The Challenge

A large acute NHS Hospital Trust wanted to increase the quality and frequency of ward-based team learning, by training ward leaders to use the AAR approach because it can be applied easily to clinical concerns and successes as well as exceptional events. The move was part of a wider initiative to strengthen the ward leaders’ role as change agents with local power to facilitate improvement.

The Solution

The face-to-face AAR Conductor Development workshop blended theory with practice to provide a rich learning experience. After a morning exploring the key principles of AAR, we filmed and replayed delegates’ participation in practice AARs and to ensure all understood how to maintain psychological safety and create an ideal environment for learning to improve patient safety and to engage the team in finding solutions for process improvement.

The Result

26 staff participated in the training over 2 days with 100% of them agreeing with the statement “I learnt more than I expected” (88% strongly) and 100% agreeing that “I can see how valuable AAR will be in this organisation” (88% strongly).

The aspects of the AAR approach that they found particularly interesting and valuable were, in their own words:

• The more informal approach of AAR – not being constrained by a need to generate lengthy action plans
• How to chair an AAR to get the best effective learning outcomes
• I have learned how to perform an AAR and about the language to be aware of that will impact how successful it can be to learning in my areas
• The structure to break down the learning in a safe place for all
• First person language – you get so much more value in terms of change
• Including the question “What is expected?” as hundreds of patient complaints come from lack of expectations being met. So, to use this stuff in AAR I feel will help me understand and improve

The aspects of the training that participants found most valuable were, in their own words:

• The role play simulations were powerful at consolidating the learning and my own behaviours
• Whilst the role play was dauting at first it was a crucial source of learning for me and insightful how I can improve and fine tune my skills to be a conductor
• The theory of AAR in the morning followed by the opportunity to practise AAR skills
• The facilitator was extremely encouraging and knowledgeable. I liked the style of learning
• I have really enjoyed the course – lots of engagement and my confidence and knowledge has grown over the day
• Enjoyable day, thank you. Your enthusiasm and passion for the subject made the day even better those expectations
• The trainer relates things to our practice setting so we get a deeper understanding of how we can use it

Ahead of the publication of PSIRF, this Trust is now familiar with and using AAR. Those who were trained, are suggesting topics for AARs as well as leading them, and one of the clearest results reported is the change in mindset. Ward leaders now are reframing problems as opportunities to learn from with the AAR approach, rather than as issues to regretted and put in the “too hard to tackle” box . AAR has given them the means to support ward based learning from experience.