Page - 138 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Input (I) is what the function acts on or changes Output (O) is what emerges from the function Precondition (P) is what must be satisfied before the function can begin Resources (R) are materials/people needed to carry out the function Control (C) is how the function is monitored or controlled Time (T) is any time constraints that might affect the function Figure 1. FRAM activity hexagon [25] . A FRAM model is built using a software tool called the FRAM Model Visualiser (FMV).[25] The potential variability of each activity is annotated as the model is built, and can be defined in terms of source of variability (internal or external, type, likelihood), output with regard to time (too early, on time, too late, not at all), and output with regard to precision (possible but unlikely, typical, possible and likely). The resulting model can be interpreted to determine how variability present in each activity affects other activities, and how delays can propagate through the system. Such a model can help to predict unwanted variation when the new system is implemented. In the telehealth service case, two levels of direct client support are provided: (1) Customer Support Officers (CSOs) provide standardised advice on common situations, such as planning for pregnancy, foods to avoid when pregnant, and breastfeeding, and (2) accredited counsellors provide psychological support and counselling. To illustrate where we found variability in Work-as-Done in our telehealth evaluation, Figure 2 is a FRAM model showing the portion of the work activity where calls are answered and dispositioned by the CSO (we have simplified the FRAM for ease of interpretation, and have not included Resource, Control or Time aspects in the figure). Calls answered and resolved by the CSO form a linear process, passing through steps 1 to 4 (shadowed steps). Variation is indicated in the model by the sine curve within the function (see steps 2 and 4). In this case, the time taken to chat with the client to establish the purpose of the call (2) can vary depending on the client, the purpose of the call, and the expertise of the CSO. The time taken to resolve the call (4) can also vary depending on the complexity of the problem raised by the client, and the amount of information that must be passed from CSO to client to resolve the issue. Once the CSO has resolved the problem (Step 4), they are then available to return to Step 1 to take the next call (CSO availability shown as a precondition). R.Clay-WilliamsandJ.Braithwaite /ResilientHealthCare138