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It’s time to consider national culture when designing team training initiatives in healthcare
  1. Julie Rice1,
  2. Lina Daouk-Öyry2,3,
  3. Eveline Hitti4
  1. 1Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2Olayan School of Business, American University of Beirut, Beirut, Lebanon
  3. 3Evidence-based Healthcare Management Unit, American University of Beirut, Beirut, Lebanon
  4. 4Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  1. Correspondence to Dr Julie Rice, Emergency Medicine, Johns Hopkins University, Baltimore, MD 21218, USA; jrice24{at}

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The cultivation of a workplace culture that promotes patient safety is critical to the delivery of healthcare around the world. Since the 1999 Institution of Medicine report To Err is Human there has been growing focus on healthcare safety.1 Breakdowns in communication and teamwork are often cited as root causes of preventable medical error in hospital and malpractice claims data.2

Patient safety initiatives that focus on individual and team behaviours have been shown to improve the quality and safety of healthcare.1 2 Taking cues from the aviation industry, hospital safety team training programmes aim to flatten hierarchy, promote communication clarity and emphasise a team-oriented approach to patient care.3 Given that individual behaviours and interpersonal dynamics are highly impacted by cultural context, it is no surprise growing evidence suggests important regional differences in healthcare safety culture.4–6 This is relevant given that most healthcare team training programmes were developed in the USA. While readiness assessments and stakeholder engagement are recognised as key tools to prepare for training, recommendations on adaptation to account for differences in national culture are lacking.

Our aim is to examine the role of national culture on team training programmes in healthcare. This article will focus on national culture rather than professional or organisational cultures. This paper highlights the importance of national context when creating or adapting initiatives to train healthcare teams and proposes a proactive process for programme adaptation when using pre-existing curricula.

The global reach of team training in healthcare

In 2001, the US Congress’ National Defense Authorization Act mandated that military treatment facilities implement safety focused team training.7 In response, the US Department of Defense and the Agency for Healthcare Research and Quality collaborated to create and disseminate Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) as a national standard for healthcare team training. Several …

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  • Contributors JR, EH and LDÖ all contributed to the development of content and the writing of this manuscript.

  • Funding JR reports grants from the American University of Beirut Medical Center, during the conduct of the study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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