Proposing leading indicators for blood sampling: application of a method based on the principles of resilient healthcare

In recent years, healthcare has put a growing attention to the investigation of successful processes as a supplement to analyzing and investigating unwanted processes, like adverse events and near misses. This new perspective paves the way for developing methods and tools for investigating and understanding how processes function, and how variability can contribute to both success and failure. In the light of this, we have developed a method applicable for identifying leading indicators for successful outcomes of complex healthcare processes. The method, which is termed leading indicator identification method (LIIM) was inspired from similar methods applied in high-risk industries. To demonstrate the usefulness of the method we have conducted a case study with the aim of identifying leading indicators for blood sampling among patients in a Biomedical Department within a Danish hospital. The method builds on and uses steps from the functional resonance analysis method (FRAM). FRAM was developed to analyze how work is performed on a daily basis, in complex systems and can be used prospectively to monitor, manage and control such systems. The contribution of the work is to present the LIIM along with four leading indicators that are important to consider in the planning, management and monitoring of the blood sampling process.