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https://prod.org.br/article/doi/10.1590/0103-6513.20220081
Production
Research Article

A functional perspective for Intensive Care Unit modelling

Natália Ransolin; Priscila Wachs; Wagner Pietrobelli Bueno

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Abstract

Paper aims: This study demonstrates the complexity of the patient flow from admission to discharge of an adult Intensive Care Unit (ICU) through the application of the Functional Resonance Analysis Method (FRAM).

Originality: This paper shows the daily functioning of the patient flow, shedding light on the high levels of interdependence and variabilities in Complex Sociotechnical Systems.

Research method: The research was developed according to the four steps for FRAM analysis. Sources of evidence involved empirical data collection in a leading teaching public hospital in Brazil.

Main findings: There were identified 34 functions performed mainly by caregivers and support staff. Five instantiations were described to illustrate the functional resonance scenarios caused by the variability propagation across the functions.

Implications for theory and practice: Limitations of this study and suggestions for future research are pointed out. The resulting model is a basis for context understanding for ongoing and following studies.

Keywords

Complexity, Healthcare, Services, Resilience, FRAM

References

Alm, H., & Woltjer, R. (2010). Patient safety investigation through the lens of FRAM. In D. Waard, A. Axelsson, M. Berglund, B. Peters & C. Weikert (Eds.), Human factors: a system view of human, technology and organisation (pp. 153-165). Maastricht: Shaker Publishing.

Arcuri, R., Bellas, H. C., Ferreira, D. S., Bulhões, B., Vidal, M. C. R., Carvalho, P. V. R., Jatobá, A., & Hollnagel, E. (2022). On the brink of disruption: applying Resilience Engineering to anticipate system performance under crisis. Applied Ergonomics, 99, 103632. http://dx.doi.org/10.1016/j.apergo.2021.103632. PMid:34740073.

Braithwaite, J., Churruca, K., Long, J. C., Ellis, L. A., & Herkes, J. (2018). When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC Medicine, 16(1), 63. http://dx.doi.org/10.1186/s12916-018-1057-z. PMid:29706132.

Brasil, Agência Nacional de Vigilância Sanitária - ANVISA. (2010, February 25). Dispõe sobre os requisitos mínimos para funcionamento de Unidades de Terapia Intensiva e dá outras providências (Resolução de Diretoria Colegiada - RDC nº 7, de 24 de fevereiro de 2010). Diário Oficial da República Federativa do Brasil.

Carey, G., Malbon, E., Carey, N., Joyce, A., Crammond, B., & Carey, A. (2015). Systems science and systems thinking for public health: a systematic review of the field. BMJ Open, 5(12), e009002. http://dx.doi.org/10.1136/bmjopen-2015-009002. PMid:26719314.

Carvalho, P. V. R., Righi, A. W., Huber, G. J., Lemos, C. D. F., Jatoba, A., & Gomes, J. O. (2018). Reflections on work as done (WAD) and work as imagined (WAI) in an emergency response organization: a study on firefighters training exercises. Applied Ergonomics, 68, 28-41. http://dx.doi.org/10.1016/j.apergo.2017.10.016. PMid:29409645.

Clay-Williams, R., Hounsgaard, J., & Hollnagel, E. (2015). Where the rubber meets the road: using FRAM to align work-as-imagined with work-as-done when implementing clinical guidelines. Implementation Science : IS, 10(1), 125. http://dx.doi.org/10.1186/s13012-015-0317-y. PMid:26319404.

Clegg, C. (2000). Sociotechnical principles for system design. Applied Ergonomics, 31(5), 463-477. http://dx.doi.org/10.1016/S0003-6870(00)00009-0.

Crandall, B., Klein, G. A., & Hoffman, R. R. (2006). Working minds: a practitioner’s guide to cognitive task analysis. Cambridge: MIT Press. http://dx.doi.org/10.7551/mitpress/7304.001.0001.

Dekker, S. (2003). Failure to adapt or adaptations that fail: contrasting models on procedures and safety. Applied Ergonomics, 34(3), 233-238. http://dx.doi.org/10.1016/S0003-6870(03)00031-0. PMid:12737923.

Dekker, S. (2006). Resilience engineering: chronicling the emergence of confused consensus. In J. Pariès, E. Hollnagel, D. Woods & J. Wreathall (Eds.), Resilience engineering (pp. 77-92). Boca Raton: CRC Press.

Dekker, S. (2011). Systems Thinking 1.0 and systems Thinking 2.0: complexity science and a new conception of “cause”. Aviation in Focus-Journal of Aeronautical Sciences, 2(2), 21-39.

Eisenhardt, K. (1989). Building theories from case study research. Academy of Management Review, 14(4), 532-550. http://dx.doi.org/10.2307/258557.

Faculty of Intensive Care Medicine - FICM. (2015). Guidelines for Provision of Intensive Care Services (GPICS). London: Faculty of Intensive Care Medicine, Intensive Care Society Royal.

Furniss, D., Nelson, D., Habli, I., White, S., Elliott, M., Reynolds, N., & Sujan, M. (2020). Using FRAM to explore sources of performance variability in intravenous infusion administration in ICU: A non-normative approach to systems contradictions. Applied Ergonomics, 86, 103113. http://dx.doi.org/10.1016/j.apergo.2020.103113. PMid:32342897.

Hollnagel, E. (2012). FRAM: the functional resonance analysis method: modelling complex socio-technical systems. Boca Raton: CRC Press.

Hollnagel, E., & Goteman, O. (2004). The functional resonance accident model. Proceedings of Cognitive System Engineering in Process Plant, 2004, 155-161.

Hollnagel, E., Braithwaite, J., & Wears, R. (2013). Resilient health care. Burlington: Ashgate.

Hollnagel, E., Hounsgaard, J., & Colligan, L. (2014). FRAM - the Functional Resonance Analysis Method: a handbook for the practical use of the method. Denmark: Centre for Quality.

Hounsgaard, J. (2016). Patient safety in everyday work: learning from things that go right (Doctoral dissertation). Syddansk Universitet, Denmark.

Kaya, G. K., Ovali, H. F., & Ozturk, F. (2019). Using the functional resonance analysis method on the drug administration process to assess performance variability. Safety Science, 118, 835-840. http://dx.doi.org/10.1016/j.ssci.2019.06.020.

Mabry, P. L., Olster, D. H., Morgan, G. D., & Abrams, D. P. (2008). Interdisciplinarity and systems science to improve population health: a view from the NIH Office of Behavioral and Social Sciences Research. American Journal of Preventive Medicine, 35(2, Suppl.), S211-S224. http://dx.doi.org/10.1016/j.amepre.2008.05.018. PMid:18619402.

Malhotra, S., Jordan, D., Shortliffe, E., & Patel, V. L. (2007). Workflow modeling in critical care: piecing together your own puzzle. Journal of Biomedical Informatics, 40(2), 81-92. http://dx.doi.org/10.1016/j.jbi.2006.06.002. PMid:16899412.

McNab, D., Freestone, J., Black, C., Carson-Stevens, A., & Bowie, P. (2018). Participatory design of an improvement intervention for the primary care management of possible sepsis using the Functional Resonance Analysis Method. BMC Medicine, 16(1), 174. http://dx.doi.org/10.1186/s12916-018-1164-x. PMid:30305088.

Patriarca, R., Di Gravio, G., Woltjer, R., Costantino, F., Praetorius, G., Ferreira, P., & Hollnagel, E. (2020). Framing the FRAM: a literature review on the functional resonance analysis method. Safety Science, 129, 104827. http://dx.doi.org/10.1016/j.ssci.2020.104827.

Pickup, L., Lang, A., Atkinson, S., & Sharples, S. (2018). The dichotomy of the application of a systems approach in UK healthcare the challenges and priorities for implementation. Ergonomics, 61(1), 15-25. http://dx.doi.org/10.1080/00140139.2017.1306632. PMid:28306384.

Ransolin, N., Saurin, T. A., & Formoso, C. T. (2020). Integrated modelling of built environment and functional requirements: Implications for resilience. Applied Ergonomics, 88, 103154. http://dx.doi.org/10.1016/j.apergo.2020.103154. PMid:32678774.

Rennke, S., Nguyen, O. K., Shoeb, M. H., Magan, Y., Wachter, R. M., & Ranji, S. R. (2013). Hospital-initiated transitional care interventions as a patient safety strategy: a systematic review. Annals of Internal Medicine, 158(5 Pt 2), 433-440. http://dx.doi.org/10.7326/0003-4819-158-5-201303051-00011. PMid:23460101.

Riccardo, P., Gianluca, D. P., Giulio, D. G., & Francesco, C. (2018). FRAM for systemic accident analysis: a matrix representation of functional resonance. International Journal of Reliability Quality and Safety Engineering, 25(1), 1850001. http://dx.doi.org/10.1142/S0218539318500018.

Righi, A. W., & Saurin, T. A. (2015). Complex socio-technical systems: Characterization and management guidelines. Applied Ergonomics, 50, 19-30. http://dx.doi.org/10.1016/j.apergo.2015.02.003. PMid:25959314.

Salehi, V., Hanson, N., Smith, D., McCloskey, R., Jarrett, P., & Veitch, B. (2021a). Modeling and analyzing hospital to home transition processes of frail older adults using the functional resonance analysis method (FRAM). Applied Ergonomics, 93, 103392. http://dx.doi.org/10.1016/j.apergo.2021.103392. PMid:33639319.

Salehi, V., Smith, D., Veitch, B., & Hanson, N. (2021b). A dynamic version of the FRAM for capturing variability in complex operations. MethodsX, 8, 101333. http://dx.doi.org/10.1016/j.mex.2021.101333. PMid:34430239.

Saurin, T. A., Rooke, J., & Koskela, L. (2013). A complex systems theory perspective of lean production. International Journal of Production Research, 51(19), 5824-5838. http://dx.doi.org/10.1080/00207543.2013.796420.

Slater, D., Hollnagel, E., MacKinnon, R., Sujan, M., Carson-Stevens, A., Ross, A., & Bowie, P. (2022). A systems analysis of the COVID-19 pandemic response in the United Kingdom-Part 1-The overall context. Safety Science, 146, 105525. http://dx.doi.org/10.1016/j.ssci.2021.105525. PMid:34658531.

Sujan, M., Bilbro, N., Ross, A., Earl, L., Ibrahim, M., Bond-Smith, G., Ghaferi, A., Pickup, L., & McCulloch, P. (2022). Failure to rescue following emergency surgery: a FRAM analysis of the management of the deteriorating patient. Applied Ergonomics, 98, 103608. http://dx.doi.org/10.1016/j.apergo.2021.103608. PMid:34655965.

van Dijk, L. M., van Eikenhorst, L., & Wagner, C. (2022). Daily practice performance (Work-as-Done) compared to guidelines (Work-as-Imagined) of medication reconciliation at discharge: outcomes of a FRAM study. Safety Science, 155, 105871. http://dx.doi.org/10.1016/j.ssci.2022.105871.

Vicente, K. J. (1999). Cognitive work analysis: toward safe, productive, and healthy computer-based work. Boca Raton: CRC Press.. http://dx.doi.org/10.1201/b12457.

Wachs, P., & Saurin, T. A. (2018). Modelling interactions between procedures and resilience skills. Applied Ergonomics, 68, 328-337. http://dx.doi.org/10.1016/j.apergo.2017.12.013. PMid:29409652.

Wong, P., Liamputtong, P., Koch, S., & Rawson, H. (2015). Families’ experiences of their interactions with staff in an Australian intensive care unit (ICU): a qualitative study. Intensive & Critical Care Nursing, 31(1), 51-63. http://dx.doi.org/10.1016/j.iccn.2014.06.005. PMid:25245202.

Woods, D. D. (2006). Essential characteristics of resilience. In J. Pariès, E. Hollnagel, D. Woods & J. Wreathall (Eds.), Resilience engineering (pp. 21-34). Boca Raton: CRC Press.
 


Submitted date:
06/15/2022

Accepted date:
02/22/2023

641498cfa95395403f10fe72 production Articles
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