebrating what went right and how we can replicate success. They offer a structured method for teams to reflect on what happened, why it happened, and how future operations can be improved. This iterative learning process is crucial for fostering a culture of continuous improvement.

Creating a Psychologically Safe Environment

For AARs to be truly effective, it’s essential to cultivate an environment where team members feel comfortable sharing their honest feedback without fear of retribution. This involves:

Embracing Vulnerability: Encouraging everyone, from frontline staff to senior leaders, to openly discuss their mistakes and learnings.

Eliminating Hierarchy: In AARs, every voice matters. Breaking down hierarchical barriers ensures that insights from all levels of the organisation are heard and valued.

Dave Cooper explains that AAR’s should consist of a short meeting in which all of the team gather to discuss and replay key decisions. Crucially they are not led by commanders, there are no agendas and no minutes are kept. The goal is to create a flat landscape where people can figure out what really happened and talk about mistakes – especially their own. As Cooper describes succinctly “rank switched off, humility switched on” with the most important four words any leader can say being “I screwed that up”.

The Impact in the NHS

When done correctly, AARs can lead to:

Improved Patient Safety: By systematically analysing incidents, near misses, and successes, we can implement changes that prevent future errors and enhance patient care.

Enhanced Team Collaboration: AARs promote a culture of open communication and trust, strengthening teamwork and morale.

Ongoing Professional Development: Continuous learning through AARs helps healthcare professionals develop critical thinking and problem-solving skills.

By adopting the principles of the Navy SEALs and prioritising psychological safety, the NHS can harness the full potential of AARs to drive excellence in patient care and operational efficiency.

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