Formal responsibility and task execution: the importance of modelling task delegation in FRAM to optimise the identification of potential improvement strategies
研究了围手术期抗凝管理中任务委派在协议与日常实践中的差异，通过FRAM模型揭示正式责任与执行分离带来的改进机会，对医疗流程优化有参考价值。
To investigate how task delegation for perioperative anticoagulation management is reported in protocols and daily practice, and how this translates to additional information in work-as-imagined and work-as-done using FRAM to identify improvement possibilities. Existing FRAM visualisations of perioperative anticoagulant management in a Dutch academic hospital were extended to include task delegation in protocols using document analysis and in daily practice using a focus group of eight healthcare professionals, analysed using content analysis. Distinguishing between formal responsibility and task execution revealed additional functions and roles in both work-as-done and work-as-imagined, resulting in more discrepancies between work-as-done and work-as-imagined. Professionals experienced responsibility for delegated tasks, even without formal accountability, and needed to feel qualified and capable as well as complete clear information to accept these tasks. Including task delegation in FRAM models improves the understanding of healthcare processes, communication about distribution of responsibilities and thereby development of more effective improvement strategies. • First study to explicitly add task delegation into FRAM visualisations and analysis. • Work-as-done shows more executing roles than guidelines (work-as-imagined). • Professionals felt responsible for delegated tasks without formal responsibility. • Safe task delegation requires that professionals feel qualified and capable. • Delegation in FRAM prevents oversimplification and enriches process insight.