Combining Failure Mode and Functional Resonance Analyses in Healthcare Settings

Socio-technical systems rely on technological artefacts as well as human and professional practices in order to achieve organisational safety. From an organisational viewpoint of analysis, different safety barriers are often put in place in order to mitigate risks. The complexity of such systems poses challenges to safety assessment approaches that rely on simple, identifiable cause and effect links. Failure Mode and Effects Analysis (FMEA), for instance, is an established technique for the safety analysis of technical systems, but the assessment of the severity of consequences is difficult in socio-technical settings like healthcare. This paper argues that such limitations need to be addressed by combining diverse methodologies in order to assess vulnerabilities that might affect complex socio-technical settings. The paper describes the application of FMEA for the identification of vulnerabilities related to communication and handover within an emergency care pathway. It reviews and discusses the applicability of the Functional Resonance Analysis Method (FRAM) as a complementary approach. Finally, a discussion about different aspects of emerging technological risk argues that taking into account socio-technical hazards could be useful in order to overcome limitations of analytical approaches that tend to narrow the scope