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Can using the functional resonance analysis method, as an intervention, improve patient safety in hospitals?: a stepped wedge design protocol.

Dijk, L.M. van, Meulman, M.D., Eikenhorst, L. van, Merten, H., Schutijser, B.C.F.M., Wagner, C. Can using the functional resonance analysis method, as an intervention, improve patient safety in hospitals?: a stepped wedge design protocol. Health Services Research: 2021, 21, Art.nr. 1228
Background
Healthcare professionals are sometimes forced to adjust their work to varying conditions leading to discrepancies between hospital protocols and daily practice. We will examine the discrepancies between protocols, ‘Work As Imagined’ (WAI), and daily practice ‘Work As Done’ (WAD) to determine whether these adjustments are deliberate or accidental. The discrepancies between WAI and WAD can be visualised using the Functional Resonance Analysis Method (FRAM). FRAM will be applied to three patient safety themes: risk screening of the frail older patients; the administration of high-risk medication; and performing medication reconciliation at discharge.

Methods
A stepped wedge design will be used to collect data over 16 months. The FRAM intervention consists of constructing WAI and WAD models by analysing hospital protocols and interviewing healthcare professionals, and a meeting with healthcare professionals in each ward to discuss the discrepancies between WAI and WAD. Safety indicators will be collected to monitor compliance rates. Additionally, the potential differences in resilience levels among nurses before and after the FRAM intervention will be measured using the Employee Resilience Scale (EmpRes) questionnaire. Lastly, we will monitor whether gaining insight into differences between WAI and WAD has led to behavioural and organisational change.

Discussion
This article will assess whether using FRAM to reveal possible discrepancies between hospital protocols (WAI) and daily practice (WAD) will improve compliance with safety indicators and employee resilience, and whether these insights will lead to behavioural and organisational change. Trial registration: Netherlands Trial Register NL8778; https://www.trialregister.nl/trial/8778. Registered 16 July 2020. Retrospectively registered.