Using FRAM to Study Organisational Resilience in Care for the Dependent Older Person in Scotland

Ross, A. , Selveindran, S. and Anderson, J.E. (2019) Using FRAM to Study Organisational Resilience in Care for the Dependent Older Person in Scotland. 13th International Workshop on the Functional Resonance Analysis Method (FRAM), Malaga, Spain, 27-29 May 2019.

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Background: Care of the dependent older person is difficult due to residents’ complex needs, and multiple competing tasks and priorities for care home staff. [1] This paper reports on a two-year study in the UK based on Resilient Health Care principles which set out to a) examine how Care Home organisations flexibly adapt to variable conditions to achieve successful outcomes, and b) identify opportunities for intervention to improve health and wellbeing. Methods: A comparative case study method was employed, with 12 Care Home sites being purposively recruited to ensure a range of provision. Procedures included: 36 hrs of broad and targeted observations; examination of protocol and care planning documents; 46 semi- structured interviews with residents/families and staff at all levels; three focus groups with service providers and regulators (n= 15); workshop with stakeholders (n= 40). Analysis: An adapted Work Domain Analysis [2] was used initially to identify key functions and supporting activities in different domains of care such as medications, personal care, safety, social activity, oral care, and diet/nutrition. The Functional Resonance Analysis Method (FRAM; [3]) was then employed to look at interactions within and across these broad domains. Results: Co-ordination of care is complex and challenging, with multiple time and resource pressures. Key functions include providing and maintaining standards, exchanging information, anticipating risks, balancing and prioritising options, and monitoring and re-evaluating care. Instantiation shows the resilient potential of technical innovation via electronic care documenting and planning. Conclusions: FRAM provided a contextual framework for how different domains of work interact, identifying areas of strength and/or vulnerability that can be targeted in future interventions.

Item Type:Conference or Workshop Item
Glasgow Author(s) Enlighten ID:Selveindran, Dr Santhani and Ross, Dr Alastair
Authors: Ross, A., Selveindran, S., and Anderson, J.E.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
705781Improving Systems of Care for the Older PErson (I-SCOPE)Alastair RossDunhill Medical Trust (DUNHILLM)R462/0216SM - DENTAL SCHOOL