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J R Soc Med. 2012 Jul;105(7):283-7. doi: 10.1258/jrsm.2012.120093.

Life in the slow lane: making hospitals safer, slowly but surely.

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Education Programme Lead, The UCH Education Centre, UCLH NHS Foundation Trust, London, UK.


Recognition that serious deficiencies in mutual respect and team work were hampering safe and effective patient care led to the creation of the cultural change initiative described here. We feel this has widespread applicability to other healthcare settings. The After Action Review (AAR) concept was adapted for use in the NHS for the first time as it provides a deceptively simple vehicle to structure healthy blame free team interactions with the aim of improving practice and team behaviours. The organizational and psychological barriers to being able to do this in multi-professional teams are accentuated by the hierarchical nature of the clinical context, but this project has begun to make lasting change so that AAR is an approach that is now widely understood and frequently used.

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