After Action Reporting and Improvement Planning: Perhaps the Most Important Step in Your Health Care Emergency Exercise

February 15, 2021

For those responsible for emergency management at a hospital or health care facility, exercises are one of the best ways to keep staff “on their toes” and familiar with emergency procedures— not to mention that they are required by our regulatory organizations. Typically, a lot of effort and resources go into the planning and execution of exercises in order to ensure they are meeting the needs and getting the most value from the time staff commit to them.

Even though these are just simulations, there often is a sense of relief when the exercise’s last trauma victim is sent to the operating room, the final patient comes through the decontamination tent, or the group finishes out the last task on a tabletop exercise.

While definitely an accomplishment, however, the end of the “action” could be considered the start of the real work for the emergency manager: creating the After Action Report (AAR) and Improvement Plan (IP). In order to gain the full benefit from any exercise we do, it’s essential that we have processes in place to accurately capture data about performance and synthesize it into a meaningful form that can be used to help us learn and get better.

Collecting and synthesizing your exercise data

You should consider the evaluation, data collection process, and after action assessment of your exercise early on during the initial planning phase. Do this by ensuring that you have clear exercise goals and objectives, and by instructing your observers to keep these in mind when evaluating the exercise.

Create an Exercise Evaluation Guide (EEG) to provide the observers with the objectives, capabilities, and critical tasks the exercise will focus on so they are well informed about what to watch for. Be sure to debrief the observers after the exercise and collect their completed documents as well as any additional notations they have made—all of this will be useful when it’s time to analyze the data!

Once everything is gathered together, the emergency manager should work with the exercise team to take a good look at what went well and where there are opportunities to improve. Ask these questions to guide the evaluation process:

• How did the players do?
• Did we meet the objectives?
• Was what we thought would happen actually what happened? 

Take the time to do a “deep dive” into the various aspects of the exercise while not being afraid to discover things that might not have gone well. Synthesize all of the data collected—EEGs, notes, anecdotes, direct observations—to drill down to the main issues found. Record these as the strengths and areas for improvement.

Creating the AAR

Once we have created a good list of strengths and areas for improvement (and be honest here…no skimping!), we are now ready to start our AAR/IP. This very well could be the most important document that comes out of your exercise development process, as it will not only provide an overview of the exercise, but will highlight the key findings and more importantly what you are going to do about them! A good AAR/IP is more than just a list of “good and bad;” it’s a plan for how you are going to learn from the mistakes to help prevent them from reoccurring in the future. 

For each area of improvement identified, do some improvement planning:

• Take the observations and build corrective actions around them
• Be sure the corrective actions are “SMART” (meaning that they are specific, measurable, achievable, relevant, and time-bound). Really try to avoid corrective actions that don’t have these qualities—they won’t drive a good improvement process if they don’t
• Clearly assign these corrective actions to individuals or teams in your organization that can get them fixed, and put a timeline on them

Now, not every corrective action can be fixed with a snap of the fingers, so take this into consideration with your timeline and expectations, but be sure to challenge yourself and your team to make progress.

Even after the AAR, the work isn’t done

Once you have finalized your AAR/IP, present it to your emergency management team or administrative leadership to share with them what you have found, highlighting the strengths of course but spending time on the corrective actions. Some things to keep in mind include:

• Keep the AAR/IP corrective actions “alive” by referring back to them at regular intervals to track progress. Don’t just put the AAR/IP on the shelf never to be read again!
• Consider tracking all AAR/IP corrective actions identified, both in exercises and real events, on a continual basis and documenting progress as a performance measure for your emergency management program
• Continual improvement in the mitigation, preparedness, response, and recovery cycle is a key element of a successful emergency management program for your organization, and a robust AAR/IP process will help keep this spinning

For more information on exercise development, check out the Homeland Security Exercise and Evaluation Program (HSEEP) website.

If your organization would like assistance with developing, executing, and evaluating an exercise, consider contacting HAPevolve for comprehensive support to help you build a resilient framework to prepare for and recover from natural and human caused disasters, infrastructure failures, medical surge events, evacuations, and other crises.