Siobhán is a Programme Director and Lecturer for the MSc Quality & Safety in Healthcare
Management at the RCSI. Siobhan supervises MSc and PhD dissertations supporting multi-disciplinary healthcare professionals to research and enhance quality and safety. Currently, she is co-investigator on a HRB/HSE funded study measuring the effect of After Action Review (AAR) on safety culture and second-victim experience and its implementation in an Irish Hospital (iCAARE), and was RCSI co-lead of the in-person AAR simulation based training programme. iCAARE findings are currently being prepared for submission for publication. iCAARE educational outputs include open access videos of simulated AARs and accompanying peer reviewed paper. Other research activities include collaborative work with the RCSI Healthcare Outcomes Research Centre and HSE National Quality Improvement Team which involved the conduct of a scoping review of quality improvement studies conducted in Ireland (2015 – 2020). Previously Siobhán has developed and evaluated the effect of online patient safety education on junior doctors’ safety knowledge, beliefs and practices. On behalf of the Irish Medical Council, Siobhán has led a multi-stakeholder study of medical-regulation in Ireland, at the time a new Medical Practitioners Act was being prepared for Ireland. Prior to this, Siobhán worked in a research development and education role in St John of God Hospitaller Services, supporting the development of infrastructure and strategy for research across the service.
Originating in the US Army and now in the Incident Management Framework (IMF) of the Irish Health Service, After Action Review (AAR) is a non-hierarchical facilitated approach to team learning. AAR enables groups to come to a shared mental model about what happened, why it happened and to identify learning. AAR has been linked to improved safety culture in the US fire-fighting sector. How best to support adoption of AAR in healthcare is unknown, as well its effectiveness. Therefore, we examined the effect of AAR on safety culture and second victim experience (the impact of patient safety events on staff) and its implementation at an Irish hospital.
Drawing on Proctor et al’s framework, we conducted a mixed-methods effectiveness-implementation study. Hospital staff completed surveys (Hospital Survey on Patient Safety 2.0 and Second Victim Experience and Support Tool) before, and at the end of a twelve-month AAR intervention period. Core implementation strategies were the site adoption of AAR as part of the Health Service Executive IMF and the training of hospital selected staff (one in twelve) as AAR Facilitators using a simulation-based training programme. Six months after the training, using the Theoretical Domains Framework (TDF), focus groups were conducted with AAR Facilitators to explore the enablers and barriers to AAR implementation. Information about number of AAR meetings, their quality and financial costs were also estimated.
Findings were triangulated using Proctor’s framework. These will demonstrate potential changes in safety culture and second victim experience and support and the impact of AAR practice and the implementation context. Recommendations for behaviour change techniques to support future AAR implementation are made.
Results will directly inform local hospital decision making and national policy approaches to incorporating AAR in hospitals in Ireland.