Page - 137 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

understanding healthcare professionals and the system in which they work. The tools of RHC, while still in early stages of development, have potential to complement other determinant frameworks such as computational simulation modelling (e.g. system dynamic modeling,[16-18] discrete event modelling[19, 20] and agent based modelling[21, 22]). This chapter presents two aspects of RHC applicable to interventions in health informatics: understanding how normal variation in everyday work can affect design and implementation of sustainable digital health systems, and designing information systems to cope with unexpected events. 2. Applications of Resilient Health Care in health informatics 2.1. Identifying and understanding variability in everyday work The importance of considering wanted and unwanted variation in everyday work when designing sustainable digital health systems is illustrated through a case study of the implementation of an Australia-wide video consultation and triage service supporting expecting parents and parents, families and carers of young children. Established in 2010, the telehealth service consists of a national helpline, video and website service sponsored by the Australian government. Telephone consultation and triage services are commonly used to deliver health advice worldwide. In Australia, availability of high-speed internet services in remote areas is driving a move from telephone to video telehealth services for healthcare providers; however, providers are unfamiliar with how to introduce and operate a video service. When designing a new system of work, it is important to take into consideration how day-to-day work is currently carried out, in order to improve uptake and reduce workarounds when the system is implemented.[23] A useful tool for understanding variation in everyday work, including how that variation in combination with multiple interacting activities can affect outcomes, is the Functional Resonance Analysis Method (FRAM).[24] The FRAM supports modelling complex socio-technical systems and is developed by determining the activities or functions that make up a process, and how they are coupled. Depending on the problem to be solved or question to be answered, the process can be modelled broadly, or at a more detailed level. For example, if we wanted to model the processes involved in using an automatic teller machine (ATM), we might break the process broadly into activities of (1) insert card, (2) enter PIN, (3) enter withdrawal amount, and (4) take money and card. However, if we were interested in specific detail such as the usability of the ATM screen, we might expand step (3) to include additional steps for select savings account, check account balance, enter withdrawal amount, request receipt, and so on. The data for developing a FRAM model can be obtained through a number of methods, including ethnography, interviews, documented processes, and so on. Each function is then described in terms of six aspects (see Figure 1): R.Clay-WilliamsandJ.Braithwaite /ResilientHealthCare 137