Learn from what goes right: A demonstration of a new systematic method for identification of leading indicators in healthcare

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

doi:10.1016/j.ress.2017.08.019

Cited by 38 publications

(55 citation statements)

References 21 publications

(36 reference statements)

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“…To date, only a limited number of studies applied FRAM to evaluate healthcare processes (Buikstra, 2018;Clay-Williams et al, 2015;Damen et al, 2018;Laugaland et al, 2014;McNab et al, 2018;Raben et al, 2018;Ross et al, 2018). We believe FRAM is very useful for visualizing the complexity of healthcare processes, such as the double check.…”

Section: Discussionmentioning

confidence: 99%

“…This resilience results in adjusting to situations in practice (McNamara and Fealy, 2010). The number of studies that used FRAM in healthcare processes are limited (Buikstra, 2018;Clay-Williams et al, 2015;Damen et al, 2018;Laugaland et al, 2014;McNab et al, 2018;Raben et al, 2018;Ross et al, 2018). FRAM provides a unique opportunity to visualize complex processes.…”

Section: [Figure 1]mentioning

confidence: 99%

“…Previous studies on other proceedings have used The Functional Resonance Analysis Method (FRAM) to evaluate complex clinical processes (Damen et al, 2018;Laugaland et al, 2014;Raben et al, 2018). Protocols are often implemented with the Safety-I idea of preventing errors, whereby compliance is the outcome measure (Clay-Williams et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Double checking injectable medication administration: Does the protocol fit clinical practice?

et al. 2019

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Objectives: It is unclear how nurses adjust the double check during injectable medication administration andguarantee patient safety. We used the Functional Resonance Analysis Method (FRAM) to determine the fit betweenthe double check according to the protocol (work-as-imagined) and clinical practice (work-as-done). Weaimed to learn about process variation in order to optimize safety during injectable medication administration. Methods: A qualitative study (February-July 2018) with semi-structured group interviews. An internal medicineand a surgery ward of two Dutch hospitals participated (four wards total). We interviewed nurses about injectable medication administration practices, based on prior observations. A work-as-done model was constructedfor each hospital. The work-as-imagined model was based on the Dutch protocol for safe injectablemedication administration. Results: A total of 27 nurses were interviewed. In both hospitals, nurses split the double check into a digital andphysical check to improve workflow. The digital check was routinely conducted. For the physical check, nursesmade their own risk-impact analysis and assessed staffing, familiarity with the medication, severity of sideeffects, type of 

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Section: Discussionmentioning

confidence: 99%

Section: [Figure 1]mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Double checking injectable medication administration: Does the protocol fit clinical practice?

et al. 2019

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“…Finally, we did not weight functions in this study, rather inducing a general model of functions, synthesised as appropriate from various qualitative and quantitative data, to target intervention at those that produce variable output. This is akin to the approach of Raben et al who suggest FRAM as a method for identifying leading indicators for health care processes ( Raben et al, 2017a ). Future work might consider weighting function output probabilistically.…”

Section: Discussionmentioning

confidence: 99%

A systems approach using the functional resonance analysis method to support fluoride varnish application for children attending general dental practice

et al. 2018

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BackgroundAll children attending General Dental Practice in Scotland are recommended to receive twice-yearly applications of sodium fluoride varnish to prevent childhood caries, yet application is variable. Development of complex interventions requires theorizing and modelling to understand context. This study applies the Functional Resonance Analysis Method (FRAM) to produce a sociotechnical systems model and identify opportunities for intervention to support application.MethodsThe FRAM was used to synthesise data which were: routine monitoring of fluoride varnish application in 2015/16; a longitudinal survey with practitioners (n = 1090); in-depth practitioner and key informant interviews (n = 43); and a ‘world café’ workshop (n = 56).ResultsWe describe a detailed model of functions linked to application, and use this to make recommendations for system-wide intervention.ConclusionsRigorous research is required to produce accessible models of complex systems in healthcare. This novel paper shows how careful articulation of the functions associated with fluoride varnish application can support future improvement efforts.

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“…Hence, they provide information about adverse outcomes and sources of failure and unreliability, rather than about the extent to which a system is able to anticipate and to adapt to changes and disturbances. 30 …”

Section: Healthcare Organisations Fail To Learnmentioning

confidence: 99%

A Safety-II Perspective on Organisational Learning in Healthcare Organisations Comment on "False Dawns and New Horizons in Patient Safety Research and Practice"

Sujan

2018

Int J Health Policy Manag

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In their recent editorial Mannion and Braithwaite provide an insightful critique of traditional patient safety improvement efforts, and offer a powerful alternative vision based on Safety-II thinking that has the potential to radically transform the way we approach patient safety. In this commentary, I explore how the Safety-II perspective points to new directions for organisational learning in healthcare organisations. Current approaches to organisational learning adopted by healthcare organisations have had limited success in improving patient safety. I argue that these approaches learn about the wrong things, and in the wrong way. I conclude that organisational learning in healthcare organisations should provide deeper understanding of the adaptations healthcare workers make in their everyday clinical work, and that learning and improvement approaches should be more democratic by promoting participation and ownership among a broader range of stakeholders as well as patients.

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Learn from what goes right: A demonstration of a new systematic method for identification of leading indicators in healthcare

Cited by 38 publications

References 21 publications

Double checking injectable medication administration: Does the protocol fit clinical practice?

Double checking injectable medication administration: Does the protocol fit clinical practice?

A systems approach using the functional resonance analysis method to support fluoride varnish application for children attending general dental practice

A Safety-II Perspective on Organisational Learning in Healthcare Organisations Comment on "False Dawns and New Horizons in Patient Safety Research and Practice"

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