Action Plans After Incidents: How to Implement, Track and Evidence Improvement

February 5, 2026

Many providers can describe what action they took after an incident, but fewer can evidence that the action worked. Strong learning, incidents and continuous improvement relies on action plans that translate learning into day-to-day practice changes. Robust governance and leadership ensures actions are owned, tracked and tested for effectiveness, with clear assurance for commissioners and CQC that risks are being controlled.

This article sets out how to build post-incident action plans that are practical, measurable and defensible — not just lists of intentions.

Why action plans fail in real services

Action plans typically fail for predictable reasons:

Actions are generic (“remind staff”, “review policy”) and don’t change practice
Ownership is unclear, especially across multiple services
Timescales are missing or unrealistic
There is no measure of success, so impact cannot be shown
Actions are “closed” without assurance checks

A strong action plan is a mini-control framework: it specifies what will change, who will make it happen, and how leaders will confirm it has reduced risk.

Building blocks of a defensible action plan

Each action should include:

Problem statement: what risk or failure is being addressed
Action: what will change in practice, process or oversight
Owner: named accountable person (not a team or “service”)
Deadline: a realistic completion date
Evidence of completion: what proof will be retained
Effectiveness test: how the provider will check it worked

Operational example 1: Post-fall action plan strengthens routine controls

Context: A series of falls occur during bathing routines in a care home.

Support approach: The service develops an action plan that changes both practice and oversight.

Day-to-day delivery detail: Actions include revising bathing risk assessments with clear mobility prompts, implementing a “two staff for transfers” rule for identified residents, and adjusting rotas so a senior is always available during peak personal care periods. The plan assigns the deputy manager to monitor compliance via daily spot checks for two weeks, then weekly for six weeks.

How effectiveness or change is evidenced: Spot check logs demonstrate compliance, falls reduce in that routine window, and the action tracker shows the rota change was implemented and reviewed at governance.

Linking actions to training, supervision and competency

Actions that rely on staff behaviour change should rarely be “training only”. They should also include:

Competency reassessment (observation, checks, sign-off)
Supervision prompts (what supervisors will test and reinforce)
Clear escalation rules (when staff must seek guidance)

This is particularly important where incidents relate to restrictive practices, safeguarding, medication or moving and handling.

Operational example 2: Safeguarding action plan improves supervision and culture

Context: A safeguarding concern is raised regarding disrespectful language and rushed support.

Support approach: The provider focuses on supervision quality and leadership visibility.

Day-to-day delivery detail: Actions include a structured dignity-in-care observation tool, weekly unannounced manager walkarounds for a month, and supervision sessions that explicitly test staff understanding of respectful communication and professional boundaries. The manager also introduces a feedback loop so staff can report routine pressures that lead to rushed care (for example, short staffing or unrealistic scheduling).

How effectiveness or change is evidenced: Observation scores improve, supervision notes demonstrate consistent messaging, and staff feedback logs show reduced pressure points after rota adjustments.

Operational example 3: Medication action plan introduces targeted assurance

Context: Medication incidents occur across multiple domiciliary care runs.

Support approach: The action plan combines targeted training, improved auditing and better communication tools.

Day-to-day delivery detail: Actions include refresher training for staff involved, competency checks for all medication staff over eight weeks, and a revised audit programme that samples high-risk medicines weekly. The provider introduces a simple escalation prompt in the care notes so staff must record when they have queried a medicine or packaging change and who they contacted.

How effectiveness or change is evidenced: Audit results show improved compliance, incident rates fall, and the provider can evidence learning through governance reporting and competency logs.

Tracking delivery: the action tracker as a governance tool

The action tracker should be reviewed routinely, with clear status updates and evidence references (for example, “rota revised – evidence: published rota week commencing X; impact: reduced incidents”). Where actions slip, the tracker should capture:

Reason for delay
Interim risk controls
Revised completion date

This prevents “paper closure” and demonstrates responsible leadership.

Commissioner expectation

Commissioner expectation: Commissioners expect action plans to reduce repeat harm and improve outcomes. They look for clear accountability, timely completion and evidence that actions have been tested for effectiveness rather than simply completed.

Regulator / Inspector expectation

Regulator / Inspector expectation (CQC): CQC expects providers to learn and improve. Inspectors test whether action plans address underlying issues, whether leaders monitor impact, and whether improvements are sustained over time.

Proving impact: what to measure

Effectiveness measures should be proportionate and meaningful. Common measures include repeat incident reduction, improved audit compliance, improved supervision completion, better care plan quality, or reduced restrictive practice use. The key is to select measures that reflect the actual risk the action plan is trying to control and to document results over time.