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Tomaino Arm Care Network

Dr. Tomaino's Blog

After Action Reviews

February 1st, 2015
To maintain the highest levels of patient satisfaction, I need to deliberately and continually focus on care processes, culture, team effectiveness, objective outcomes, and perceived outcomes. In “The Fifth Discipline” by Peter Senge, After Action Reviews (AARs) are advocated as a practice which links reflection with action---in pursuit of continual learning. These are not merely reports; rather these debriefings are part of the daily reflection on:

1. What was expected?

2. What were the actual outcomes?

3. What explanations exist to explain any gap?

In the July 2005 issue of Harvard Business Review, Darling, Parry, and Moore, in their article entitled “Learning in the Thick of It” define After Action Review (AAR) as a method for extracting lessons from one event or project and applying them to others.

They write: “The U.S. Army’s Opposing Force (commonly known as OPFOR), a 2,500-member brigade whose job is to help prepare soldiers for combat, treats every action as an opportunity for learning—about what to do but also, more important, about how to think. Instead of producing static “knowledge assets” to file away in a management report or repository, OPFOR’s AARs generate raw material that the brigade feeds back into the execution cycle. And while OPFOR’s reviews extract numerous lessons, the group does not consider a lesson to be truly learned until it is successfully applied and validated. AAR meetings became a popular business tool after Shell Oil began experimenting with them in 1998 at the suggestion of board member Gordon Sullivan, a retired general. Teams at such companies as Colgate-Palmolive, DTE Energy, Harley-Davidson, and J.M. Huber use these reviews to identify both best practices (which they want to spread) and mistakes (which they don’t want to repeat).

Darling, Parry, and Moore also acknowledge that “most corporate AARs, however, are faint echoes of the rigorous reviews OPFOR performs. It is simply too easy for companies to turn the process into a pro forma wrap-up. All too often, scrapped projects, poor investments, and failed safety measures end up repeating themselves. AAR should be more verb than noun—a living, pervasive process that explicitly connects past experience with future action. “Accountability” comes up a lot during OPFOR’s in the context that it is forward-looking rather than backward-looking. Units are accountable for learning their own lessons. And OPFOR’s leaders are accountable for taking lessons from one situation and applying them to others—for forging explicit links between past experience and future performance."

By creating tight feedback cycles between thinking and action, AARs are critical to building highly efficient teams. The culture is averse to assigning individual blame or culpability for a process error or poor outcome. To the extent that all members of the team are a de facto part of the System, blame detracts from team learning, and threatens communication. A “cover one’s behind mentality” in order to avoid revealing vulnerability or accountability may be one of the greatest threats to continual improvement. Continual learning requires dialogue, trust, and shared vision and commitment to excellence.

Having become a TEAM STEPPS Instructor in March 2014, and being well acquainted with the four pillars of this patient safety initiative---leadership, communication, situation monitoring, and mutual support----it is very clear that After Action Reviews are a critical part of this initiative as well. AARs require deliberate practice and commitment. They are seamlessly made part of the care process and team culture. They do not happen without leadership.


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