Nurse Managers Can Lead Unit Reflection with After Action Reviews

By Caryl Goodyear, PhD, RN, NEA-BC, CCRN-K, FAAN Jun 16, 2020

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The impact of COVID-19 infections varies.

The impact of COVID-19 infections varies. In one area of a state the effects of the pandemic may create havoc and in other areas there is not much effect. In either case, everyone has prepared for this pandemic to hit their hospitals. Whether you lived through a surge or are waiting for one to arrive, preparations were made, policies and procedures were changed and innovative staffing models were deployed.

Just like other businesses, hospitals are also preparing to reopen by increasing surgical operations. As we start the next normal, it’s important to consider and reflect on what just happened. What went well, so well, that we would decide to keep it or institute it for the next crisis or pandemic? What didn’t go so well? What do we want to do differently next time?

Nurse managers are in an ideal position to lead this important unit reflection. We know that reflection helps inform our future. After Action Reviews (AARs) can be the perfect model for initiating a unit’s reflection. Created and used by our military, AARs provide a structured approach to assess performance and outcomes in order to learn from both success and failure. Whether you would reflect on the surge or the preparation phase, AAR is a tool to help you maximize learning by reflecting on strengths and weaknesses and deciding on changes to keep and areas for improvement. The "Guide to the After Action Review" is a good framework that provides a concise and clear explanation of the “how to.”

The four overall questions in the AAR:

  • 1What was expected to happen?

  • 2What actually occurred?

  • 3What went well and why?

  • 4What can be improved and how?

The discussion should not assess blame; the goal is to share honest observations about what happened. Good ground rules are important to begin AAR. Some of these rules may include the following:

  • Every viewpoint is considered and valued
  • Active participation is important and expected
  • Being open and honest is encouraged
  • There are no right or wrong answers

Who should be involved in the AAR? As we know, it is difficult and highly unlikely to have everyone in the unit participate in this review. You may want to pick formal and informal leaders to participate, ensuring that all shifts are represented. Or you may decide to use the shared governance council to decide on participants and meeting structure. The council leadership may be interested in facilitating the discussion.

“After Action Review. Continuous Improvement Made Easy,” by Artie Mahal (Technics Publications, 2018) provides a structure for the review. It also imparts foundational information on being a facilitator, including competencies for active listening, good questioning, intervening and managing group dynamics.

AARs provide the structure to give you insight on what was learned and what to keep for the future. My hope is that your unit participates in this learning and grows from the experience.

What successes do you think an AAR might identify for your unit?