Dr. Siobhán McCarthy, Programme Director for the MSc Quality and Safety in Healthcare Management, delivered a keynote presentation at the HMI conference titled, “The Irish Safety Culture and After Action Review Experience (iCAARE) study – implications for healthcare managers.” McCarthy is co-investigator of the iCAARE study, which examined the implementation and effect of AARs over a year at one hospital site in Ireland
McCarthy explained that After Action Reviews (AARs) originated in the US military as a method for learning from training missions. This practice has since been adopted by various industries, including firefighting, public health emergency response, and other safety-critical sectors. AARs involve a group reflecting on four key questions:
- What did we expect to happen?
- What actually happened?
- Why was there a difference?
- What have we learned?
Since 2018, the Health Service Executive (HSE) in Ireland has integrated AARs into its National Incident Management Framework. The RCSI Graduate School of Healthcare Management, on behalf of the HSE, trained approximately 500 healthcare staff as AAR facilitators through in-person simulation-based training between 2018 and 2001.
Recognising the need for innovation in learning from patient safety events, AARs were advanced in the Irish Health System before a strong evidence base was established. The iCAARE team, comprising researchers and knowledge users, has addressed this evidence gap.
Drawing on an iCAARE publication in Safety Science, McCarthy’s presentation focused on enablers and barriers to AARs and identification of behaviour change techniques to support implementation, alongside potential implications for healthcare managers.
She shared key enablers to AAR implementation, identified at the study site, six months post the training, included:
- Knowledge: Understanding the AAR process and its benefits.
- Skills: Proficiency in facilitating AARs.
- Optimism: A positive attitude towards AARs and their potential impact.
Key barriers to AAR implementation included:
- Lack of reinforcement: Lack of organizational push for AARs.
- Environmental Constraints: Factors such as the COVID-19 pandemic and staff shortages.
Drawing on the published research, McCarthy suggested that addressing reinforcement and environmental constraints could help mitigate potential barriers related to emotions and social roles. She also noted strong reinforcement of AARs during the early stages of adoption is crucial.
To enhance enablers and overcome barriers, McCarthy emphasized the use of a portable recorded resource of simulated AAR. Developed by the iCAARE research team and available in BMJ Open Quality, four open access videos have been produced. These cover:
- Introduction to the AAR facilitation process
- Simulation of a facilitated formal AAR
- Techniques for handling challenging situations in AARs
- Reflection on the benefits of the AAR process
These open access videos are being used widely in the HSE, NHS, and other countries to support AAR awareness and training.
McCarthy recommended the videos to the audience of healthcare managers, and suggested healthcare managers prioritise AAR awareness and training for staff, and address any practical and emotional barriers to AARs among staff.
Finally, she recommended to the audience to keep abreast of iCAARE team updates in the coming months, which will feature additional study findings and strategies to support AAR.
This implementation science research study was funded by a HRB Applied Partnership Award, with co-funding from the HSE National Quality and Patient Safety Directorate. Dr Natasha Rafter is the iCAARE Principal Investigator, and Ms Lorraine Schwanberg the Lead Knowledge User.
