Better & systematic trauma care (BEST) in Norway: from a local quality improvement project to a national collaborative.

purposeHealthcare professionals in Norwegian local hospitals have focused on the need for improved trauma care since the late 1990s. Because of lack of national guidelines the hospital management of patients with serious trauma varied. The authors and colleague health care providers felt a need for improvement. Therefore, a project called Better & Systematic Trauma care (BEST) was established. The goal was to improve trauma care through training and preparation for infrequently occurring situations, with a focus on the team.

methodsThe project began as a bottom-up initiative in four local hospitals. Through cross-professional team training and local simulation, staff built competence in trauma care and practised non-technical skills such as communication, cooperation, leadership, and decision-making in their local setting. Creating a national meeting place for all hospitals was essential for fostering collaboration across institutions.

resultsA 1-day team course was developed and adopted nationwide. Network meetings have enabled the collaborative development of tools and training materials without national strategic leadership or external influence. Over time, the focus shifted from individual professions to the trauma team. A damage-control surgery course was created for all surgical teams. All materials remained freely available, and the project operated independently of the government, organisations, or industry.

conclusionThe BEST Project showed that local bottom-up initiatives can effectively improve clinical care. Facilitating professional interaction based on local needs is essential. The project also illustrates how a small, locally driven quality improvement effort can be scaled nationwide.