Resilience plays a key role in desired outcomes of socio‐technical systems. However, the Functional Resonance Analysis Method (FRAM), which has been the main modeling tool in light of resilience engineering, does not make explicit the role of resilience. This paper addresses this gap by proposing new procedures for the development of FRAM models of desired outcomes. They are: (i) the active search for functions that display resilient performance; (ii) the assessment of the frequency at which the function output is expected to occur at the same way as it occurred in the desired outcome – frequent unwanted variabilities that occur despite desired outcomes tend to be hidden; (iii) understanding of the reasons for desired outcomes based on the analysis of the logical associations between each function, the abilities of resilient systems and guidelines for coping with complexity; and (iv) the proposal of recommendations for sustaining the observed successful performance. Two case studies of events with desired outcomes in an intensive care unit illustrate the applicability of the proposal. The proposal is expected to be useful for making systems more resilient to everyday work, in which vulnerabilities might be hidden by desired outcomes.
The COVID-19 pandemic has posed unprecedented challenges for healthcare services, which have been forced to upscale their capacity to cope with successive surges in demand. The adjustments to match capacity to demand and deal with a new disease have involved creativity and solutions that were not part of the pre-pandemic standardized operating procedures. Those changes are considered manifestations of resilience. This paper focuses on the role played by the built environment of healthcare services during the pandemic, in terms of how it is integral to resilient performance. As such, we investigated the experience of a leading private hospital in Brazil, documenting the main changes related to the built environment and how they influenced resilience. Data collection involved eight interviews with hospital staff. A content analysis allowed the development of a generic functional model of the patient journey and the identification of ten resilience practices. Based on this, six lessons learnt were devised. These lessons are expected to be useful for the design and use of the built environment, supporting the resilience of services.
Paper aims: This study demonstrates the complexity of the patient flow from admission to discharge of an adult Intensive Care Unit (ICU) through the application of the Functional Resonance Analysis Method (FRAM).Originality: This paper shows the daily functioning of the patient flow, shedding light on the high levels of interdependence and variabilities in Complex Sociotechnical Systems. Research method:The research was developed according to the four steps for FRAM analysis. Sources of evidence involved empirical data collection in a leading teaching public hospital in Brazil.Main findings: There were identified 34 functions performed mainly by caregivers and support staff. Five instantiations were described to illustrate the functional resonance scenarios caused by the variability propagation across the functions.Implications for theory and practice: Limitations of this study and suggestions for future research are pointed out. The resulting model is a basis for context understanding for ongoing and following studies.
Construction projects are exposed to a wide diversity of variabilities, which suggests the existence of a correspondent wide diversity of variability coping mechanisms, whether they are designed or not. This wide diversity is not properly accounted for by the concept of buffer, as it neglects the social and informal dimensions of coping with variability. The use of the concept of slack is proposed as an alternative. A companion IGLC 29 paper defines slack and discusses its relationships with proxy concepts such as flexibility and resilience. This paper presents nine practical examples of slack in managerial processes and topics that are of interest for the lean construction community. These examples suggest that, while slack has been concealed by the lack of theorization and consistent terminology, it is ubiquitous in lean construction. Opportunities for future studies are outlined.
Construction projects are known to be complex, due to being subject to uncertainty and variability. The use of buffers to protect them from the detrimental impact of variability has been well-researched. A key managerial choice is not whether or not to buffer variability, but rather how to define the necessary combination of buffers. Slack is a concept related to buffers but has been used in the literature to describe a broader range of strategies for coping with complexity. It allows an organisation to adapt to internal pressures for adjustment or to external pressures for change in policy. This paper aims to further develop the concept of slack and to unveil its relationships with other concepts and ideas that are partly overlapping such as buffers, resilience, robustness, flexibility, and redundancy. A concept map was devised in order to articulate the nature of the slack concept. This paper explores in detail this concept map and proposes a conceptual role for slack in the realm of Lean.
Objective: The aim of this study was to develop built environment (BE) design knowledge to support resilient healthcare by systematically reviewing the evidence-based design (EBD) literature. Background: Although the EBD literature is vast, it has not made explicit its contribution to resilient healthcare, which is a key component of the highly complex health service. Method: This review followed the steps recommended by the Preferred Reporting Items for Systematic reviews and Meta-Analyses method. After applying the inclusion and exclusion criteria, 43 journal papers were selected. The papers were analyzed in light of five guidelines for coping with complexity, allowing for the development of BE design knowledge that supports resilient healthcare. Results: The design knowledge compiled by the review was structured according to four levels of abstraction: five design-meta principles, corresponding to the five complexity guidelines, seven design principles, 21 design prescriptions, and 58 practical examples. The design knowledge emphasizes the interactions between the BE as physical infrastructure and the functions that it supports. Conclusions: The design knowledge is expected to be useful not only to architects but also to those involved in the functional design of health services as they interact with the BE. Furthermore, our proposal provides a knowledge template that can be continuously updated based on the experience of practitioners and academic research.
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