A collaborative project between Sweden and Kosovo with the aim to develop treatment guidelines for the ambulance services was undertaken. Firstly, relevant guidelines were identified, then translated, and processed to fit with the Kosovan ambulance service system. The next step was to train instructors in becoming proficient in training colleagues to use the guidelines. A train the trainer approach was chosen as it can be seen as grounded in Kolb's experiential learning theory and Crossan et al. organizational learning theory. Those theories describe how individuals learn and how organizations develop.

This implementation project supported training of local instructors to become proficient in training colleagues in 13 selected treatment guidelines for the ambulance services using scenario training. Initially, Kosovar instructors received directions from Swedish instructors then they observed the Swedish instructors. After this, they took more responsibility for the training. Seven Swedish instructors instructed eight Kosovar instructors for a week where about 100 Kosovan doctors and nurses were trained in patient assessment and treatment guidelines. The trainees were divided into four parallel groups of 4-5 participants with one Kosovar instructor supported by a Swedish instructor.

After the training week, eight instructors from two different ambulance service centers achieved proficiency in training colleagues in using treatment guidelines. Each Kosovar instructor was involved in 30 training occasions.

The training resulted in the involved Kosovar ambulance service centers being able to train new colleagues in providing standardized patient assessment and treatment using treatment guidelines. In addition, the trained Kosovar instructors will be able to contribute to the development of new guidelines and revision of established guidelines.

Applying a train the trainer approach, theoretically grounded in learning theories, provides a sound basis to achieve systematic change for improving patient safety. Here, the knowledge distribution among practitioners is improved in an inexpensive manner.