Embracing Pressure. A qualitative analysis of team strengthening principles in military and elite sporting domains and consideration of their applicability to healthcare teams

Background. The Crew Resource Management teamwork training model widely used in healthcare improves teamwork behaviours, but evidence of improved patient outcomes is weak. Other professions with teams displaying high performance under pressure, such as military units and sporting teams may have lessons for teamworking in healthcare. We conducted a qualitative study with trainers from these environments, to explore aspects of their approaches and beliefs which might inform an alternative model for healthcare team strengthening. Methods. We conducted and thematically analysed semi-structured interviews with 14 coaches or leaders of military and sporting teams. The findings were used to define principles for team strengthening programmes. Experienced healthcare staff and Human Factors experts reviewed these principles and identified challenges in translating them into healthcare environments. Results: We identified 6 themes and 18 sub-themes. The principles identified encompassed A. Deliberate self-development of team values by the group, their promotion by leaders and maintenance by experienced team members B. Frequent intensive realistic whole team training, and full integration of sub-teams, C. Celebration of success and encouragement of an attitude of embracing pressure D. Use of Buddying and mentoring, symbols of belonging and team social events. Important contextual issues requiring attention when adapting these principles for healthcare environments were identified. Conclusion: The approaches to creating cultures of mutual supportiveness associated with high performance under pressure in military and sports teams were very similar. Adoption of these in healthcare may be feasible, but would require significant contextual adaptation. Pilot studies would allow refinement and evaluation of potential benefits.