Abstract
This chapter elaborates on experiences with the Functional Resonance Analysis Method (FRAM) in various hospital settings. FRAM is a useful Safety-II tool to visualise a process in everyday practice that is well received and understood by health care professionals. The method allows identification of functions that are important in daily work, which can be used to inform feasible and practical improvement initiatives. FRAM can be used for various purposes such as process optimisation, incident investigations, development and interpretation of guidelines or interventions, and prospective risk management. Visual models of Work-as-Imagined and Work-as-Done can be used to assess how to reconcile the two, in dialogue with involved professionals. The models help reveal where professionals are muddling through with purpose, for example, due to unclear or impractical task division. In addition, FRAM helps to identify workarounds, personal aids, and naturally developed control mechanisms. The workload was found to be comparable to those of traditional methods such as root-cause analysis. Because the same themes and muddling behaviours appeared in all our FRAMs so far, we suggest a practical framework to structure the interpretation of the models, looking at task division and role clarity, multidisciplinary collaboration, efficiency and guidance and support.
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