A novel approach to explore Safety-I and Safety-II perspectives in in situ simulations—the structured what if functional resonance analysis methodology

Abstract

Objectives With ever increasingly complex healthcare settings, technology enhanced simulation (TES) is well positioned to explore all perspectives to enhance patient safety and patient outcomes. Analysis from a Safety-II stance requires identification of human adjustments in daily work that are key to maintaining safety. The aim of this paper is to describe an approach to explore the consequences of human variability from a Safety-II perspective and describe the added value of this to TES. Methods The reader is guided through a novel application of functional resonance analysis methodology (FRAM), a method to analyse how a system or activity is affected by human variability, to explore human adaptations observed in in situ simulations (ISS). The structured applicability of this novel approach to TES is described by application to empirical data from the standardised ISS management of paediatric time critical head injuries (TCHI). Results A case series is presented to illustrate the step-wise observation of key timings during ISSs, the construction of FRAM models and the visualisation of the propagation of human adaptations through the FRAM models. The key functions/actions that ensure the propagation are visible, as are the sequelae of the adaptations. Conclusions The approach as described in this paper is a first step to illuminating how to explore, analyse and observe the consequences of positive and negative human adaptations within simulated complex systems. This provides TES with a structured methodology to visualise and reflect upon both Safety-I and Safety-II perspectives to enhance patient safety and patient outcomes.

Is in situ simulation in emergency medicine safe? A scoping review

“…This definition of safety has been used in other simulation studies. [23][24][25] We selected specific criteria such as wait time, patients leaving without being seen or accident reports, which are based on literature on safety metrics in EM. 26 27 We explored two safety concepts: 'ongoing' safety of patients being managed while ISS was ongoing in the ED (measured by ISS cancellation rate, accident reports, ED median wait time, number of patients who left without being seen) and 'future patient' safety with more long-term benefits from ISS (measured by LST evaluation).…”

Functional Resonance Analysis in an Overtaking Situation in Road Traffic: Comparing the Performance Variability Mechanisms between Human and Automation

“…However, it must also be considered that drivers are usually not well trained, and such a complex function allocation could lead to confusion besides advantages. Therefore, in future research, the FRAM model for the overtaking scenario and the current design recommendations should be checked by "what-if analyses" [99,100] as various instantiations of the FRAM model in other scenarios (for example in curves or bad weather conditions) on the one hand, and on the other hand for dynamic performance changes over time, such as by Hirose et al [57]. Furthermore, it is not only the performance variability that can change but also new functions will emerge through the collaboration between humans and automation, which is why an adaptation of the FRAM model in relation to the context conditions is necessary.…”

Human error doesn't exist in isolation: it's now time for a deeper understanding of human factors in anaesthesia

“…Newer methods such as the Systems Theoretic Accident Model and Process (STAMP), AcciMAP and Functional Resonance Analysis Methodology (FRAM) look at interdependencies and interactions between components of the system. These methods are dynamic, observing how individuals might act under different circumstances and how different levels of the system such as regulatory bodies and management as well as production pressures might change the circumstances [23]. Patterns may be found that will inform future clinicians and managers as to how best adapt to the system or re‐engineer it, rather than finding a simple, convenient but ultimately unhelpful root cause.…”