Where the rubber meets the road: using FRAM to align work-as-imagined with work-as-done when implementing clinical guidelinesReportar como inadecuado




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Implementation Science

, 10:125

First Online: 29 August 2015Received: 19 December 2014Accepted: 20 August 2015DOI: 10.1186-s13012-015-0317-y

Cite this article as: Clay-Williams, R., Hounsgaard, J. & Hollnagel, E. Implementation Sci 2015 10: 125. doi:10.1186-s13012-015-0317-y

Abstract

BackgroundUptake of guidelines in healthcare can be variable. A focus on behaviour change and other strategies to improve compliance, however, has not increased implementation success. The contribution of other factors such as clinical setting and practitioner workflow to guideline utilisation has recently been recognised. In particular, differences between work-as-imagined by those who write procedures, and work-as-done—or actually enacted—in the clinical environment, can render a guideline difficult or impossible for clinicians to follow. The Functional Resonance Analysis Method FRAM can be used to model workflow in the clinical setting. The aim of this study was to investigate whether FRAM can be used to identify process elements in a draft guideline that are likely to impede implementation by conflicting with current ways of working.

MethodsDraft guidelines in two intensive care units ICU, one in Australia and one in Denmark, were modelled and analysed using FRAM. The FRAM was used to guide collaborative discussion with healthcare professionals involved in writing and implementing the guidelines and to ensure that the final instructions were compatible with other processes used in the workplace.

ResultsProcesses that would have impeded implementation were discovered early, and the guidelines were modified to maintain compatibility with current work processes. Missing process elements were also identified, thereby, avoiding the confusion that would have ensued had the guideline been introduced as originally written.

ConclusionsUsing FRAM to reconcile differences between work-as-imagined and work-as-done when implementing a guideline can reduce the need for clinicians to adjust performance and create workarounds, which may be detrimental to both safety and quality, once the guideline is introduced.

AbbreviationsFMVFRAM Model Visualiser

FRAMFunctional Resonance Analysis Method

ICUintensive care unit

WADwork-as-done

WAIwork-as-imagined

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Autor: Robyn Clay-Williams - Jeanette Hounsgaard - Erik Hollnagel

Fuente: https://link.springer.com/







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