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Evaluation of aviation-based safety team training in a hospital in The Netherlands

Dirk F. de Korne (Health Innovation, Singapore National Eye Centre, Singapore and Institute of Health Policy and Management at Erasmus University Rotterdam, Rotterdam, The Netherlands)
Jeroen D.H. van Wijngaarden (Erasmus University Rotterdam, Rotterdam, The Netherlands)
Cathy van Dyck (Department of Organizational Sciences, VU University, Amsterdam, The Netherlands)
U. Francis Hiddema (Rotterdam Eye Hospital, Rotterdam, The Netherlands)
Niek S. Klazinga (Department of Social Medicine, University of Amsterdam, Amsterdam, The Netherlands)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 11 November 2014




The purpose of this paper is to evaluate the implementation of a broad-scale team resource management (TRM) program on safety culture in a Dutch eye hospital, detailing the program’s content and procedures. Aviation-based TRM training is recognized as a useful approach to increase patient safety, but little is known about how it affects safety culture.


Pre- and post-assessments of the hospitals’ safety culture was based on interviews with ophthalmologists, anesthesiologists, residents, nurses, and support staff. Interim observations were made at training sessions and in daily hospital practice.


The program consisted of safety audits of processes and (team) activities, interactive classroom training sessions by aviation experts, a flight simulator session, and video recording of team activities with subsequent feedback. Medical professionals considered aviation experts inspiring role models and respected their non-hierarchical external perspective and focus on medical-technical issues. The post-assessment showed that ophthalmologists and other hospital staff had become increasingly aware of safety issues. The multidisciplinary approach promoted social (team) orientation that replaced the former functionally-oriented culture. The number of reported near-incidents greatly increased; the number of wrong-side surgeries stabilized to a minimum after an initial substantial reduction.

Research limitations/implications

The study was observational and the hospital’s variety of efforts to improve safety culture prevented us from establishing a causal relation between improvement and any one specific intervention.


Aviation-based TRM training can be a useful to stimulate safety culture in hospitals. Safety and quality improvements are not single treatment interventions but complex socio-technical interventions. A multidisciplinary system approach and focus on “team” instead of “profession” seems both necessary and difficult in hospital care.



F. de Korne, D., D.H. van Wijngaarden, J., van Dyck, C., Francis Hiddema, U. and S. Klazinga, N. (2014), "Evaluation of aviation-based safety team training in a hospital in The Netherlands", Journal of Health Organization and Management, Vol. 28 No. 6, pp. 731-753.



Emerald Group Publishing Limited

Copyright © 2014, Emerald Group Publishing Limited

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