title: The functional resonance analysis method: assessing, advancing, and applying a novel systems thinking methodology in healthcare research
Creators: name: McGill, Ali
Publisher: name: Memorial University of Newfoundland
publisherIdentifier: https://ror.org/04haebc03
publisherIdentifierScheme: ROR
Year: 2024

description: Introduction This PhD research work assesses, advances, and applies a novel systems thinking methodology in healthcare research; the Functional Resonance Analysis Method (FRAM). An extensive review of the literature is provided and knowledge gaps related to assessing and advancing the FRAM in healthcare research are addressed. Additionally, the research work applies the FRAM and a customized version of the methodology, DynaFRAM, to examine how the community based health and social care system for older people currently operates in Newfoundland and Labrador. The FRAM analysis intends to identify areas of strength and vulnerability in a local care system and use those insights as a basis to propose health policy recommendations for the implementation of a more integrated model of care for older people. Although this thesis applies the FRAM and DynaFRAM to examine health and social care for older people in NL, the literature presented demonstrates the methodology can be applied to complex healthcare processes and systems in other jurisdictions. Aims The three aims of this research work are: i) To assess and demonstrate the usability of the FRAM as a methodology to analyze complex processes and systems in the healthcare domain (chapter 2). ii) To advance the FRAM in the healthcare domain by: a) providing guidance on qualitative data collection and analysis to inform the building of a FRAM model (chapter 3). b) providing guidance on quality enhancement criteria and strategies so resulting FRAM models and insights afforded by them are trustworthy (chapter 4). iii) To apply the methodology (FRAM and DynaFRAM) in a community based health and social care system to identify micro-, meso-, and macro-level challenges and opportunities that impact capacity to move toward a more integrated model of care delivery for older people in NL (chapter 5). Methods a) To assess the usability of the FRAM as a healthcare research methodology, a scoping review of the literature was conducted in accordance with Joanna Briggs Institute methodology. b) To advance the FRAM in healthcare research. Two papers were written to provide methodological guidance to healthcare researchers, administrators, and clinicians. c) In conducting research of the community based health and social care system in NL, the FRAM and DynaFRAM were applied to model the local care system for older people and create a hypothetical patient journey scenario. Data collection consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting. Findings a) The scoping review presented in chapter 2 assessed and demonstrated the FRAM’s usability and practical application in modeling complex healthcare processes and systems in the healthcare domain. b) The papers presented in chapters 3 and 4 provided healthcare domain specific guidance on data collection and analysis to inform the building of a FRAM model and the inclusion of quality enhancement criteria and strategies that can enhance the trustworthiness of healthcare studies using the FRAM. c) The community based study presented in chapter 5 identified challenges and opportunities for implementing integrated care in one health region. Findings from the FRAM and DynaFRAM analysis informed the co-design of micro-, meso-, and macro-level process improvement recommendations that aim to move one community based comprehensive geriatric assessment process towards a more integrated model of care. Conclusions This thesis met the intended aims of assessing, advancing, and applying the FRAM as a novel healthcare research methodology as demonstrated in the papers presented. Healthcare system design and policy recommendations to move the community based health and social care system towards a more integrated model of care were needed. This could not be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision makers in their efforts to implement transformative healthcare system changes.