After-action Review Research Articles

An After-Action Review at Municipal Level in the Public Health Service - Lessons Learned at the Corona Unit of the Duesseldorf Public Health Authority after the end of the Covid-19 Pandemic, March 2023

After-Action Reviews (AARs) represent structured, qualitative evaluations of crisis interventions. Here, we describe the implementation of an AAR to assess the Corona Unit of the Duesseldorf Health Department. We employed an after-action review (AAR) using the working group format supplemented by structured interviews with key personnel. Our approach was guided by the guidelines for AARs provided by the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC). Participants identified nine relevant challenges with potential for improvement in three categories: (I) challenges in recruiting requested personnel, (II) overarching coordination issues, and (III) frequent relocations. Participants proposed solutions for these challenges: (I) 1. Routine cross-agency inquiries for voluntarily available personnel, 2. consideration of resources from municipal subsidiaries and involvement of personnel with leadership experience from other departments, 3. Better coordination of deployment and onboarding, 4. proposal for early communication regarding different compensation regulations, (II) 5. establishment of an overarching coordination authority for the crisis unit, 6. clearer delineation of responsibilities within the crisis unit with explicit job profiles, 7. establishment of a shared working platform, and 8. creation of a central dashboard for generating all situation reports. Additionally, they identified (III) 9. a facility for housing a crisis unit in case of an emergency. This study represents one of the first applications of an AAR for evaluating crisis structures at the level of a local Public Health Authority (LPHA) in the context of the COVID-19 pandemic. While some of the identified challenges are specific to Duesseldorf, many municipalities faced personnel recruitment and coordination challenges during the COVID-19 pandemic. Municipal crisis plans can be reviewed and adjusted concerning the identified challenges. Sharing evaluation results among LPHA stakeholders can contribute to strengthening crisis structures in the long term.

A Development of Online Problem-Based Learning Model to Promote Self-Regulated Learning among Undergraduates

This research aimed to develop and evaluate an online problem-based learning (PBL) model to enhance undergraduates' self-regulated learning (SRL). The Research and Development method was used in two phases: the first was to develop and validate the model. It began with a literature review to identify core features of effective PBL and SRL within an online environment, then set a concept framework and create the model manually. Seven experts were reviewed following the model, and it was piloted for further optimization. Second, the model will be implemented and evaluated with a sample of 52 students at Thailand National Sports University, Chumphon Campus. The main instruments used were the developed model, the model quality questionnaire, SRL assessments (pre- and post-), and after-action review forms. The results showed that (1) a developed model consisting of four sections: orientation of the model, the model of instruction, application, and student outcomes. Six core components: authentic problems, online collaborative learning, self-regulated learning, instructional scaffolding, online learning resources, and authentic assessments, which are organized through three main processes: preparation, implementation of SRL strategies, and summative assessment, and all activities using an iterative learning three stages: meeting the problem and planning, doing and checking, and presenting the result and reflecting. Experts agreed on the quality of this model, which was excellent. (M= 4.61, SD=0.52). (2) Average SRL score was significantly higher after learning with this model compared to prior us (p<0.01, large effect size; d=1.03). The findings of this study support the developed model that can improve the students' SRL effectiveness. Overall, the students agreed that an instructor plays a critical role in developing their SRL and problem-solving skills. The students demonstrated more self-assurance and were apt to use this method to learn other subjects.

The John Sealy Hospital Fire Evacuation.

Advances in fire safety and building construction have made fires in modern health care facilities uncommon and easily contained. Therefore, emergent hospital evacuations resulting from an internal fire are rare. On January 4, 2017, a fire occurred at the John Sealy Hospital, part of the University of Texas Medical Branch at Galveston, resulting in emergent evacuation of the hospital building and an adjacent office and patient care building. The internal emergency response system was quickly activated, and more than 100 patients and 200 staff members were evacuated within 27 minutes with no fire- or smoke-related injuries. Obstacles encountered during the evacuation process included difficulties with communication and confirming patient count in a timely manner. This article describes the emergent hospital evacuation during the fire, summarizes the subsequent reflections of a multiagency after-action review, and issues a call to action for further research and publication on emergency patient evacuation.

Abstract C011: The Critical Role of Developmental Evaluation in Supporting and Enhancing an Equitable Transdisciplinary Approach to Address Cancer Disparities

Abstract Background: Complex problems such as cancer disparities require deeper integration of social and scientific problem-solving and a broader systems approach. Given the nature of disparities, it also demands that we not just seek equitable outcomes but collaborate in ways that reflect equity in the process. To address breast and lung cancer disparities, we developed a unique transdisciplinary approach that creates teams inclusive of community, clinicians, and researchers and builds capacity to understand at a deep level the factors that underpin disparities and design and implement newer sustainable solutions. Methods: This study focuses on a phase I planning period for a transdisciplinary process with five teams locally embedded where lung and breast cancer disparities are significant. A leadership team that included primary investigators from academic medicine and public health supported community-based facilitators and evaluators responsible for guiding local teams. Deep equity, considerations on the biology to policy spectrum, and systems thinking are grounding principles in our approach. At the end of phase I, an evaluator facilitated After-Action Reviews (AAR) to assess effectiveness in maintaining fidelity to the framework and to identify successful practices and areas for improvement. These data informed changes to our approach to implementation to further root our commitment to equity during implementation. Seven AAR sessions were conducted: individual teams members, facilitators and evaluators, and the leaderships team (n-=50). The evaluator triangulated the data from the different AARs and facilitated a discussion of the integrated findings to the expanded leadership team. Results: The AAR highlighted three primary themes for critical self-reflection including (1) strengthening the understanding and use of our approach, (2) reducing ambiguity while preserving slack (e.g. flexibility with resources) and creativity, and (3) integrating project’s partners intentionally into our wider transdisciplinary network. In examining these themes, we identified several strategies for improving our transdisciplinary approach during implementation and for wider replication of our framework with future integrated science-social problem solving. These areas included improved systems for 360-degree communication, clear expectations of roles, and additional support for transdisciplinary collaboration and application of grounded principles to better self-organize a transdisciplinary system within a wider less resilient system like academic medicine. Discussion: To successfully innovate socially and scientifically within complexities of cancer disparities, we need to push beyond conventional models of research and program intervention. This means incorporating methods across fields and sectors including evaluation. An After-Action Review is an effective evaluation tool for assessing a complex process with numerous contributors to ensure a stronger outcome including more refined and relevant research questions and sustainability program, policy and practice. Citation Format: Tobi Cawthra, Laura Pinsoneault, Jerica Broeckling, Kristen Gardner-Volle, Tim Meister, Kailey Taebel, Jada Proctor, Felicia Fairfield, Kelly Hackett, David Frazer, Staci Young, Melinda Stolley. The Critical Role of Developmental Evaluation in Supporting and Enhancing an Equitable Transdisciplinary Approach to Address Cancer Disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C011.

Learning interventions in the WHO Eastern Mediterranean region: supporting Member States to get prepared for better response to health emergencies in the region.

The Eastern Mediterranean Region (EMR) faces numerous public health risks caused by biological, chemical, man-made, and natural hazards. This manuscript aimed to assess the multifaceted interventions and strategies used to strengthen the EMR's preparedness capacities to respond properly to current and upcoming health emergencies. To address these challenges, it is crucial to implement comprehensive and robust strategic risk assessments and health emergency preparedness frameworks. The World Health Organization (WHO) takes a risk-based approach, emphasizing the significance of all-hazards emergency management and the creation of national health risk profiles using the Strategic Toolkit for Assessing Risk (STAR). Furthermore, the International Health Regulations (IHR) Monitoring and Evaluation Framework (MEF) ensures continuous learning and capacity building among Member States, enhancing their ability to manage health emergencies effectively. Key components include State Party Annual Reporting (SPAR), Joint External Evaluation (JEE), After Action Review (AAR), Intra Action Review (IAR), and Simulation Exercises (SimEx). Moreover, initiatives like One Health, Emergency Care Systems, Safe Hospitals, and Public Health Emergency Operations Centers (PHEOCs) reinforce preparedness and response capacities. Risk communication and community engagement (RCCE) strategies play a pivotal role in disseminating timely information and fostering community resilience. Furthermore, the management of Chemical, Biological, and Radiological (CBRN) incidents remains a priority, necessitating collaboration between the public health and security sectors. This comprehensive approach aims to strengthen health systems, reduce risks, and improve emergency response capabilities throughout the EMR, thereby promoting global health security and resilience. The EMR is addressing public health challenges through frameworks like IHR-MEF, and RCCE. It is strengthening emergency care systems, ensuring safe hospitals, and establishing PHEOCs. Proactive measures to address CBRN events and collaboration are enhancing resilience. The inclusion of the One Health approach underscores the EMR's holistic strategy to address the health threats at the human-animal-environment interface. This demonstrates the EMR's commitment to global health security.

A systematic review of technology in the after-action review (or debrief)

The after-action review (AAR), also termed debrief, is a training approach that commonly encompasses some form of technology, but technology is largely a tangential consideration, which serves as the impetus for this review. Based on a systematic review of 91 empirical studies (113 AARs), a variety of nuances are identified about (1) where in the AAR technology is used, and the (2) users, (3) type, and (4) use of that technology. Technology is indeed common to AARs, but typically relegated to either aid in the task performance episode (92%) or in the provision of task feedback (52%). More broadly, the findings from the present review reflect the inherent complexity of determining how best to use technology in AARs with little extant guidance. These findings are followed by a set of six recommendations that will ideally spur greater use of technology in AARs to address longstanding issues that attenuate its effectiveness.

Reflective learning: a new leadership development framework driving engineering innovation

ABSTRACT Innovation is an organizational learning process that demands a reflexive perspective to take on uncertainties and question deeply held assumptions, propelling leadership and organizational structures forward. Discussions on the relationships between innovation and reflexivity predominantly focus on individuals rather than considering it a shared capability within an organization. This study elucidates the impact of reflexive-learning-based leadership development on promoting collective reflexivity, navigating its implications for organizational leadership and structures in innovation. A reflexive-learning-based leadership development program is a set of collective actions comprising four fundamental steps: acknowledging problems, reassessing assumptions, thinking of alternatives, and developing new perspectives. This study demonstrates its effectiveness in developing collective reflexivity within an engineering organization by repurposing the After-Action Review (AAR) as reflexive learning training. The findings underscore reflexive learning, making leaders exhibit the traits of ambiguity tolerance and interdisciplinary knowledge that favor innovation. This research contributes to an academic framework, opening avenues for future investigations into organizational development from a reflexive perspective and providing a proven managerial practice to improvise an effective solution to overcome those uncertainties in real-world innovations.

Testing the Functionality of Joint Zoonotic Disease Electronic Surveillance and Reporting Systems through a Pandemic Influenza Full-Scale Simulation Exercise in Jordan

Zoonotic disease surveillance and response simulation exercises are an important tool to assess national infrastructures and mechanisms supporting joint zoonotic disease surveillance and information sharing across sectors. In December 2022, the Jordanian Ministries of Health and Agriculture, supported by the World Health Organization Country Office, conducted a 10-day full-scale simulation exercise in Amman, Jordan, to evaluate the linkage between their electronic surveillance and response systems. An exercise management team designed a realistic fictitious scenario of an outbreak of avian influenza on a poultry farm that subsequently led to human infections. The functions and actions tested included all aspects of outbreak management, from initial reporting to conclusion. Debriefings and an after-action review were conducted after the activities were completed. Gaps in both ministries’ surveillance systems, epidemiological investigations, biosafety and biosecurity, sample collection, sample transport, laboratories, interventions, and coordination were identified. This simulation exercise was a unique exercise focusing on multiple technical and operational capacities that related to the joint response to potential zoonotic disease outbreaks and real-time information sharing between the sectors under the One Health approach. This exercise is a step towards the operationalization of the One Health approach in Jordan, building on the coordination mechanisms already in place.

After-action Review of Hospital Environments Exploring the ‘New Normal,’ Focusing on Structural Management Aspects and Bacterial Culture in Thai Hospitals Amid the COVID-19 Pandemic

OBJECTIVE This study aimed to explore the management of hospital environments during the COVID-19 pandemic, focusing on the structural aspects of ‘new normal’ health services delivery practices and bacterial culture in hospital rooms. METHODS This study employed a cross-sectional design that involved the evaluation of hospital environment management, the detection of indoor bacterial colonies in hospitals, and interviews with healthcare administrators on the ‘new normal’ measures. RESULTS The evaluation form was completed by 543 healthcare division heads from 30 hospitals. Respondents in each group reported that hospitals where they worked had effectively implemented new normal measures, making changes to the structure, processes, and personnel management components in line with the ‘new normal’ concept. The majority of the hospitals investigated, accounting for 71.7%, were found to have pathogenic bacterial counts lower than the permissible limits. The statistical analysis identified a significant association between ventilation, structural management under the ‘new normal’, and bacterial counts (p < 0.05). CONCLUSIONS The incorporation of the structural aspects of new normal practices for managing the workplace environment should be a routine and integral part of efforts to control healthcare-associated infections in hospitals. KEYWORDS hospital environment, the new normal, COVID-19, bacterial culture

IMPROVEMENT OF THE VOCATIONAL TRAINING SYSTEM MILITARY SERVANTS IN THE CONTEXT OF TRANSFORMATION SYSTEMS OF MILITARY EDUCATION

The article reveals the essence of the transformation of the military education system according to international standards. It was revealed that it should become the basis for improving the quality of training of military specialists, ensuring national interests and strengthening the country's defense capabilities. It was found that the problems of public administration in the defense sphere, the functioning of the higher education system were studied by domestic scientists, but in the context of the transformation of the military education system, the issue of improving the system of professional training of military personnel based on international standards requires consideration. Improving the system of professional training of military personnel is a complex and multifaceted process, important for ensuring the effective work of military units and the security of the country as a whole, which requires the joint efforts of military commands, scientists and specialists in the field of education. It was determined that efforts should be directed to the creation of an innovative educational environment that will contribute to the maximum disclosure of the internal capabilities of cadets, trainees and students. As a result of the professional training of servicemen, it is expected that they will develop the knowledge, skills and abilities necessary to perform combat tasks. The implementation of innovative teaching methods can be aimed at solving these problems. It was concluded that in connection with changes in the modern military sphere, the system of professional training of military personnel needs constant improvement. The main task of which is the development of military personnel necessary competencies for the effective performance of their duties. Among the areas of improvement of the professional training system, it is important to review teaching methods and introduce innovations into the education system. One of these innovative methods is the after-action review (AAR) method. It allows you to analyze and evaluate the results of military operations, identify errors and shortcomings in military training, and develop new strategies and tactics for further work.

After action review of the COVID-19 surveillance system in Quang Ninh Province, Vietnam, in 2020.

Surveillance is the backbone of any response to an infectious disease outbreak, and comprehensive evaluation of surveillance systems is crucial. However, structured evaluations of surveillance systems during the COVID-19 pandemic are scarce. We conducted an after action review (AAR) of the performance of the COVID-19 surveillance system in Quang Ninh Province, Vietnam, during 2020 using the COVID-19-specific AAR methodology developed by the World Health Organization in combination with guidance from the US Centers for Disease Control and Prevention (CDC). We conducted a stakeholder survey, document reviews, and key informant interviews with staff from Quang Ninh CDC's COVID-19 surveillance system. The COVID-19 surveillance system was based on the pre-existing surveillance system in the province. The system's strengths were early preparation for emergency response, strong governance and central coordination, and multidisciplinary collaboration. Stakeholders agreed that the system proved useful and adaptive to the fast-evolving COVID-19 situation but was weakened by overly complex systems, redundant administrative processes, unclear communication channels, and lack of resources. Overall, the surveillance systems in Quang Ninh province proved effective in containing COVID-19 and adaptive in a fast-changing epidemiological context. Several recommendations were made based on identified areas of concern that are of relevance for COVID-19 surveillance systems in Vietnam and similar settings.

An After-Action Review of the Implementation of a Statewide Respiratory Protection Program- Perspectives from Fit Test Assessors and Program Leads

An After-Action Review of the Implementation of a Statewide Respiratory Protection Program- Perspectives from Fit Test Assessors and Program Leads

Applying after-action reviews to child and family teams to improve mental health service linkage within child welfare services: a study protocol

BackgroundHalf of child-welfare-involved children and adolescents meet the criteria for at least one mental health diagnosis. This project proposes to improve successful mental health service linkage in child welfare services (CWS) by adapting and testing the after-action review (AAR) team effectiveness intervention to augment the child and family team (CFT) services’ intervention. Despite being both required and a collaborative approach to service planning, CFT meetings are implemented with questionable fidelity and consistency, rarely including the voice of children and families as intended.MethodsUsing a parallel group trial design, with non-equivalent comparison groups, and qualitative and quantitative methodology, this study will tailor and assess the impact of the AAR on enhancing CFT outcomes. The authors will conduct a qualitative needs assessment targeting the ongoing implementation of the CFT services intervention in a large, publicly funded, CWS system. A qualitative inquiry consisting of interviews and focus groups with key stakeholders will result in the preparation of an action plan to address identified gaps between the current and desired CFT services intervention outcomes. The AAR implementation strategy will be adapted and tailored to address the CFT services’ intervention needs. To test the effectiveness of the AAR on improving outcomes associated with the CFT services intervention, we will utilize blocked randomization of four CWS caseworkers from two CWS system regions to either the intervention condition (CFT + AAR) or standard implementation (CFT as usual). The authors will collect data from the CWS caseworkers and additional CFT members via web-based surveys. Mechanisms of the AAR team effectiveness intervention for CFT implementation will be assessed.DiscussionBy inclusion of child and family voice, the AAR-enhanced CFT should lead to increased fidelity to the CFT intervention and greater levels of parental satisfaction with the service and shared decision-making, thus resulting in enhanced follow-through with service plans and linkage to mental health treatment services for children. The knowledge gained by this randomized clinical trial has the potential to benefit service delivery and integration for CWS leaders, caseworkers, formal and informal CFT member support persons, parents/caregivers, and children with open cases. Improving intervention effectiveness, both at the system and family levels, is crucial for practice efficiencies and improved child and family outcomes.Trial registrationNCT05629013. Approval date: November 28, 2022 (version 1).Trial sponsorUniversity of California, San Diego.Responsible partyDanielle Fettes.

Changing Virtual Team Communication by After-action Review with Objective Data

Changing Virtual Team Communication by After-action Review with Objective Data

Changing perspectives: enhancing learning efficacy with the after-action review in virtual reality training for police

The After-Action Review (AAR) in Virtual Reality (VR) training for police provides new opportunities to enhance learning. We investigated whether perspectives (bird’s eye & police officer, bird’s eye & suspect, bird’s eye) and line of fire displayed in the AAR impacted the officers’ learning efficacy. A 3 x 2 ANOVA revealed a significant main effect of AAR perspectives. Post hoc pairwise comparisons showed that using a bird’s eye view in combination with the suspect perspective elicits significantly greater learning efficacy compared to using a bird’s eye view alone. Using the line of fire feature did not influence learning efficacy. Our findings show that the use of the suspect perspective during the AAR in VR training can support the learning efficacy of police officers. Practitioner summary: VR systems possess After-Action Review tools that provide objective performance feedback. This study found that reviewing a VR police training scenario from the bird’s eye view in combination with the suspect perspective enhanced police officers’ learning efficacy. Designing and applying the After-Action Review effectively can improve learning efficacy in VR.

The Spiritual's Post-Covid Asnaf Entrepreneurs Toward Zakat on Business

This study assesses the spiritual’s post-covid Asnaf entrepreneur’s toward zakat on business. It indicated the new insight of Asnaf entrepreneur’s spirituality after covid. After participating in the AEP, Asnaf became the zakat payer and directly will be give the positive effect to zakat collection. However, many small businesses, especially business from Asnaf entrepreneurs are financially fragile because of Covid- 19 challenges. To meet the challenges posed by the Covid-19, the Asnaf entrepreneurs had to react in agile and decisive ways by relating the spirituality toward business and able to maintain as the zakat payer soon. This involves conducting an after-action review in spiritual by lessons learned from the pandemic and enhance the business value. Therefore, in this paper, we explore the Spiritual’s Asnaf entrepreneurs toward zakat on business after facing the Covid-19. The analysis was performed to examine the reliability and validity of the measurement, and the structural equation modelling techniques (SEM). Spiritual among Asnaf entrepreneur’s toward zakat on business after Covid-19. Hence, the study provides an insight to zakat institution that the Covid-19 seek out the opportunities emerging in the recovery and stability return by move to digitalization business.
 Keywords: asnaf, entrepreneur, spiritual quotient, post covid

Videos of simulated after action reviews: a training resource to support social and inclusive learning from patient safety events

Innovation in the education and training of healthcare staff is required to support complementary approaches to learning from patient safety and everyday events in healthcare. Debriefing is a commonly used...

Framework and Thematic Analysis of Historical After Action Review Reports from the Australian Capital Territory Emergency Services Agency

Introduction:Emergency services organizations routinely undertake internal quality improvement activities following training and operational activities. One form of a quality improvement activity is the After Action Review (AAR). An AAR is a facilitator-led post-event review where data is collected from individuals and groups of individuals using either surveys, focus group-like meetings, or individual interviews. Data is collected using a semi-structured data collection tool which is usually customized to the specific tasks being reviewed and the priorities and goals of the organization. The quality of AARs has been noted to vary significantly across organizations with reporting biases and differences between exercise or real event AARs and biases introduced by utilization of internal rather than external evaluators, and limited justification for data selection and collection rationales. The Australian Capital Territory Emergency Services Agency (ACT ESA) has identified that interoperability and integration between internal ACT ESA sub-agencies and externally with other agencies is a key problem. The aim of this study was to identify specific areas of consistent interoperability concern through the examination of historical AARs.Method:In this qualitative study a Framework Analysis of historical AAR text documents was conducted, following the standard five step process. This was followed by detailed thematic analysis in aggregate and examined longitudinally, with emergent themes undergoing further analysis.Results:AARs relating to major emergency response and training activities 2016-2022 were examined. There was a substantial variation in quality, level of detail, completeness and structure across the different AAR documents. Consistent themes emerging from the data highlighted concerns regarding inter-agency culture, uncertainty when conducting joint activities and its impact on decision making, logistics concerns, resourcing and breakdown of shared understanding and communication between teams.Conclusion:Despite a centralized command structure, historical AAR analysis shows ACT ESA has had persistent operationally impacting interoperability and integration problems within the organization and with external agencies.

Lessons Learned from a Multiple Casualty Blast Incident

Introduction:On February 24, 2021, a large explosion and fire occurred in an industrial estate in Singapore. Eight casualties with major burns were conveyed to the emergency department (ED) at Singapore General Hospital, the designated regional Burns Centre. This article details the events and recommendations arising from this multiple casualty incident.Method:An After-Action Review (AAR) was conducted to examine the prehospital notification process, casualty triage & tagging, medical management, manpower and resource allocation, and command-and-control structure.Results:All eight casualties were conveyed by the national Emergency Medical Services (EMS) and arrived within a 46-minute window. The first three suffered 90% full-thickness burns and inhalational injuries and were intubated. The remaining five suffered between 37% to 64% burns, with three requiring intubations as well.Four major areas were identified for improvement:Firstly, there was scant information from EMS regarding total casualty count. There was also inadequate knowledge of mass burns triage protocols in the ED. Thus, resources were heavily utilized for the first three casualties - all of whom were later deemed unsalvageable, given palliative care and demised.Secondly, casualty identities were initially unknown. They were tagged with similar-looking ten-digit serial numbers, resulting in a near-miss event involving mislabelled blood tubes.Thirdly, there was unfamiliarity with the incident response plan for a multiple casualty incident of this scale. This contributed to lack of situational oversight and inconsistent leadership direction from various stakeholders with resulting conflicting instructions.Fourthly, routine trauma computed tomography pan-scans for all casualties caused delayed reporting by Radiology and created a bottleneck in casualty disposition.A multi-disciplinary workgroup comprising Emergency, Trauma, Burns and Intensive Care departments outlined several recommendations based on the AAR findings. Drills were strongly recommended to resume following a hiatus due to COVID-19.Conclusion:AARs help provide invaluable insights. Response plans should be refined together with relevant stakeholders.

Broken Butterfly Wings: Exploring the Role of Textile Blends in the Circular Economy for Recycling and Disassembly

In the context of a transition to a more sustainable fashion and textile industry, blended textiles (materials where two or more different resources are combined) are a major issue. These are described as “monstrous hybrids” and used to create “Frankenstein products” that are difficult to recover and recycle. The circular economy champions mono-materiality. It asks that technical and biological materials are kept in separate cycles, as shown in the Ellen MacArthur Foundation’s “butterfly model”; named because of its two wing-like sides. But in reality, materials are mixed in most of the textiles that surround us, and fully mono-material design is unrealistic in many cases. The butterfly wings are broken. This paper explores the various ways textile designers make blended textiles and acknowledges their role and creativity when providing solutions for aesthetic and technical requirements. The study draws on the first two authors’ PhD practice research that explored these issues from complementary re-active and pro-active approaches. Both carried out at the University of the Arts London, one project investigated Textile Design for Disassembly and the other Design for Recycling Knitwear. Using an after-action review approach, joint insights from both projects are presented. The paper investigates blending across three themes: hierarchy, technique and fibre type. It focuses on why these themes are relevant to designers and explores their different levels of complexity, before demonstrating how multiple perspectives are necessary to address the complex and systemic issues tied to blend recyclability. The paper concludes that blending and recovery are not mutually exclusive and that blended textiles can, with forethought, form part of the circular economy.