FRAM Analysis of Successful Hospital Discharge: A Case Study on Putting Safety-II Principles into Practice

Area of Science:

• Healthcare quality improvement
• Patient safety research
• Systems thinking in healthcare

Background:

• The Functional Resonance Analysis Method (FRAM) is a tool for understanding daily healthcare practices and enhancing safety through a Safety-II approach.
• Limited guidance exists on translating FRAM model results into practical healthcare improvements.

Purpose of the Study:

• To explore the practical application of FRAM in implementing Safety-II principles within the healthcare discharge process.
• To investigate how FRAM facilitates the integration of Safety-II concepts into clinical workflows.

Main Methods:

• A qualitative case study was conducted, focusing on the hospital discharge process.
• A FRAM model was developed using observations, interviews, and group discussions of current discharge practices.
• Group discussions with healthcare professionals explored the practical utility of FRAM for Safety-II implementation.

Main Results:

• Awareness of daily practice complexity and interdependencies is increased by FRAM models.
• FRAM facilitates learning from successful practices and enhances healthcare adaptability.
• A tendency to revert to a "find and fix" approach, focusing on reducing the gap between imagined and actual work, was observed.

Conclusions:

• FRAM effectively raises awareness and improves mutual understanding among healthcare professionals.
• Sustaining Safety-II principles requires moderated discussions around FRAM models to support professionals in variable conditions.