Modeling and analyzing hospital to home transition processes of frail older adults using the functional resonance analysis method (FRAM)

Vahid Salehi; Natasha Hanson; Doug Smith; Rose McCloskey; Pamela Jarrett; Brian Veitch

doi:10.1016/j.apergo.2021.103392

Modeling and analyzing hospital to home transition processes of frail older adults using the functional resonance analysis method (FRAM)

Vahid Salehi, Natasha Hanson, Doug Smith, Rose McCloskey, Pamela Jarrett, Brian Veitch

Research output: Contribution to journal › Article › peer-review

31 Citations (Scopus)

Abstract

The main purpose of this study was to model and analyze hospital to home transition processes of frail older adults in order to identify the challenges within this process. A multi-phase, multi-sited and mixed methods design was utilized, in which, Phase 1 included collecting semi-structured interviews and focus group data, and Phase 2 consisted of six patient/caregiver dyad prospective case studies. This study was conducted in three hospitals in three cities in a single province in Canada. The Functional Resonance Analysis Method (FRAM) was employed to model daily operations of the transition process. The perspectives of both healthcare providers and patients/caregivers were used to build the FRAM model. The transition model was then tested using a customized version of the FRAM. The six patient/caregiver cases were used in the process of testing the FRAM model. The results of building the FRAM model showed that five categories of functions contributed to the transition model, including admission, assessment, synthesis, decision-making, and readmission. The outcomes of using the customized version of the FRAM revealed challenges affecting the transition process including waitlists for geriatric units, team-based care, lack of a discharge planner, financial concerns, and follow-up plans. The findings of this study could assist managers and other decision makers to improve the transition processes of frail older adults by addressing these challenges. The FRAM method employed in this study can be applied widely to identify work practices that are more or less successful, so that procedures and practices can be adapted to nudge healthcare processes towards paths that will yield better outcomes.

Original language	English
Article number	103392
Journal	Applied Ergonomics
Volume	93
DOIs	https://doi.org/10.1016/j.apergo.2021.103392
Publication status	Published - May 2021
Externally published	Yes

Bibliographical note

Funding Information:
Funding for the research study was provided through the Canadian Frailty Network (CFN) 2018 Catalyst Grant, with matching funds from the New Brunswick Health Research Foundation (NBHRF) , Canada. We would like to acknowledge the other research team members who helped formulate the larger research project, which this is a part of: Dr. Patrick Feltmate, Dr. Jason MacDonald, Beth Harris, Dr. Linda Yetman, Samantha Fowler, Dr. Chris A. McGibbon, and Dr. Erik Scheme, Emily Kervin and Leanne Skerry. As well, we would like to acknowledge Sherry Gionet, Caitlin Robertson, Karen Totton, Danika DesRoches, Whitney Tucker, Michelle Thibodeau, and Chloe Jardine who helped to collect the research data. We would also like to thank the participants for making this research possible. The first, third, and last authors acknowledge with gratitude the financial support of the NSERC-Husky Energy Industrial Research Chair, Canada.

Publisher Copyright:
© 2021 The Author(s)

ASJC Scopus Subject Areas

Human Factors and Ergonomics
Physical Therapy, Sports Therapy and Rehabilitation
Safety, Risk, Reliability and Quality
Engineering (miscellaneous)

PubMed: MeSH publication types

Journal Article

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10.1016/j.apergo.2021.103392

Cite this

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title = "Modeling and analyzing hospital to home transition processes of frail older adults using the functional resonance analysis method (FRAM)",

abstract = "The main purpose of this study was to model and analyze hospital to home transition processes of frail older adults in order to identify the challenges within this process. A multi-phase, multi-sited and mixed methods design was utilized, in which, Phase 1 included collecting semi-structured interviews and focus group data, and Phase 2 consisted of six patient/caregiver dyad prospective case studies. This study was conducted in three hospitals in three cities in a single province in Canada. The Functional Resonance Analysis Method (FRAM) was employed to model daily operations of the transition process. The perspectives of both healthcare providers and patients/caregivers were used to build the FRAM model. The transition model was then tested using a customized version of the FRAM. The six patient/caregiver cases were used in the process of testing the FRAM model. The results of building the FRAM model showed that five categories of functions contributed to the transition model, including admission, assessment, synthesis, decision-making, and readmission. The outcomes of using the customized version of the FRAM revealed challenges affecting the transition process including waitlists for geriatric units, team-based care, lack of a discharge planner, financial concerns, and follow-up plans. The findings of this study could assist managers and other decision makers to improve the transition processes of frail older adults by addressing these challenges. The FRAM method employed in this study can be applied widely to identify work practices that are more or less successful, so that procedures and practices can be adapted to nudge healthcare processes towards paths that will yield better outcomes.",

author = "Vahid Salehi and Natasha Hanson and Doug Smith and Rose McCloskey and Pamela Jarrett and Brian Veitch",

note = "Funding Information: Funding for the research study was provided through the Canadian Frailty Network (CFN) 2018 Catalyst Grant, with matching funds from the New Brunswick Health Research Foundation (NBHRF) , Canada. We would like to acknowledge the other research team members who helped formulate the larger research project, which this is a part of: Dr. Patrick Feltmate, Dr. Jason MacDonald, Beth Harris, Dr. Linda Yetman, Samantha Fowler, Dr. Chris A. McGibbon, and Dr. Erik Scheme, Emily Kervin and Leanne Skerry. As well, we would like to acknowledge Sherry Gionet, Caitlin Robertson, Karen Totton, Danika DesRoches, Whitney Tucker, Michelle Thibodeau, and Chloe Jardine who helped to collect the research data. We would also like to thank the participants for making this research possible. The first, third, and last authors acknowledge with gratitude the financial support of the NSERC-Husky Energy Industrial Research Chair, Canada. Publisher Copyright: {\textcopyright} 2021 The Author(s)",

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doi = "10.1016/j.apergo.2021.103392",

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AU - Hanson, Natasha

AU - Smith, Doug

AU - McCloskey, Rose

AU - Jarrett, Pamela

AU - Veitch, Brian

N1 - Funding Information: Funding for the research study was provided through the Canadian Frailty Network (CFN) 2018 Catalyst Grant, with matching funds from the New Brunswick Health Research Foundation (NBHRF) , Canada. We would like to acknowledge the other research team members who helped formulate the larger research project, which this is a part of: Dr. Patrick Feltmate, Dr. Jason MacDonald, Beth Harris, Dr. Linda Yetman, Samantha Fowler, Dr. Chris A. McGibbon, and Dr. Erik Scheme, Emily Kervin and Leanne Skerry. As well, we would like to acknowledge Sherry Gionet, Caitlin Robertson, Karen Totton, Danika DesRoches, Whitney Tucker, Michelle Thibodeau, and Chloe Jardine who helped to collect the research data. We would also like to thank the participants for making this research possible. The first, third, and last authors acknowledge with gratitude the financial support of the NSERC-Husky Energy Industrial Research Chair, Canada. Publisher Copyright: © 2021 The Author(s)

PY - 2021/5

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N2 - The main purpose of this study was to model and analyze hospital to home transition processes of frail older adults in order to identify the challenges within this process. A multi-phase, multi-sited and mixed methods design was utilized, in which, Phase 1 included collecting semi-structured interviews and focus group data, and Phase 2 consisted of six patient/caregiver dyad prospective case studies. This study was conducted in three hospitals in three cities in a single province in Canada. The Functional Resonance Analysis Method (FRAM) was employed to model daily operations of the transition process. The perspectives of both healthcare providers and patients/caregivers were used to build the FRAM model. The transition model was then tested using a customized version of the FRAM. The six patient/caregiver cases were used in the process of testing the FRAM model. The results of building the FRAM model showed that five categories of functions contributed to the transition model, including admission, assessment, synthesis, decision-making, and readmission. The outcomes of using the customized version of the FRAM revealed challenges affecting the transition process including waitlists for geriatric units, team-based care, lack of a discharge planner, financial concerns, and follow-up plans. The findings of this study could assist managers and other decision makers to improve the transition processes of frail older adults by addressing these challenges. The FRAM method employed in this study can be applied widely to identify work practices that are more or less successful, so that procedures and practices can be adapted to nudge healthcare processes towards paths that will yield better outcomes.

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Modeling and analyzing hospital to home transition processes of frail older adults using the functional resonance analysis method (FRAM)

Abstract

Bibliographical note

ASJC Scopus Subject Areas

PubMed: MeSH publication types

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