FRAM is an analysis method that looks at tasks, known as functions, and their connectivity and dependence on each other which are called aspects. The aspects within FRAM that are used to connect the functions and demonstrate the dependencies are inputs, outputs, preconditions, controls, time and resources.
FRAM uses
FRAM is used in many different safety industries to look at systems, processes and specific tasks to see how they work, or don’t work. The beauty of FRAM is in its versatility and ability to be used proactively or reactively depending on your requirements.
Procedure/policy proofing (proactive)
New procedures are often implemented, followed for a period of time for testing, then adjusted. During the testing phase it is noted where the procedure might be improved, what’s gone wrong with it and then it is rewritten. The cycle continues until you, hopefully, have a process that works with successful outcomes. With FRAM you can plot out the procedure as a tabletop exercise and identify where there are weaknesses or ‘stressed’ functions that are likely to fail. You can identify functions with high loading, or if they have certain resources or dependencies missing for example. It has the ability to identify learning and improvement before rolling out the procedure for the testing phase.
Simulation (proactive/reactive)
FRAM is used reactively within simulations to view how things happened during an incident and how simulations may want to be run. It allows you to see how timings have worked and impacted on events, when certain aspects have been missing and the impact they had on the outcome of an event. You can also use it proactively to simulate procedures in a similar manner to procedure proofing, only updating the FRAM in real time as the procedure is conducted in the simulation.
Incident investigation (reactive)
Investigations can look at processes in a number of ways using FRAM, comparing ‘work as done’ vs ‘work as prescribed’. The result highlights adaptations or workarounds to the written procedure. It’s an effective way of analysing the system that is in place and being able to see how workarounds have been employed and whether they make the system more or less efficient, effective and safe.
Investigation analysis
When using FRAM during investigation analysis it’s really important to remember who you are doing the FRAM for. The model is used with a specific purpose that is limited by the scope of the investigation and the functions that are relevant to the incident. Therefore, functions and aspects are added where relevant and impacting on the event being investigated, which is where the skill of the investigator comes in, asking and identifying ‘when enough is enough?’
HSSIB has used FRAM on several investigations to great effect to identify inefficiencies in process that have impacted on incidents. An example of this was in the ‘Management of chronic health conditions in prisons’ investigation, where a constant loop cycle was identified that was a result of IT systems from different departments that did not talk to each other and staff were not provided with key information.
FRAM was used during the ‘Caring for adults with a learning disability in acute hospitals’ investigation and is also being used in the ‘Healthcare provision in prisons’ investigations and has identified high stress functions putting staff under huge pressure.
One of the best things about FRAM is that it takes you away from the individual staff working in the system and makes you focus on the system itself and identifying the weaknesses in that system. This really helps the investigator make meaningful systemic change.
FRAM visualiser
Making FRAM easier to use and helping people to understand how you have come to your conclusion and recommendations is key, and to help with this there is a visualiser tool. The tool allows you to create the functions and add the aspects. It then connects the functions to each other as you add the information in. Below is an example of the constant loop cycle, from one of our investigation reports:
Useful information
Healthcare organisations may want to consider FRAM as they develop their incident investigation capability as well as using it for its proactive benefits of policy development. More information can be found on the FRAM website, including the free to download FRAM visualiser.
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