What an after-action review is
An after-action review, or AAR, is a short, structured team debrief that turns a recent case or shift into lessons you can use on the next one. It is simple by design: gather the people who did the work, agree on what success looked like, compare that expectation with what took place, spot the gaps and wins, and convert those notes into small changes with clear owners. In care settings, the same method fits resuscitations, ward rounds, clinic sessions, handovers, discharges, and project rollouts.
AARs are not investigations and not performance appraisals. They sit alongside incident reporting and deeper reviews while helping teams learn in the flow of work. Many hospitals teach this method through team training programs such as the AHRQ TeamSTEPPS debrief, which promotes brief, routine reviews after key events.
After-action review in healthcare: time and place
Run an AAR any time the team wants to capture learning while details are fresh. High-yield moments include first cases with new equipment, near misses, complex handoffs, rapid transfers to higher care, long waits, delayed results, and any moment when work felt messy or surprisingly smooth. The team can also schedule a short AAR at the end of a shift or clinic list. Ten minutes today beats a forgotten story next week.
Quick agenda and prompts
Use this simple agenda to keep the session tight and useful. Keep a visible timer. Aim for action by the end.
| Stage | Purpose | Sample prompts |
|---|---|---|
| Setup (1–2 min) | Pick the case, timebox, name a facilitator, set a speak-up tone. | “We have 15 minutes. We’re here to learn, not to blame. Let’s stick to facts and actions.” |
| Expectations (3–4 min) | Align on what good looked like for this case or process. | “What did we plan? What would ‘textbook’ look like here?” |
| What happened (3–4 min) | Build a short timeline from different roles. | “Walk us through key moments. Where did we slow down or speed up?” |
| Gaps and wins (3–4 min) | Compare plan vs reality; name friction and bright spots. | “What helped? What got in our way? What should we repeat every time?” |
| Actions (2–4 min) | Turn notes into 1–3 concrete changes with owners and dates. | “What will we change before the next case? Who owns it and by when?” |
Doing an after-action review in healthcare teams
Start fast. Invite the people who were hands-on, plus anyone who controls a step the team wants to change. Pick a neutral facilitator who can keep pace, draw out quieter voices, and park side topics. Open with ground rules: speak with respect, keep judgment out, center on process, and end with owned actions. Then walk the four questions in order. Keep the focus on the work, not on individuals.
Capture notes where everyone can see them: a whiteboard, a shared screen, or a form in your reporting tool. Tag items as sustain or change. A few sticky issues will need a deeper forum; log them, then park them. Forward them to a safety lead, a specialty lead, or a project huddle for follow-up.
The four questions that keep it on track
1. What did we expect to happen?
Agree on the goal and the standard. That might be a pathway time target, a sepsis bundle, a handover checklist, or a transfer protocol. When everyone shares the same picture of “good,” the later gaps make sense and the wins are easier to list.
2. What actually happened?
Build a short timeline. Ask different roles to add one or two facts each. Stick to observable events: who called whom, when meds arrived, when imaging reported, which bed was ready, who escalated, which alarm fired. Facts first, interpretation later.
3. Why were there differences?
Now pull causes and enablers. Look across people, tasks, tools, and setting. Was the plan unclear? Was capacity tight? Did the EHR workflow hide a step? Were supplies missing? Did roles clash? Was a handoff rushed? Keep the tone calm and specific.
4. What will we change or repeat?
End on action. Pick one to three changes you can ship fast, plus one or two practices to keep. Make each action testable in the next week. Add an owner, a date, and a check-back plan. If an item is bigger than the team, route it to the right forum and track it.
Facilitation basics that make it safe to speak
Set the tone in the first minute
Say the purpose out loud and ask for candor. Invite dissent early. Make it clear that the session is about work systems, not blame. If the event was tough, open the floor for a moment of support, then move to the method.
Balance airtime
Invite short turns from each role. Use round-robins for the first two questions, then open discussion for causes and actions. If a voice dominates, thank them and move to the next person. If a quiet person signals they have something to add, make space.
Park rabbit holes
Create a “parking lot” for topics that need a different room. Read it back at the end with where each item will go. This protects pace without losing good ideas.
Linking AAR to incident review and RCA
AAR works best as a front-line habit that feeds your formal processes, not as a replacement. When a case meets policy for a formal review, signal that path and still hold the short team debrief. Use the debrief to collect early facts, preserve context, and list quick wins you can try now. If the deeper review uses action strength methods such as the IHI RCA2 action guidance, send your notes and early actions to that team so nothing is lost.
Regulators expect learning and action after serious events. Policies such as the Joint Commission sentinel event policy outline the need for timely review and follow-through. AAR helps the team respond fast while the formal track runs.
Measuring progress and closing the loop
Track what matters to the team and to patients: time to key steps, error types tied to the case, delays avoided, handoff clarity, patient hand-backs, and staff workload signals such as pages and alarms per hour. Small wins count. Post a simple run chart in the workroom or in your virtual huddle notes. Share back the actions that landed and those still in progress. When you close a loop, thank the people who did the work.
Make it easy to see and search past AARs. Use a standard title format, date, unit, and tags. Link AAR notes to incident tickets or project tasks so owners get reminders. A monthly scan of AARs by a specialty lead can spot patterns for the next improvement sprint.
Action capture that actually gets done
Write actions so anyone could try them tomorrow. Use verbs, a clear step, and one owner. Add a check date and where the change will live long term: a checklist, a protocol page, an order set, a label on a cart, or a note in the EHR. Pair each action with a quick measure so the team can tell if it helped.
| Action field | What to write | Tip |
|---|---|---|
| Owner | One named person with a reachable contact. | Avoid groups. One owner can pull help. |
| Change | Short sentence that starts with a verb. | “Add ‘STAT’ flag to transfer order template.” |
| Due date | A real date within two weeks. | Pick a day, not “ASAP.” |
| Where it lives | The tool or place the change sits. | Checklist, protocol page, order set, supply bin. |
| Measure | How the team will see the effect. | “Two transfers in a row with no paging delay.” |
| Follow-up | Who will check and when. | “Charge nurse will check next Friday huddle.” |
Common pitfalls and fixes
Too slow or too long
If the session drifts, cut back to the four questions and the timer. Split big topics into follow-ups. End on owned actions even if there are only one or two.
Turns into blame
Steer back to process. Use neutral language: “The syringe label looked alike” beats “Sam grabbed the wrong one.” Thank anyone who shares a slip and turn it into a change that helps the next person.
Nothing happens afterward
Assign owners in the room and log actions where the team already works. Post action status in the daily huddle notes. Close the loop in public so people see that speaking up leads to change.
Only runs after bad days
Debrief wins too. When a tricky transfer goes smoothly, hold a five-minute AAR and write down what to repeat. Positive learning builds good habits fast.
Templates you can copy
One-page AAR sheet
Title: _______________________ Date: __________ Unit: __________
Case or process: _________________________________________________
People in the room: _______________________________________________
Q1. Expectations: _____________________________________________
Q2. What happened: ___________________________________________
Q3. Why different: _____________________________________________
Q4. Actions:
- Action 1 — Owner — Due — Where it lives — Measure — Follow-up
- Action 2 — Owner — Due — Where it lives — Measure — Follow-up
- Action 3 — Owner — Due — Where it lives — Measure — Follow-up
Facilitator script (15 minutes)
- Open (1 min): “This is a short, blame-free debrief so we learn fast. We’ll use four questions and end with owners and dates.”
- Expectations (3 min): “What did we plan? What would ‘good’ look like?”
- What happened (3 min): “From each role, one key fact we need on the timeline.”
- Why different (3 min): “What helped or got in the way?”
- Actions (4 min): “Name 1–3 changes we can try this week. Who owns each and by when?”
- Close (1 min): “Thanks all. We’ll share actions in the next huddle and log them today.”
Training and spread
Teach the method in new-starter orientation and refresher drills. Rotate facilitation so the skill spreads. Pair a new facilitator with an experienced one for the first few tries. Share short stories of wins in staff meetings and chat channels. If you want packaged tools, programs such as TeamSTEPPS include debrief checklists and videos you can adapt.
Ethics, records, and care for staff
Keep patient details minimal in shared notes. Store AAR notes based on your policy and mark sensitive items. If the case was heavy, signpost staff support routes at the end of the session. A short check-in now can help people return to safe work on the next case.
Why this habit works
It is quick. It is near the work. People who saw the details build the story together, which reduces guesswork. The same four questions keep every session clear. When actions land and the team sees the effect, trust grows and people bring more issues early. Over time, that steady learning improves care and the day-to-day load on staff.
Policy signals and external guidance
Many health systems ask teams to learn from both harm and near-harm. AAR gives units a simple way to do that daily and to feed larger reviews when needed. Public guidance on learning systems from bodies such as the World Health Organization points to the value of systems that capture lessons and share them widely. Your local policy may set extra steps for serious events; the AAR still helps your team move the first actions quickly while the formal work proceeds.