Making resilience explicit in FRAM: Shedding light on desired outcomes

Abstract

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.

Coping with complexity in the COVID pandemic: An exploratory study of intensive care units

“…Table 1 presents the five guidelines for coping with complexity that have been adopted as a basis for this study. Earlier studies of these guidelines in health care (Bueno et al, 2019 , 2021 ; Mahmoud et al, 2021 ; Righi & Saurin, 2015 ; Saurin et al, 2018 ) addressed the micro (e.g., clinical care at the bedside) and meso levels (e.g., hospital or hospital unit), even though results were not explicitly categorized according to those levels. The macro level, which is concerned with regulations and networks of health services at the regional and national level (Berg et al, 2018 ), was not focused on by the previous studies.…”

Modeling of adult patient falls and the repercussions to Nursing as a second victim

“…In contexts like these, Resilience Engineering seeks improvements that may imply in the final result and uses process modeling to emphasize safety and understand the prescribed work (that previously determined, sequence of actions described in protocols) and the real work (the actions effectively performed, in interaction between people and with the environment) (4)(5)(6) .…”

“…The Functional Resonance Analysis Method (FRAM) was proposed from the perspective of Resilience Engineering and is used for modeling CSS (4)(5)(6) . FRAM presents, visually, its functions and the interaction between them, thus evidencing the complexity with the different elements that interact in a non-linear way (4,6) . FRAM considers, as a function, what needs to be performed to achieve a certain goal or process under analysis.…”

Modelagem de quedas de pacientes adultos e as repercussões à Enfermagem como segunda vítima

“…A implantação de protocolos e a reformulação de processos de trabalho para tratar e prevenir as quedas são um desafio dentro de hospitais, ambientes dinâmicos, considerados Sistemas Sociotécnicos Complexos (SSC) (3) . Em contextos como estes, a Engenharia de Resiliência busca melhorias que possam implicar no resultado final e utiliza a modelagem de processo para enfatizar a segurança e compreender o trabalho prescrito (aquele determinado previamente, sequência de ações descritas em protocolos) e o trabalho real (as ações efetivamente realizadas, em interação entre as pessoas e com o ambiente) (4)(5)(6) .…”

“…O Functional Resonance Analysis Method (FRAM) foi proposto sob a ótica da Engenharia de Resiliência e é utilizado para a modelagem de SSC (4)(5)(6) . O FRAM apresenta, visualmente, suas funções e a interação entre as mesmas, evidenciando, assim, a complexidade com os diferentes elementos que interagem de forma não linear (4,6) . O FRAM considera, como função, o que precisa ser realizado para atingir determinado objetivo ou processo em análise.…”