The Functional Resonance Analysis Method as a health care research methodology: a scoping review

Abstract

Objective:The objective of this review was to examine and map the literature on the use of the Functional Resonance Analysis Method (FRAM) in health care research.Introduction:The FRAM is a resilient health care tool tat offers an approach to deconstruct complex systems by mapping health care processes to identify essential activities, how they are interrelated, and the variability that emerges, which can strengthen or compromise outcomes. Insight into how the FRAM has been operationalized in health care can help researchers and policy-makers understand how this method can be used to strengthen health care systems.Inclusion criteria:This scoping review included research and narrative reports on the application of the FRAM in any health care setting. The focus was to identify the key concepts and definitions used to describe the FRAM; the research questions, aims, and objectives used to study the FRAM; the methods used to operationalize the FRAM; the health care processes examined; and the key findings.Methods:A three-step search strategy was used to find published and unpublished research and narrative reports conducted in any country. Only papers published in English were considered. No limits were placed on the year of publication. CINAHL, MEDLINE, Embase, PsycINFO, Inspec Engineering Village, ProQuest Nursing & Allied Health were searched originally in June 2020 and again in March 2021. A search of the gray literature was also completed in March 2021. Data were extracted from papers by two independent reviewers using a data extraction tool developed by the reviewers. Search results are summarized in a flow diagram, and the extracted data are presented in tabular format.Results:Thirty-one papers were included in the final review, and most (n = 25; 80.6%) provided a description or definition of the FRAM. Only two (n = 2; 6.5%) identified a specific research question. The remaining papers each identified an overall aim or objective in applying the FRAM, the most common being to understand a health care process (n = 20; 64.5%). Eleven different methods of data collection were identified, with interviews being the most common (n = 21; 67.7%). Ten different health care processes were explored, with safety and risk identification (n = 8; 25.8%) being the most examined process. Key findings identified the FRAM as a mapping tool that can identify essential activities or functions of a process (n = 20; 64.5%), how functions are interdependent or coupled (n = 18; 58.1%), the variability that can emerge within a process (n = 20; 64.5%), discrepancies between work as done and work as imagined (n = 20; 64.5%), the resiliency that exists within a process (n = 12; 38.7%), and the points of risk within a process (n = 10, 32.3%). Most papers (n = 27; 87.1%) developed models representing the complexity of a process.Conclusions:The FRAM aims to use a systems approach to examine complex processes and, as evidenced by this review, is suited for use within the health care domain. Interest in the FRAM is growing, with most of ...

Establishing Trustworthiness in Health Care Process Modelling: A Practical Guide to Quality Enhancement in Studies Using the Functional Resonance Analysis Method

“…Studies using the FRAM to examine and analyze healthcare processes are becoming increasingly prevalent (McGill et al, 2022). Designing and conducting a trustworthy study using the FRAM begins with developing a sound understanding of the method itself, as well as how to plan and gather qualitative data while simultaneously threading quality enhancement strategies throughout all phases of the research process.…”

Learning from errors and resilience

“…It has been used with the aim to reconcile work as imagined and work as done, identify resilient behaviors, improve patient safety efforts, and identify and manage performance variability [34 ▪▪ ].…”

Building a Functional Resonance Analysis Method Model: Practical Guidance on Qualitative Data Collection and Analysis

“…The methodology has been used to map, model, and analyze complex processes and systems in a number of domains, such as aviation, maritime transport, industry, and healthcare (Salehi, Veitch, et al, 2021). The FRAM has emerged more recently as healthcare research methodology that is gaining recognition with most studies being published since 2017 (McGill et al, 2022). In a review of the FRAM literature in 2021–2022, there have been an additional seventeen healthcare related publications featuring the FRAM ((Bos et al, 2022; Buikstra et al, 2021; Damen & de Vos, 2021; Gustafson et al, 2021; Hedqvist et al, 2022; Jatobá et al, 2022; MacKinnon et al, 2021; Schreurs et al, 2021; Slater, 2022; Slater et al, 2022; Sujan, 2021; Sujan et al, 2022; Thude et al, 2021; Tresfon et al, 2022; van Dijk et al, 2021; van Dijk et al, 2022; Watson et al, 2022).…”

“…The graphical depictions can be built, edited, and shared using specialized FRAM software (Hollnagel & Hill, 2020). The visualization of how a healthcare process can be carried outwith a FRAM model is a strength of the methodology as it allows clinicians and administrators to see all the potential ways a process can take place and to gain an appreciation the complexity that exists which may otherwise be invisible (McGill et al, 2022).…”