Paper: A systems approach using the functional resonance analysis method

Al Ross, Andrea Sherriff, Jamie Kidd, Wendy Gnich, Janet Anderson, Leigh Deas, Lorna Macpherson (2018). “A systems approach using the functional resonance analysis method to support fluoride varnish application for children attending general dental practice.” Applied Ergonomics 68: 294-303.

Open Access:  http://www.sciencedirect.com/science/article/pii/S0003687017302697

Our work found that the functional resonance analysis method (FRAM) allowed complexity to be mapped so that important factors are not missed when designing healthcare interventions.

Background
All children attending General Dental Practice in Scotland are recommended to receive twice-yearly applications of sodium fluoride varnish to prevent childhood caries, yet application is variable. Development of complex interventions requires theorizing and modelling to understand context. This study applies the Functional Resonance Analysis Method (FRAM) to produce a sociotechnical systems model and identify opportunities for intervention to support application.

Methods
The FRAM was used to synthesise data which were: routine monitoring of fluoride varnish application in 2015/16; a longitudinal survey with practitioners (n = 1090); in-depth practitioner and key informant interviews (n = 43); and a ‘world café’ workshop (n = 56).

Results
We describe a detailed model of functions linked to application, and use this to make recommendations for system-wide intervention.

Conclusions
Rigorous research is required to produce accessible models of complex systems in healthcare. This novel paper shows how careful articulation of the functions associated with fluoride varnish application can support future improvement efforts.

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