Exploring sustainable Crew Resource Management (CRM) training and tools in pediatric hospital care: a multi-method approach

Abstract Background This study deals with the long-term sustainability of Crew Resource Management (CRM) practices in pediatric hospital care, focusing on facilitators and barriers to the adoption and maintenance of these practices. The primary research question explored how CRM practices evolve and are sustained across departments with different levels of CRM experience. Methods A multi-method qualitative study was conducted in three departments of a tertiary children’s hospital, namely the pediatric intensive care unit and two intermediate care units, with respectively 17-, 5-, and 6-years’ experience with CRM. Data were collected from 44 participants through focus groups ( n = 20), observations, and interviews ( n = 24). Themes emerging from the data analysis were structured using the Consolidated Framework for Sustainability Constructs in Healthcare. Results CRM practices evolved differently across departments, shaped by contextual factors. Sustainability was facilitated by strong leadership support, tailored implementation, team ownership, and active feedback mechanisms. Key barriers included unclear procedures, lack of formal follow-up agreements and uneven psychological safety. These could be mitigated by department-specific adaptations and continuous reinforcement of CRM principles in daily practice. Conclusion CRM practices are sustained when tailored to the specific needs and dynamics of each department, supported by engaged leadership at all levels, and embedded through structured follow-up strategies. Addressing local barriers and strengthening shared responsibility among team members are essential to the long-term success of CRM. Future research should assess the impact of leadership models and tailored strategies on CRM sustainability.