FRAM Visualisations

Only 59% of studies validated their FRAM visualisations with stakeholders, down from 81% in an earlier review of 16 studies. A total of 113 FRAM visualisations appeared across the 68 included papers, with 104 being sufficiently clear to allow coupling analysis. The review found a mean of 22.7 functions per visualisation (SD=14.7), providing approximate empirical support for a 20-function ceiling while also showing wide variability. The prior proposal that FRAM visualisations in healthcare should not exceed 20 functions was made without empirical evidence. The high standard deviation in function counts indicates the 20-function guideline is widely violated, and better reporting of scoping decisions is needed. Whether the decline in stakeholder validation rates reflects a genuine change in practice or a sample-size artefact is unclear.