FRAM Analysis of Successful Hospital Discharge: A Case Study on Putting Safety-II Principles into Practice

IF 3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety Pub Date : 2026-04-01 Epub Date: 2026-01-30 DOI:10.1016/j.jcjq.2026.01.006

Milou Steenbergen RN, MSc (is Nurse Researcher, Department of General Practice & Nursing Science and Department of Internal Medicine & Dermatology, University Medical Center (UMC) Utrecht, Utrecht University), Sigrid Vervoort PhD (is Assistant Professor, Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, UMC Utrecht), Lisette Schoonhoven PhD (is Professor, Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, UMC Utrecht), Bas de Vries MEd (is Senior Quality and Patient Safety Staff Advisor, UMC Utrecht), Maarten ten Berg PhD (is Researcher, Department of Clinical Chemistry and Haematology, UMC Utrecht), Debbie Vermond PhD (is Postdoctoral Researcher, Julius Center for Health Sciences and Primary Care, UMC Utrecht), Dorien Zwart MD, PhD (is Professor and General Practitioner, Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, UMC Utrecht. Please address correspondence to Milou Steenbergen)

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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成功出院的FRAM分析：以实施安全ii原则为例。

背景：功能共振分析方法（FRAM）有助于理解日常实践，并通过Safety-II方法改善医疗保健。然而，关于如何将FRAM模型的结果转化为实践的指导很少。方法：我们进行了定性案例研究，探讨FRAM如何通过将其应用于排放过程，将安全ii原则付诸实践。为此，我们基于观察、访谈和小组讨论创建了当前出院实践的FRAM模型。通过与医疗保健专业人员的小组讨论，我们探讨了FRAM如何将Safety-II的原则付诸实践。结果：我们确定了与FRAM如何将安全ii原则付诸实践有关的三个主题。首先是承认日常实践的复杂性，因为FRAM模型提高了对复杂性和所涉及的相互依赖性的认识。第二个主题是吸取经验教训，加强适应能力。基于FRAM模型，医疗保健专业人员可以确定哪些是有效的，并更好地理解其背后的原因。第三个主题是回归“发现并修复”的方法。他们没有去了解事情通常是如何顺利进行的，从而加强工作的有效性，而是主要寻求缩小想象工作和实际工作之间的差距，并强调限制可变性。结论：FRAM是提高认识和增进相互理解的有用工具。然而，FRAM需要对模型进行适度的讨论，以维持安全ii原则，以支持医疗保健专业人员在不同条件下取得成功的能力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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