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Aligning work-as-imagined and work-as-done using FRAM on a hospital ward: a roadmap

INTRODUCTION: Modern safety approaches in healthcare differentiate between daily practice (work-as-done) and the written rules and guidelines (work-as-imagined) as a means to further develop patient safety. Research in this area has shown case study examples, but to date lacks hooking points as to h...

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Autores principales: Tresfon, Jaco, Brunsveld-Reinders, Anja H, van Valkenburg, David, Langeveld, Kirsten, Hamming, Jaap
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9535208/
https://www.ncbi.nlm.nih.gov/pubmed/36192037
http://dx.doi.org/10.1136/bmjoq-2022-001992
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author Tresfon, Jaco
Brunsveld-Reinders, Anja H
van Valkenburg, David
Langeveld, Kirsten
Hamming, Jaap
author_facet Tresfon, Jaco
Brunsveld-Reinders, Anja H
van Valkenburg, David
Langeveld, Kirsten
Hamming, Jaap
author_sort Tresfon, Jaco
collection PubMed
description INTRODUCTION: Modern safety approaches in healthcare differentiate between daily practice (work-as-done) and the written rules and guidelines (work-as-imagined) as a means to further develop patient safety. Research in this area has shown case study examples, but to date lacks hooking points as to how results can be embedded within the studied context. This study uses Functional Analysis Resonance Method (FRAM) for aligning work-as-imagined with the work-as-done. The aim of this study is to show how FRAM can effectively be applied to identify the gap between work prescriptions and practice, while subsequently showing how such findings can be transferred back to, and embedded in, the daily ward care process of nurses. METHODS: This study was part of an action research performed among ward nurses on a 38 bed neurological and neurosurgical ward within a tertiary referral centre. Data was collected through document analysis, in-field observations, interviews and group discussions. FRAM was used as an analysis tool to model the prescribed working methods, actual practice and the gap between those two in the use of physical restraints on the ward. RESULTS: This study was conducted in four parts. In the exploration phase, work-as-imagined and work-as-done were mapped. Next, a gap between the concerns named in the protocol and the actual employed methods of dealing with physical restraint on the ward was identified. Subsequently, alignment efforts led to the co-construction of a new working method with the ward nurses, which was later embedded in quality efforts by a restraint working group on the ward. CONCLUSION: The use of FRAM proved to be very effective in comparing work-as-done with work-as-imagined, contributing to a better understanding, evaluation and support of everyday performance in a ward care setting.
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spelling pubmed-95352082022-10-07 Aligning work-as-imagined and work-as-done using FRAM on a hospital ward: a roadmap Tresfon, Jaco Brunsveld-Reinders, Anja H van Valkenburg, David Langeveld, Kirsten Hamming, Jaap BMJ Open Qual Original Research INTRODUCTION: Modern safety approaches in healthcare differentiate between daily practice (work-as-done) and the written rules and guidelines (work-as-imagined) as a means to further develop patient safety. Research in this area has shown case study examples, but to date lacks hooking points as to how results can be embedded within the studied context. This study uses Functional Analysis Resonance Method (FRAM) for aligning work-as-imagined with the work-as-done. The aim of this study is to show how FRAM can effectively be applied to identify the gap between work prescriptions and practice, while subsequently showing how such findings can be transferred back to, and embedded in, the daily ward care process of nurses. METHODS: This study was part of an action research performed among ward nurses on a 38 bed neurological and neurosurgical ward within a tertiary referral centre. Data was collected through document analysis, in-field observations, interviews and group discussions. FRAM was used as an analysis tool to model the prescribed working methods, actual practice and the gap between those two in the use of physical restraints on the ward. RESULTS: This study was conducted in four parts. In the exploration phase, work-as-imagined and work-as-done were mapped. Next, a gap between the concerns named in the protocol and the actual employed methods of dealing with physical restraint on the ward was identified. Subsequently, alignment efforts led to the co-construction of a new working method with the ward nurses, which was later embedded in quality efforts by a restraint working group on the ward. CONCLUSION: The use of FRAM proved to be very effective in comparing work-as-done with work-as-imagined, contributing to a better understanding, evaluation and support of everyday performance in a ward care setting. BMJ Publishing Group 2022-10-03 /pmc/articles/PMC9535208/ /pubmed/36192037 http://dx.doi.org/10.1136/bmjoq-2022-001992 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Tresfon, Jaco
Brunsveld-Reinders, Anja H
van Valkenburg, David
Langeveld, Kirsten
Hamming, Jaap
Aligning work-as-imagined and work-as-done using FRAM on a hospital ward: a roadmap
title Aligning work-as-imagined and work-as-done using FRAM on a hospital ward: a roadmap
title_full Aligning work-as-imagined and work-as-done using FRAM on a hospital ward: a roadmap
title_fullStr Aligning work-as-imagined and work-as-done using FRAM on a hospital ward: a roadmap
title_full_unstemmed Aligning work-as-imagined and work-as-done using FRAM on a hospital ward: a roadmap
title_short Aligning work-as-imagined and work-as-done using FRAM on a hospital ward: a roadmap
title_sort aligning work-as-imagined and work-as-done using fram on a hospital ward: a roadmap
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9535208/
https://www.ncbi.nlm.nih.gov/pubmed/36192037
http://dx.doi.org/10.1136/bmjoq-2022-001992
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