I spent time with an amazing woman last month and, instead of writing to her directly to acknowledge what I see as her remarkable qualities as a leader, I have decided to write this as a public letter because I think these qualities are essential for leading the implementation of the After Action Review (AAR) approach in large organisations.

Dear Ann*

Bringing about change in an organisation is not everyone’s “cup of tea” and is rarely in anyone’s job description, yet I have been so impressed by your determination to make change happen and ensure patient safety is improved by using AAR.

Every AAR creates an opportunity for change, for the individuals participating and the team and organisation they belong to, as well as future patients. Whilst this is not an easy or straightforward process when the approach is so new in a Hospital Trust like yours, you remain clear in your vision.

I was amazed by how undaunted you seemed about the journey ahead, even in the face of the reluctance to do things differently that was expressed. Some people are weary and wary of change and others are doubtful of their abilities, but your energy and commitment are contagious and were felt by many in the group.

Listening to you speak to the other new AAR Conductors about the work to be done in the weeks and months ahead to embed AAR as the preferred Learning Response Tool, confirmed my view of you as a remarkable leader. Those listening were inspired too, and their fears and concerns were allayed when you articulated your grasp of their concerns and the value of the end goal.

It can’t have been easy listening to people’s high expectations for what you should be doing for them, but you responded with dignity and humility, acknowledging where you could have done more and earning respect in doing so.

I was also struck by your compassion for people’s resistance to take those first steps forward to initiate the change. You can see what After Action Review will do for the speed and quality of learning in your hospital, but pioneering is not for everyone and you understand that.

I have three pieces of advice to offer to help you in the weeks ahead:

1) Recruit and celebrate your “followers”. Not only will they make your journey more enjoyable, but they will also bring others along with them and grow the energy for change quicker. All the steps, however small, that people take in the weeks ahead to help with implementing the AAR approach, should be praised and recognised.

2) Keep the bigger picture in mind. Whenever you are having to deal with the red tape of governance, or the politics of the many stakeholders in patient safety, stay strong to the vision of rapid actionable learning and safer patient care that will be the outcome.

3) Enjoy the journey. You are young enough to be able benefit from everything you learn through doing this. As Elizabeth Blackwell, the first woman on the Medical Register of the General Medical Council in the UK, who pioneered education for women in medicine, said:

“It is not easy to be a pioneer but oh, it is fascinating! I would not trade one moment, even the worst moment, for all the riches in the world.”

As always, myself and the iTS AAR Team are here to help into 2023 and beyond.

*not her real name.