Learning by Visualize a Nurse-Led CCOS Using the Functional Resonance Analysis Method

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op 't Hoog, Sabine Adriana Johanna Josepha
van Mersbergen-de Bruin, Mariƫlle
Damen, Nikki Laurina Mathilda
Chaboyer, Wendy
Weggelaar-Jansen, Anne Marie
Eskes, Anne M
Vloet, Lilian Christina Maria
Vermeulen, Hester
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2024
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OBJECTIVES: Quality improvements (QIs) in dynamic and complex health care contexts require resilience and take variability into account in quality improvement. The Functional Resonance Analysis Method (FRAM) helps us understand resilience and gain insight into (un)desirable variability in the complex system of daily practice. We explored how using FRAM in the Deming cycle of a QI project can help professionals and researchers learn from, reflect upon, and improve complex processes. We used FRAM in a Dutch hospital to study a QI: Critical Care Outreach Service (CCOS). METHODS: The aim was to use FRAM before and after implementation to create a FRAM model and reflect to health care professionals the mismatch between Work As Imagined (WAI) and Work As Done (WAD). The WAI FRAM model was co-created with professionals before the implementation of CCOS. We used descriptions of tasks and processes for ICU nurses and verified them in 30-minute semistructured interviews (N = 2). WAD was created by input of semistructured interviews with key professionals in CCOS (N = 21) and 3 nonparticipant observations of trained CCOS nurses. We validated WAD in 2 dialogue sessions with key professionals (N = 11). Data collection continued until saturation. RESULTS: Juxtaposing the WAI and WAD models showed that WAD contained additional functions and highlighted unexpectedly complex functions. Reflecting on the application of FRAM with health care professionals revealed opportunities and challenges, especially time investment. CONCLUSIONS: FRAM helps professionals outline processes and tasks (WAI), learn from, and reflect upon their daily practice (WAD). FRAM models help professionals identify variability proactively to improve practices that enhance resilient performance.

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Journal of Patient Safety

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Ā© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons CC BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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This publication has been entered in Griffith Research Online as an advance online version.

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Nursing

Health policy

Health services and systems

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Op 't Hoog, SAJJ; van Mersbergen-de Bruin, M; Damen, NLM; Chaboyer, W; Weggelaar-Jansen, AM; Eskes, AM; Vloet, LCM; Vermeulen, H, Learning by Visualize a Nurse-Led CCOS Using the Functional Resonance Analysis Method, Journal of Patient Safety, 2024

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