Application of a non-linear model to understand healthcare processes: using the functional resonance analysis method on a case study of the early detection of sepsis

Raben, Ditte Caroline; Viskum, B; Mikkelsen, Kim Lyngby; Hounsgaard, Jeanette; Bogh, Søren Bie; Hollnagel, Erik

doi:10.1016/j.ress.2018.04.023

Cited by 47 publications

(61 citation statements)

References 18 publications

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“…in the Vessel Traffic Service system [78] and in the Air Traffic Management System which has been used to analyse a mid-air collision over the Amazon [79]. Various studies included in this systematic review used FRAM to develop models that were essential in understanding system functions, performance and variability [49,50,51,54,55,64]. Consistent with the literature [80], this systematic review found that it is imperative to combine FRAM models with quantitative data to quantify functions and measure outputs of functions in order to assess distributions of variability.…”

Section: Discussionmentioning

confidence: 99%

“…The methods used to study RHC varied in the studies: fifteen were qualitative [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55], and five used mixed methods [34][35][36][37]40]. The methods used in the studies published in books, however, were mainly qualitative [56][57][58][59][60][61][62][63][64][65][66][67][68][69] except two studies that used mixed methods [38,39].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Studies reported in peer-reviewed journals were mostly conducted in developed countries: the United Kingdom [36,41,43,45,47,54], the United States of America [34,44,52,53], Finland [46], Australia [40,49,51], Denmark [49][50][51]55], Norway [48] and Israel [37]. Two studies were conducted in developing countries: Brazil [42,52] and South Africa [35].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The Resilience Markers Framework (RMF) was used to uncover resilience strategies used by anaesthetists, and to allow participants to reflect on their work demands and to contrast routine and non-routine aspects [61]. Different studies used the FRAM method to differentiate between WAI and WAD and to develop context-specific models in different clinical settings such as a preoperative anticoagulation management [51], blood sampling [50,54], clinical guidelines implementation [49] early detection of sepsis [55] and a Medical Department's daily variations and adjustments [64].…”

Section: Tools For Studying Rhcmentioning

confidence: 99%

“…Raben DC, et al 2018 (Denmark) [55] N/A Investigate how complex processes pr positive outcomes despite variability i detection of sepsis using FRAM.…”

mentioning

confidence: 99%

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Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

Iflaifel

Lim

Ryan

et al. 2020

Preprint

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Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC is conceptualised, described and interpreted in the published literature, to describe the methods used to study RHC, and to identify factors that develop RHC.Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search undertaken for studies published in books that explained how RHC as a concept has been interpreted, what methods have been used to study it, and what factors have been important to its development. Studies were evaluated independently by two researchers. Data was synthesised using a thematic approach.Results Thirty-six studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods were mainly used to study RHC. Two types of data sources have been used: direct (e.g. focus groups and surveys) and indirect (e.g. observations and simulations) data sources. Most of the tools for studying RHC were developed based on predefined resilient constructs and have been categorised into three categories: performance variability and Work As Done, cornerstone capabilities for resilience, and integration with other safety management paradigms. Tools for studying RHC currently exist but have yet to be fully implemented. Effective team relationships, trade-offs and health care ‘resilience’ training of health care professionals were factors used to develop RHC. Conclusions Although there was consistency in the conceptualisation of RHC, methods used to study and the factors used to develop it, several questions remain to be answered before a gold standard strategy for studying RHC can confidently be identified. These include operationalising RHC assessment methods in multi-level and diverse settings and developing, testing and evaluating interventions to address the wider safety implications of RHC amidst organisational and institutional change.

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Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Tools For Studying Rhcmentioning

confidence: 99%

“…Raben DC, et al 2018 (Denmark) [55] N/A Investigate how complex processes pr positive outcomes despite variability i detection of sepsis using FRAM.…”

mentioning

confidence: 99%

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Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

Iflaifel

Lim

Ryan

et al. 2020

Preprint

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Modeling complex socio‐technical systems using the FRAM: A literature review

Salehi

Veitch

Smith

2020

Hum Ftrs & Erg Mfg Svc

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This is a review paper of studies that have employed the functional resonance analysis method (FRAM). FRAM is a relatively new systemic method for modeling and analyzing complex socio-technical systems. This review aims to address the following research questions: (a) Why is FRAM used? (b) To what domains has FRAM been applied? (c) What are the appropriate data collection approaches in practice? (d) What are the deficiencies of FRAM? A review of 52 FRAM-related studies published between 2010 and 2020 revealed that FRAM-based models can be used as a basis for improving safety management, accident/incident investigation, hazard identification/risk management, and complexity management in complex socio-technical systems. The outcomes also showed that healthcare was the most common domain that employed FRAM (31% of the investigated studies). The results of exploring data collection methods indicated a mixed method (interview, focus group, observation) was employed in 52% of the analyzed studies, and the accident investigation report was the most popular approach in aviation-related studies. An investigation of the deficiencies of the FRAM showed that it should be upgraded by exploiting supplementary methods to enhance its analytical and computational capacity to help risk analysts and safety managers in complex socio-technical systems. K E Y W O R D S accident investigation, complex socio-technical systems, complexity management, functional resonance analysis method (FRAM), hazard identification, safety management 1 | INTRODUCTION 1.1 | Background Complex socio-technical systems consist of some subsystems and subactivities linked in known or unknown ways (Hollnagel, 2012a, 2012b). Examples of socio-technical systems include healthcare, aviation, manufacturing, power industry, and automotive (Soliman & Saurin, 2017). They are inherently complex, nonlinear, uncertain, and dynamic (Jensen & Aven, 2018). Complex relationships between humans and their environments, including technologies and organizations, show that safety is not a linear and straightforward process in such systems (Grant et al., 2018). In the Safety-I perspective, the focus is on reducing adverse outcomes, such as accidents, incidents, and near misses (Hollnagel, 2018). The core idea of the established techniques for analyzing risks and accidents in the Safety-I approach is based on event chains: unexpected outcomes and potential accidents cannot be anticipated by considering event chains or possible

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Making resilience explicit in FRAM: Shedding light on desired outcomes

Bueno

Wachs

Saurin

et al. 2021

Hum Ftrs & Erg Mfg Svc

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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.

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Application of a non-linear model to understand healthcare processes: using the functional resonance analysis method on a case study of the early detection of sepsis

Cited by 47 publications

References 18 publications

Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

Modeling complex socio‐technical systems using the FRAM: A literature review

Making resilience explicit in FRAM: Shedding light on desired outcomes

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