Participatory design of an improvement intervention for the primary care management of possible sepsis using the Functional Resonance Analysis Method
department or school: Medicine, Faculty of
department or school: Non UBC
department or school: Family Practice, Department of
data provider: DSpace
identifier citation: BMC Medicine. 2018 Oct 11;16(1):174
rights copyright: The Author(s).
creator: McNab, Duncan
creator: Freestone, John
creator: Black, Chris
creator: Carson-Stevens, Andrew
creator: Bowie, Paul
issued: 2018-10-16T16:20:43Z
issued: 2018-10-11
description: Background: Ensuring effective identification and management of sepsis is a healthcare priority in many countries. Recommendations for sepsis management in primary care have been produced, but in complex healthcare systems, an in-depth understanding of current system interactions and functioning is often essential before improvement interventions can be successfully designed and implemented. A structured participatory design approach to model a primary care system was employed to hypothesise gaps between work as intended and work delivered to inform improvement and implementation priorities for sepsis management. Methods: In a Scottish regional health authority, multiple stakeholders were interviewed and the records of patients admitted from primary care to hospital with possible sepsis analysed. This identified the key work functions required to manage these patients successfully, the influence of system conditions (such as resource availability) and the resulting variability of function output. This information was used to model the system using the Functional Resonance Analysis Method (FRAM). The multiple stakeholder interviews also explored perspectives on system improvement needs which were subsequently themed. The FRAM model directed an expert group to reconcile improvement suggestions with current work systems and design an intervention to improve clinical management of sepsis. Results: Fourteen key system functions were identified, and a FRAM model was created. Variability was found in the output of all functions. The overall system purpose and improvement priorities were agreed. Improvement interventions were reconciled with the FRAM model of current work to understand how best to implement change, and a multi-component improvement intervention was designed. Conclusions: Traditional improvement approaches often focus on individual performance or a specific care process, rather than seeking to understand and improve overall performance in a complex system. T…
aggregated CHO: https://circle.library.ubc.ca/rest/handle/2429/67584
note: RESEARCH ARTICLE Open AccessParticipatory design of an improvementintervention for the primary caremanagement of possible sepsis using theFunctional Resonance Analysis MethodDuncan McNab1,2,3* , John Freestone2, Chris Black1,2, Andrew Carson-Stevens4,5,6 and Paul Bowie1,3AbstractBackground: Ensuring effective identification and management of sepsis is a healthcare priority in many countries.Recommendations for sepsis management in primary care have been produced, but in complex healthcare systems,an in-depth understanding of current system interactions and functioning is often essential before improvementinterventions can be successfully designed and implemented. A structured participatory design approach to modela primary care system was employed to hypothesise gaps between work as intended and work delivered to informimprovement and implementation priorities for sepsis management.Methods: In a Scottish regional health authority, multiple stakeholders were interviewed and the records of patientsadmitted from primary care to hospital with possible sepsis analysed. This identified the key work functions required tomanage these patients successfully, the influence of system conditions (such as resource availability) and the resultingvariability of function output. This information was used to model the system using the Functional Resonance AnalysisMethod (FRAM). The multiple stakeholder interviews also explored perspectives on system improvement needs whichwere subsequently themed. The FRAM model directed an expert group to reconcile improvement suggestions withcurrent work systems and design an intervention to improve clinical management of sepsis.Results: Fourteen key system functions were identified, and a FRAM model was created. Variability was found in theoutput of all functions. The overall system purpose and improvement priorities were agreed. Improvement interventionswere reconciled with the FRAM model of current work to understand how best to implement change…
has type: Article
is shown at: 10.14288/1.0372824
language: eng
peer review status: Reviewed
provider: Vancouver : University of British Columbia Library
publisher: BioMed Central
publisher DOI: 10.1186/s12916-018-1164-x
rights: Attribution 4.0 International (CC BY 4.0)
rights URI: http://creativecommons.org/licenses/by/4.0/
scholar level: Faculty
subject: Quality improvement
subject: Complexity
subject: Functional resonance analysis method
subject: Sepsis
subject: Primary care
type: Text
identifier URI: http://hdl.handle.net/2429/67584