In this framework, Miller
distinguished between ‘action’ and the lower levels. Action focuses
on what occurs in practice rather than what happens in an artificial
testing situation. Recognising that Miller’s framework fails to
account for important contextual factors, the Cambridge framework
(Figure 11.1) evolved from Miller’s pyramid to acknowledge
the crucial impact of systems factors (such as interactions with
other health-care workers) and individual factors (such as fatigue,
illness, etc.).