To Örebro University

BACKGROUND: This study outlines key aspects of professional development among health professionals in low- and middle-income countries (LMIC). LMICs need support in developing their continuing medical education, and non-technical skills (NTS) that have been neglected in this respect. Given the nature of NTS, educational methods should be used experientially. This study aims to explore an interactive educational approach to increase NTS among health care professionals in an LMIC setting.

METHODS: A design-based research approach was applied to develop an educational method. Key NTS concepts were identified, which directed the selection of research-based surveys. A series of workshops was designed in which a survey-based experiential approach was developed. The educational process followed a pattern of individual reflection, small group discussion and relating the concepts to the local practice in a wider group.

RESULTS: An approach to increase NTS in LMIC settings emerged in iterative development through conducting workshops with health care teams in the Balkans. The topics could be grouped into individual, team, and organisational dimensions. The approach can be described as survey-based experiential learning involving steps in recurring interaction with participants. The steps include identifying concepts in individual, team and organization dimensions and contextualising them using experiential learning on the individual and group levels.

CONCLUSION: An overarching approach has been developed that addresses NTS in an LMIC setting. The survey-based experiential learning approach can be beneficial for raising professional awareness and the development of sustainable healthcare settings in LMICs.

This paper emphasizes adapting frameworks for interprofessional collaboration (IPC) from high-income settings to culturally distinct, resource-constrained regions. We adapted and validated the Interprofessional Education Collaborative (IPEC) competency framework within a Balkan healthcare context facing systemic, educational, and financial challenges. Frameworks such as IPEC may not fully capture contextual nuances in lower-middle-income countries (LMICs). Therefore, we examined how the IPEC framework could be culturally adapted for healthcare workers in the Balkans. A convergent mixed-methods design was employed, involving two interprofessional workshops and a follow-up survey. Healthcare workers from Bosnia and Herzegovina, Montenegro, and Kosovo participated in reflective discussions and prioritized competencies from the original 38-item IPEC instrument. The adapted instrument (IPEC-21B) was evaluated for psychometric reliability and contextual relevance and proved to be both valid and practical due to its shorter format. The instrument measured attitudes toward IPC and encouraged critical dialogue about hierarchy, communication, and shared roles, positioning it as both an assessment tool and a catalyst for professional learning. The results demonstrate how an adapted survey on IPC foster systemic thinking and professional development provides a tool for increased awareness. By retaining all core IPEC domains, IPEC-21B provides a tool for increasing awareness and developing interprofessional competencies in a way that aligns with local cultural and educational needs in settings with limited traditions of interprofessional practice. Tailoring an IPC instrument to local contexts enhances healthcare workers’ understanding of collaboration and may improve patient outcomes and care equity. The participatory adaptation process emphasizes embedding dialogue and shared understanding into interprofessional education and assessment in LMICs.

BACKGROUND: Leadership is widely recognized as essential for fostering collaborative healthcare teams and improving patient outcomes. However, there is limited research on how leadership supports the development of nonclinical skills in healthcare settings in many low- and middle-income countries, including those in the Balkan region. This study addresses that gap by examining how leadership roles and practices enhance non-technical skills (NTSs)-such as communication, teamwork, and role clarity-among healthcare workers in the Balkans while also considering sustainable development, organizational values, cultural influences, and social dynamics.

METHODS: A qualitative approach was employed, drawing on data collected from three workshops conducted between 2018 and 2022 in university hospital clinics in Bosnia and Herzegovina, Kosovo, and Montenegro. Data sources included observations of group discussions, focus groups, and semi-structured interviews with healthcare leaders. Reflexive thematic analysis was used to identify patterns and develop key themes.

RESULTS: Four key themes emerged regarding the role of leadership in the development of NTSs: (1) defining roles and responsibilities, (2) fostering communication and teamwork, (3) promoting readiness for change, and (4) developing leadership competencies. The participants noted that clear role definitions enhanced team coordination, inclusive communication reduced misunderstandings, supportive leadership eased resistance to change, and mentorship served as a valuable mechanism for leadership development.

CONCLUSION: Leadership plays a key role in strengthening NTSs in Balkan healthcare contexts by promoting communication and teamwork within culturally and hierarchically complex environments. Role clarity, open dialogue, and shared accountability emerged as key factors for effective team performance and patient safety. These findings highlight the need for leadership development and the implementation of formal training initiatives-such as structured mentorship programs-to foster collaborative and resilient healthcare systems in low- and middle-income countries.