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Start with the exercise objective and the procedure being tested
Before deciding what to change, confirm what the drill was designed to test and what the facility’s plan said should happen. Evaluate performance against that objective, not against a vague standard such as “communication should improve.”
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Choose exercise objectives based on hazards identified in the facility’s risk assessment and establish evaluation areas before the exercise. Depending on the facility and scenario, those areas might include evacuation versus shelter-in-place decisions, accounting for people with access or functional needs, locating staff, assessing patient acuity, coordinating with local agencies, or preserving continuity-of-care information. A facility does not need to test every capability in every drill.
ASPR guidance recommends an evaluation plan and realistic scenarios that test the plan. CMS also describes emergency preparedness as an all-hazards program with risk assessment and planning, policies and procedures, a communication plan, and training and testing. See CMS Health Care Provider Guidance and ASPR TRACIE healthcare coalition exercise guidance.
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Gather evidence and perspectives while details are fresh
Use more than a debrief’s general impressions. Collect evaluator notes, participant and role-player feedback, and relevant records such as notification messages, incident-command forms, or patient-tracking documents. Invite the staff and partner organizations who took part so the report reflects how the process worked across roles and boundaries.
Hold a brief post-exercise “hot wash” soon after the drill to capture immediate successes and challenges. Then schedule a more structured AAR discussion after participants have had time to recover and the management team can prepare. ASPR’s exercise guidance discusses both evaluation planning and gathering feedback from exercise participants: ASPR TRACIE healthcare coalition exercise guidance.
Describe the gap in operational terms
For each finding, state the expected action, the observed action, and the effect on the exercise objective. Then investigate the conditions that contributed to the difference. Separate the symptom from its cause: “the receiving department did not get the transfer update” identifies a specific breakdown; “communication failed” does not explain what to fix.
Possible causes could include an outdated contact list, unclear role ownership, an unavailable communication channel, or a procedure that had not been practiced. These are possibilities to investigate, not conclusions to assume. Focus evaluation on systems, processes, and procedures rather than assigning blame to individual workers. CMS survey guidance calls for documenting expected and actual performance, strengths, improvement opportunities, and a plan with timelines. See CMS State Operations Manual, Appendix Z, Revision 186.
Write corrective actions that can be completed and verified
Each action should specify the change, the accountable person or role, a due date or milestone, and the evidence that will show whether the change was completed and effective. A useful action might be to update a notification procedure, clarify who sends a transfer update, train a particular shift, revise a contact path, address a resource dependency, or rehearse a patient-tracking step.
Prioritize actions according to potential effects on patient and staff safety, continuity of care, and the facility’s risk assessment. Also consider who controls the fix, how long it may take, whether funding or an outside partner is needed, and how a later exercise could test it.
- Risk and urgency: What could happen if the gap remains?
- Ownership and control: Can the facility act directly, or does it depend on a coalition, local agency, vendor, or other partner?
- Time and dependencies: Is this a near-term procedure or training change, or does it require staffing, resources, or funding?
- Testability: What observable result in a later exercise would demonstrate that the capability works?
- Applicability: Does the action fit the facility’s hazards, patient population, and provider-specific requirements?
Make decisions about recommendations deliberately. ASPR guidance allows recommendations to be accepted, revised, declined with a reason, or deferred when dependent on funding; document the decision and any dependencies. See ASPR TRACIE healthcare coalition exercise guidance.
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Put each action in a shared tracking process, whether that is a spreadsheet or an existing organizational system. Keep it visible until it is completed and its verification evidence has been recorded. A task marked “done” because a document was edited is not the same as a capability shown to work.
FEMA describes improvement plans as dynamic documents whose corrective actions are monitored and implemented continuously. ASPR likewise recommends assigned responsibility, priority review, and tracking through a continuing corrective-action program. See FEMA HSEEP Improvement Planning and ASPR TRACIE healthcare coalition exercise guidance.
Retest the changed capability
Use a later exercise—or an actual event, when one occurs—to check whether the change works under operational conditions. Select a test that can show the relevant result: whether staff followed the revised procedure, whether a handoff reached the intended recipient, or whether the objective was achieved.
If the test reveals that the gap remains, revise the action and continue tracking it. Feed what the retest shows into planning, training, exercises, and resource decisions. ASPR’s healthcare preparedness guidance describes exercises as a way to identify gaps, plan corrective actions, and validate changes: ASPR TRACIE healthcare coalition exercise guidance.
What an after-action report should contain
An AAR should present evidence and a usable path from findings to improvement, rather than just a narrative of the drill. Include:
- The exercise objective and the capability or procedure evaluated.
- What was expected and what actually happened.
- What went well, alongside the gaps and their effects on the objective.
- Relevant observations, feedback, and records supporting each finding.
- Corrective actions with owners, priorities, due dates or milestones, dependencies, and verification methods.
CMS lists a voluntary Health Care Provider After Action Report/Improvement Plan template and instructions. ASPR TRACIE catalogs the CMS template as a tool for documenting exercise or actual-event performance and recommending improvements. CMS cautions that its templates and checklists are general resources and do not guarantee compliance. See CMS Templates & Checklists and ASPR TRACIE: Health Care Provider After Action Report/Improvement Plan Template and Instructions.
Keep documentation aligned with current requirements
For Medicare-participating providers and suppliers, CMS describes preparedness requirements in terms of risk assessment and planning, policies and procedures, a communication plan, and training and testing. The applicable details depend on provider category, location, and accreditor; facilities should check the current requirements and interpretive guidance that apply to them.
CMS State Operations Manual, Appendix Z, Revision 186, issued March 4, 2019, says facilities should document lessons from exercises and real-life emergencies, show that necessary improvements were incorporated, and retain records for review for no less than three years. Because that is a 2019 manual revision, confirm the current record-retention rule and other requirements for your provider type rather than treating the period as a universal current rule. A template alone does not establish compliance.
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