Hong Kong Med J 2024 Feb;30(1):80–1 | Epub 1 Feb 2024
© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
Specialised crew resource management programme for non–locally trained healthcare professionals: expediting healthcare cultural adaptation
Eric HK So, MB, BS, FHKAM (Anaesthesiology),1,2; Victor KL Cheung, MSc (OP), RegPsychol (HKPS)1; Avis SH Leung, MSSc, RN1; SS So, MSc, BBA1; Jeff LK Hung, MSc, BSSc1; Terry ML Yau, MBA, SNM3; NH Chia, MB, BS, FRCSEd (Gen)1,4; George WY Ng, MB, BS, FCICM1,5
1 Multi-Disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hong Kong SAR, China
2 Department of Anaesthesiology and Operating Theatre Services, Queen Elizabeth Hospital, Hong Kong SAR, China
3 Central Nursing Division, Kowloon Central Cluster, Hospital Authority, Hong Kong SAR, China
4 Department of Surgery, Queen Elizabeth Hospital, Hong Kong SAR, China
5 Intensive Care Unit, Queen Elizabeth Hospital, Hong Kong SAR, China
Corresponding author: Dr Eric HK So (sohke@ha.org.hk)
 Full paper in PDF
To the Editor—Healthcare delivery is one of the most complex sociotechnical processes with healthcare practitioners working under adverse and stressful conditions despite being adequately trained for medical-technical proficiency. Human factors contribute to 70% to 80% of medical incidents.1 The focus has shifted gradually from individual competence to teamwork as a prerequisite to improve patient safety.1 2
Teamwork skills training, crew resource management (CRM), has become an essential and integral part of a corporate-wide teamwork training programme in the Hong Kong Hospital Authority.1 Applying CRM can transform a team of highly specialised experts into an expert team for safe patient care, good working climate and team member satisfaction.1
In April 2023, the Hospital Authority launched its first Greater Bay Area (GBA) Healthcare Talents Visiting Programme.1 In September 2023, a Multi-Disciplinary Simulation and Skills Centre at Queen Elizabeth Hospital and the Central Nursing Division co-organised a 4-hour classroom-based interactive group sharing programme for 14 non–locally trained professionals in the Kowloon Central Cluster (Table).3 4 The elements covered in the Cluster’s CRM training include assertiveness, communication, leadership and followership (interpersonal skills), and situational awareness (cognitive skills).

Table. Curriculum of crew resource management (CRM) sharing programme for non–locally trained healthcare professionals (4 doctors, 10 nurses) from the Greater Bay Area
This pilot programme, titled ‘Sharing Activity for Non–Locally Trained Healthcare Professionals’ (深化醫療團隊協作), aimed to broaden participants’ awareness of the Hospital Authority organisational structure and training centre development and share elements of standard Kowloon Central Cluster CRM training. The objective was improved better clinical teamwork and adaptation among interdisciplinary professionals from diverse training backgrounds.1 5
We conducted an evaluation before and after this pilot programme. All items on pre- and post-questionnaires used a 5-point Likert scale (1=Strongly disagree, 2=Disagree, 3=Neutral, 4=Agree, 5=Strongly agree). Our evaluation identified a remarkable increase in understanding of the local healthcare service (score range of the results of items in this category=3.79-4.90; overall increase in knowledge from pre-test to post-test in this category=23%) and elements of CRM (score range of the results of items in this category=4.19-5; overall increase in knowledge from pre-test to post-test in this category=20%). All participants (n=14, 100%) found acquisition of CRM could improve patient safety and 93% (n=13) were confident that they could apply the principles in clinical practice. From the perspective of personal interests and clinical benefits, participants placed a high value on all content but especially ‘Concept of CRM’ (mean ± standard deviation=4.93 ± 0.27) and ‘Simulation technology applied in training and research’ (mean=5). A Self-Evaluated Behaviour Assessment (SEBA-28) addressed the overall impact of the programme on participants’ attitude towards CRM-related behaviours (+10%), in particular ‘Situational awareness’ (+14%).5 When identifying challenges in healthcare cultural adaptation, 93% of participants (n=13) were optimistic that implementing the concept of CRM would mitigate challenges regarding communication, interdisciplinary team cooperation, and cultural diversity.
The evaluation demonstrates the potential and value of a CRM programme for non–locally trained healthcare professionals. Various Hospital Authority training centres could play an important role to facilitate integration and interaction of team members from diverse training backgrounds through CRM training. Further study should be planned to fill the knowledge and research gaps and build resilient expert teams in the Hospital Authority.
Author contributions
All authors contributed to the concept or design of the letter, acquisition of data, and analysis or interpretation of data. EHK So and VKL Cheung drafted the letter. All authors critically revised the letter for important intellectual content. All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity.
Conflicts of interest
All authors have disclosed no conflicts of interest.
The authors express their gratitude to the Hospital Authority Head Office Medical Grade and the hospital management of the Kowloon Central Cluster for their support and contribution to the Crew Resource Management programme specialised for non–locally trained healthcare professionals from the Greater Bay Area.
This letter received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
1. Chan CK, So EH, Ng GW, Ma TW, Chan KK, Ho LY. Participant evaluation of simulation training using crew resource management in a hospital setting in Hong Kong. Hong Kong Med J 2016;22:131-7. Crossref
2. Hospital Authority. HASLink: strengthen exchange with Greater Bay Area. November 2022. Available from: https://www3.ha.org.hk/ehaslink/issue122/en/feature-1.html. Accessed 5 Sep 2023.
3. So EH, Chia NH, Ng GW, et al. Multidisciplinary simulation training for endotracheal intubation during COVID-19 in one Hong Kong regional hospital: strengthening of existing procedures and preparedness. BMJ Simul Technol Enhanc Learn 2021;7:501-9. Crossref
4. Cheung VK, Chia NH, So SS, Ng GW, So EH. Expanding scope of Kirkpatrick model from training effectiveness review to evidence-informed prioritization management for cricothyroidotomy simulation. Heliyon 2023;9:e18268. Crossref
5. Leung AS, So EH, Chan CN, et al. Embracing human factors in assertiveness, communication, leadership and followership, and situational awareness through O&G specific CRM classroom training. Presented at: KCC Convention; 26 November 2021; Hong Kong SAR, China.