Methods for scaling simulation-based teamwork training

Effective teamwork and communication is now recognised as a critical component of safe and high-quality patient care. Researchers, policymakers and frontline providers are in search of strategies to improve teamwork in healthcare. The most frequently used strategy is teamwork training.1 Teamwork training involves a systematic process in which a team is guided (often by facilitators) to improve and master different skills for working together effectively. Single-centre teamwork training initiatives have demonstrated improvements in patient care, but these results have been challenging to reproduce at scale.2 In this issue of BMJ Quality and Safety, Lenguerrand et al report the results of a stepped-wedge randomised controlled trial in which PRactical Obstetric Multi-Professional Training (PROMPT), an interprofessional intrapartum training package, was implemented across 12 maternity units in Scotland.3 Each participating unit identified an in-house training team to travel to attend a 2-day PROMPT Train the Trainers programme conducted in one simulation centre; two units were unable to send training teams. Training teams were subsequently responsible for coordinating the delivery of in-house PROMPT courses to all maternity staff within 12 months. The courses were intended to cover core obstetrical emergencies, such as postpartum haemorrhage, sepsis, shoulder dystocia, teamwork and fetal monitoring. In addition to clinical outcomes, each maternity unit collected process data about their local PROMPT courses, including the total number of staff trained and courses delivered and the actual course content. The authors found a significant amount of variability in the implementation across units. For example, all courses included elements of teamwork whereas fetal monitoring and shoulder dystocia training were not universally included. Despite the previously demonstrated benefits of PROMPT in single-centre studies, the final results did not demonstrate a reduction of term babies with a low Apgar score. The authors postulate this null finding may be in part related …