• Nathan Anderson, Rajesh G Krishnan, Maneesh Kumar, Tim Ayres, David Slater, Amith Vir Neelakantapuram, Paul Bowie, and Andrew Carson-Stevens.
• Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
• Ann Emerg Med. 2023 Sep 1; 82 (3): 288297288-297.

AbstractEmergency departments (EDs) are dynamic, complex, and demanding environments. Introducing changes that lead to improvements in EDs can be challenging owing to the high staff turnover and mix, high patient volume with different needs, and being the front door to the hospital for the sickest patients. Quality improvement is a methodology applied routinely in EDs to instigate change to improve several outcomes such as waiting times, time to definitive treatment, and patient safety. Introducing the changes needed to transform the system in this way is seldom straightforward with the risk of "not seeing the forest for the trees" when attempting to change the system. In this article, we demonstrate how the functional resonance analysis method can be used to capture the experiences and perceptions of frontline staff to identify the key functions in the system (the trees), to understand the interactions and dependencies between them to make up the ED ecosystem ("the forest") and to support quality improvement planning, identifying priorities and patient safety risks.Copyright © 2022 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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