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

The Functional Resonance Analysis Method (FRAM) helps understand daily practice and improve healthcare through a Safety-II approach. However, little guidance is provided on how to translate the results of a FRAM model into practice.

We conducted a qualitative case study to explore how FRAM worked for putting the Safety-II principles into practice by applying it to the discharge process. For this, we created a FRAM model of current discharge practices based on observations, interviews, and group discussions. Through group discussions with healthcare professionals, we explored how FRAM works for putting the principles of Safety-II into practice.

We identified three themes relating to how FRAM works putting Safety-II principles into practice. The first is acknowledging the complexity of daily practice as a FRAM model raises awareness of the complexity and interdependencies involved. The second theme is learning from what works and strengthening adaptability. Based on the FRAM model, healthcare professionals can identify what works and gain a better understanding of the reasons behind it. The third theme is reverting to the "find and fix" approach. Rather than developing an understanding of how things usually go right to reinforce what works, they primarily sought to narrow the gap between work-as-imagined and work-as-done, and emphasize limiting variability.

We illustrate that FRAM is a useful tool for raising awareness and enhancing mutual understanding. However, FRAM requires moderated discussions on the model to maintain Safety-II principles for supporting healthcare professionals' ability to succeed under varying conditions.