Page - 139 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Figure 2. Resolving calls – CSO. Figure 3 is the same FRAM model showing the portion of the work activity where calls are passed to the counsellor for resolution. It is easy to see from the Figure that including only one additional person in the process increases the complexity and resulting variation. In this process, the CSO takes the call from the client (1), establishes the purpose of the call (2) and decides whether it needs to be passed to a counsellor (3). Sometimes the CSO lacks sufficient expertise, or is uncertain about the correct disposition, so must consult with a counsellor (4) to obtain more information (5) and make the decision (6). The call can then be passed to the counsellor (7), who will resolve the client issue (8). Variation is evident in terms of the time for the CSO to establish the problem (2), in consultation with the counsellor if necessary (3, 4, 5); and for the counsellor to resolve the call with the client (8). We will also see interactions between functions that can exacerbate variability: for example, the counsellor must be available to give advice at step 4, and not on another call. Otherwise the CSO must either wait, or seek advice from another counsellor. We can see where workarounds might arise: if, for example, all counsellors are on other calls, the CSO may decide to proceed without advice, potentially leading to incorrect disposition. We can also see how the advice loop (steps 3-4-5-6) could consume CSO and counsellor time, leading to delays in providing advice by counsellors (8), and backup of new calls waiting for the CSO (1, precondition). R.Clay-WilliamsandJ.Braithwaite /ResilientHealthCare 139