Functional Couplings and Adaptive Behavior in Intake and Care Processes in a Nighttime Emergency Department: An Exploratory Study Combining FRAM and a Questionnaire

Abstract

Resilience is increasingly discussed in medical safety as the adaptive capacity of organizations and individuals to restore normal operations after unexpected events. Prior research has largely highlighted its benefits, but the burdens of maintaining resilience remain understudied. Semi-structured interviews were conducted with 14 experienced staff members (≥5 years in the night emergency department; ≥3 years of night duty). Using the Functional Resonance Analysis Method (FRAM), the work system was modeled as a set of interacting functions. Next, 33 night-duty nurses rated each function on resource availability, adaptive behavior required, and associated anxiety. FRAM identified 15 functions in the nighttime emergency process. Ratings showed that a subset of functions carried disproportionately high burdens, were performed by only some nurses, and demanded greater adaptation and higher anxiety than other functions. Overall, resilience in this setting appeared to depend on concentrated adaptive efforts at specific upstream functions in the workflow.