Keeping the spirit high: why trauma team training is (sometimes) implemented

Background: Systematic and multiprofessional trauma team training using simulation was introduced in Norway in 1997. The concept was developed out of necessity in two district general hospitals and one university hospital but gradually spread to 45 of Norway's 50 acute-care hospitals over the next decade. Implementation in the hospitals has varied from being a single training experience to becoming a regular training and part of quality improvement. The aim of this study was to better understand why only some hospitals achieved implementation of regular trauma team training, despite the intentions of all hospitals to do so. Methods: Focus group interviews were conducted with multiprofessional respondents in seven hospitals, including small and large hospitals and hospitals with and without regular team training. Interviews were transcribed and analyzed using a Grounded Theory approach. Results: 'Keeping the spirit high' appeared to be the way to achieve implementation. This was achieved through 'enthusiasm,' 'strategies and alliances,' and 'using spin-offs.' It seems that the combination of enthusiasts, managerial support, and strategic planning are key factors for professionals trying to implement new activities. Conclusions: Committed health professionals planning to implement new methods for training and preparedness in hospitals should have one or more enthusiasts, secure support at the administrative level, and plan the implementation taking all stakeholders into consideration.