Applying the theoretical domains framework to identify enablers and barriers to after action review: An analysis of implementation in an Irish tertiary specialist hospital

Background: After Action Review (AAR) is a debriefing methodology for learning from events. The method is a facilitated discussion among a team exploring what they expected to happen, what did happen, and what they learned. Ireland's Health Service Executive includes the AAR methodology as part of its national Incident Management Framework. This paper explores enablers and barriers to AAR implementation in an Irish tertiary specialist hospital. Methods: Fifty staff were trained as AAR facilitators in a 1.5 day simulation training programme. Six months after training, focus group discussions explored facilitator perceptions of enablers and barriers to AAR implementation. Framework analysis was applied to the data, informed by the Theoretical Domains Framework. Results: Four focus group discussions with 14 AAR facilitators were conducted. Seven enablers, twelve barriers and eight enablers/barriers were identified across all 14 TDF domains. Three domains of reinforcement; professional role and identity; and emotion contained the richest data on processes acting as enablers and barriers to AAR implementation. Conclusion: To promote implementation of AAR, practical experience must be reinforced in the aftermath of training; professional position in teams and units must be considered in initiating and facilitating AAR; and staff emotions around facilitation must be supported as enablers through practice and skill development.