By Rameen Tahir, Valérie Balvert and Candela Iglesias Chiesa
A colleague came to me the other day with a concern: She wanted to evaluate the COVID-19 intervention that her team has been working on for the past 20 months, but since she knew that the process had been quite chaotic in the beginning, she was concerned that the exercise could turn into a blaming game which would not benefit anyone. I told her about after action reviews (AARs) and how they can help us analyze our past work with an emphasis on learning and not on mistakes.
In this blog post, you can read more about the famous AAR, what it entails, and why they are so important in Public Health.
What is an After Action Review (AAR)?
AARs were originally developed in the military and later taken up and modified by private and public organizations. In the health space, the WHO recommends AARs to review “the actions taken in response to an actual public health event, as a means of identifying and documenting best practices, gaps and lessons”. Public health events where we can use AARs include natural disasters (e.g. hurricanes, earthquakes), disease outbreaks, epidemics/pandemics, political instabilities and wars, etc.
In other words, an AAR is a review of the actions that have been taken in response to a public health event. Data analyzed in AARs can be quantitative (e.g. number of days to respond to disease outbreak) but there is a focus on qualitative questions (e.g. what did not go well in the response?).
AARs aim to analyze what happened, why it happened, and most importantly, how it can be done better. During an AAR, a public health team sits down shortly after a PH intervention or health project to openly discuss four major points:
The four major points of an After Action Review.
- What was supposed to happen?
- What actually happened?
- What went well and why?
- What can we improve, and how?
As you can see, it has no focus on who did what or who is to blame. While things that did not work are also analyzed (as part of the last question on improvement), the endpoint is future oriented: how do we get better at this? If facilitated correctly, this focus can create a psychological safe space where participants can openly share what they think worked well, did not work, and ideas for improvement.
When should an AAR be conducted?
For the best outcomes, the WHO recommends that the AAR takes place within three months after the end of a public health intervention. This is because you want to make sure that the main stakeholders involved in the intervention (e.g. PH professionals, local authorities, NGOs, other actors outside the healthcare sector, etc.) are still available and their memory of the event is still fresh.
What are different types of AARs?
The WHO suggests four types of AARs:
- Debrief AAR
- Working Group AAR
- Key Informant Interview AAR
- Mixed Method AAR
To give you a better idea of what each type of AAR looks like in practice, here’s a scenario. Your team was responsible for providing emergency medical aid to the inhabitants of city X due to a flood that has injured many and made access to healthcare services challenging.
During the intervention, your main team was divided into smaller teams with different functions. Some of the functions included distributing food/water to the inhabitants, providing emergency medical supply to healthcare workers, setting up medical tents, and treating injured individuals. Furthermore, you worked with local actors such as the fire department and external actors such as skilled professionals who came from abroad to volunteer.
After your team’s health intervention, which lasted over two weeks, you decide to conduct an AAR to try to identify what went well/wrong and how to improve similar interventions in the future. This is what the different types of AAR would look like:
- The team responsible for providing medical supplies came together for a couple of hours to debrief on lessons learned from this specific function, with the support of a facilitator who led the discussion (debrief AAR).
- During three days, the entire team (all functions) came together and discussed in parallel what went well/wrong in each role and how they can work better together, as a whole, in the future (working group AAR).
- The team leader holds a virtual interview with the head of the fire department and/or volunteer group and asks them for their perspective of the health intervention (key informant interview).
- You combine all three methods to provide you with in-depth information on what went well/wrong and how to improve, from each function and stakeholders of the health intervention (mixed method AAR).
Why do we need AARs?
The explicit link of the AAR process to future actions (what can we improve?) is key to ensure that the AAR does not become just another report gathering dust on someone’s desk. The engagement of all participants also helps to ensure that needed changes are carried out, and strengthens institutional memory of the learnings.
Two great assets of AARs, when conducted properly, are that they can turn unconscious learning into something tangible and applicable, and that it can help build trust and collaboration inside or across teams. AARs can also be used as one component of a larger evaluation that includes reviewing documents, carrying out interviews and analyzing and triangulating from all these data sources for the analysis.
Where can I find more information on how to conduct an AAR?
WHO has developed tools and guidelines to help set up and facilitate AARs for public health actions. A nice component of their tools is that in the final stage, participants can work their way through the list of recommendations and identify learning that they can apply immediately to improve processes and responses, as well as those which will require medium and longer term efforts.
You can find their guidance for AARs here.
If your organization or team is looking to evaluate a public health or global health intervention or project, and you’d like to discuss if an AAR or other methods could be the way to do it, we’d be happy to help. Email us at firstname.lastname@example.org or comment below and we can set up a call!
Link for image and WHO AAR video : https://youtu.be/l61dcs45HDI
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