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.