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Getting the most from after action reviews to improve global health security

BACKGROUND: After Action Reviews (AARs) provide a means to observe how well preparedness systems perform in real world conditions and can help to identify – and address – gaps in national and global public health emergency preparedness (PHEP) systems. WHO has recently published guidance for voluntar...

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Autores principales: Stoto, Michael A., Nelson, Christopher, Piltch-Loeb, Rachael, Mayigane, Landry Ndriko, Copper, Frederik, Chungong, Stella
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785939/
https://www.ncbi.nlm.nih.gov/pubmed/31601233
http://dx.doi.org/10.1186/s12992-019-0500-z
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author Stoto, Michael A.
Nelson, Christopher
Piltch-Loeb, Rachael
Mayigane, Landry Ndriko
Copper, Frederik
Chungong, Stella
author_facet Stoto, Michael A.
Nelson, Christopher
Piltch-Loeb, Rachael
Mayigane, Landry Ndriko
Copper, Frederik
Chungong, Stella
author_sort Stoto, Michael A.
collection PubMed
description BACKGROUND: After Action Reviews (AARs) provide a means to observe how well preparedness systems perform in real world conditions and can help to identify – and address – gaps in national and global public health emergency preparedness (PHEP) systems. WHO has recently published guidance for voluntary AARs. This analysis builds on this guidance by reviewing evidence on the effectiveness of AARs as tools for system improvement and by summarizing some key lessons about ensuring that AARs result in meaningful learning from experience. RESULTS: Empirical evidence from a variety of fields suggests that AARs hold considerable promise as tools of system improvement for PHEP. Our review of the literature and practical experience demonstrates that AARs are most likely to result in meaningful learning if they focus on incidents that are selected for their learning value, involve an appropriately broad range of perspectives, are conducted with appropriate time for reflection, employ systems frameworks and rigorous tools such as facilitated lookbacks and root cause analysis, and strike a balance between attention to incident specifics vs. generalizable capacities and capabilities. CONCLUSIONS: Employing these practices requires a PHEP system that facilitates the preparation of insightful AARs, and more generally rewards learning. The barriers to AARs fall into two categories: concerns about the cultural sensitivity and context, liability, the political response, and national security; and constraints on staff time and the lack of experience and the requisite analytical skills. Ensuring that AARs fulfill their promise as tools of system improvement will require ongoing investment and a change in mindset. The first step should be to clarify that the goal of AARs is organizational learning, not placing blame or punishing poor performance. Based on experience in other fields, the buy-in of agency and political leadership is critical in this regard. National public health systems also need support in the form of toolkits, guides, and training, as well as research on AAR methods. An AAR registry could support organizational improvement through careful post-event analysis of systems’ own events, facilitate identification and sharing of best practices across jurisdictions, and enable cross-case analyses.
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spelling pubmed-67859392019-10-17 Getting the most from after action reviews to improve global health security Stoto, Michael A. Nelson, Christopher Piltch-Loeb, Rachael Mayigane, Landry Ndriko Copper, Frederik Chungong, Stella Global Health Review BACKGROUND: After Action Reviews (AARs) provide a means to observe how well preparedness systems perform in real world conditions and can help to identify – and address – gaps in national and global public health emergency preparedness (PHEP) systems. WHO has recently published guidance for voluntary AARs. This analysis builds on this guidance by reviewing evidence on the effectiveness of AARs as tools for system improvement and by summarizing some key lessons about ensuring that AARs result in meaningful learning from experience. RESULTS: Empirical evidence from a variety of fields suggests that AARs hold considerable promise as tools of system improvement for PHEP. Our review of the literature and practical experience demonstrates that AARs are most likely to result in meaningful learning if they focus on incidents that are selected for their learning value, involve an appropriately broad range of perspectives, are conducted with appropriate time for reflection, employ systems frameworks and rigorous tools such as facilitated lookbacks and root cause analysis, and strike a balance between attention to incident specifics vs. generalizable capacities and capabilities. CONCLUSIONS: Employing these practices requires a PHEP system that facilitates the preparation of insightful AARs, and more generally rewards learning. The barriers to AARs fall into two categories: concerns about the cultural sensitivity and context, liability, the political response, and national security; and constraints on staff time and the lack of experience and the requisite analytical skills. Ensuring that AARs fulfill their promise as tools of system improvement will require ongoing investment and a change in mindset. The first step should be to clarify that the goal of AARs is organizational learning, not placing blame or punishing poor performance. Based on experience in other fields, the buy-in of agency and political leadership is critical in this regard. National public health systems also need support in the form of toolkits, guides, and training, as well as research on AAR methods. An AAR registry could support organizational improvement through careful post-event analysis of systems’ own events, facilitate identification and sharing of best practices across jurisdictions, and enable cross-case analyses. BioMed Central 2019-10-10 /pmc/articles/PMC6785939/ /pubmed/31601233 http://dx.doi.org/10.1186/s12992-019-0500-z Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Stoto, Michael A.
Nelson, Christopher
Piltch-Loeb, Rachael
Mayigane, Landry Ndriko
Copper, Frederik
Chungong, Stella
Getting the most from after action reviews to improve global health security
title Getting the most from after action reviews to improve global health security
title_full Getting the most from after action reviews to improve global health security
title_fullStr Getting the most from after action reviews to improve global health security
title_full_unstemmed Getting the most from after action reviews to improve global health security
title_short Getting the most from after action reviews to improve global health security
title_sort getting the most from after action reviews to improve global health security
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785939/
https://www.ncbi.nlm.nih.gov/pubmed/31601233
http://dx.doi.org/10.1186/s12992-019-0500-z
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