What is it?

Sensemaking has been defined as the process by which meaning is given to an experience or situation. Literally, it’s when an individual or team makes sense of an event or situation, past or current.  Dr. Weick eloquently described sensemaking as, “a diagnostic process directed at constructing plausible interpretations of ambiguous cues that are sufficient to sustain action.”  Taylor and Van Every described sensemaking as “a way station on the road to a consensually constructed, coordinated system of action.”  In short, sensemaking is a springboard for action, or in the case of a high-reliability team, effective sensemaking is a springboard for effective action.

When does one use sensemaking?

Typically, sensemaking is deployed when the situation is, or the event was, unexpected, unusual or ambiguous.  The reflective or post-event retrospective sensemaking is critical to learning.  Sensemaking in the midst of a high-stress, high-risk circumstance, which drives relatively quick and effective action, is critical for a high-performing team to effectively act in an unexpected or complex situation effectively.  This sensemaking is still retrospective, but the real-time nature of it allows for the action to impact that specific circumstance.  Prospective sensemaking isn’t as well defined in the literature, but it speaks to anticipating future events and circumstances for the purposes of framing a mental model and creating understanding in order to proactively prepare.

What makes sensemaking effective?

Effective sensemaking is facilitated when wisdom, originating from practical knowledge of theory and meaningful experience with best practice, is tightly coupled with thoughtful and honest learning of accumulated experiences, as well as sufficient current situational awareness and mindfulness.   Effective sensemaking can be recognized when its there, but its hard to insert when its missing.  It can be nurtured when leaders support training, professional development, provide time for open reflection, and have a plan for recognizing, and retaining senior people.   Yet, individual commitment to excellence over time as experience accumulates is perhaps the most important element.

The more wise the leaders and influencers of a team the more effective the sensmaking of that team.  However, there are attitudinal as well as behavioral elements that influence the quality of the sensemaking.  For example, when reviewing a safety event, if a just culture attitude and approach isn’t taken, the sensemaking will be limited and not balanced.  Another example is during a rapid response or code situation.  If there isn’t a designated leader and clarity among team members as to what their roles are, the sensemaking isn’t organized and therefore is less effective.  Without psychological safety, a team can’t collectively do effective sensemaking, and can’t get better at it over time.  Someone senses that something isn’t right, but doesn’t speak up, and thus doesn’t leverage the team to sensemake and formulate an actionable picture of what’s going on.

Task saturation is the phenomenon whereby one’s brain becomes overloaded with significant information or stimuli and begins to fail itself. Task saturation often happens to a person when there is a crisis or when they are multitasking or when there is more to do in a given amount of time than is possible. Sounds like healthcare to me.

Pilots and nuclear reactor operators have developed methods and tools for overcoming task saturation. The most prominent are: 1) checklists, 2) mutual support, 3) crosschecks, and 4) huddles. Over the years, I’ve seen these things work in healthcare, but I’ve not seen them used as often as they could.  Crosschecks include double checks with colleagues, and making sure that all key indicators that will allow for effective sensemaking and situational awareness are being monitored.

Checklists exist in healthcare, but not often for crises or when the system is overwhelmed. Mutual support exists, but it’s often not there at times when it’s needed the most. Crosschecks are also used, such as in structured code situations, but they aren’t used enough. Huddles are increasingly being used, but often the time when they aren’t is when task saturation or a crisis is occurring. No one wants to take the time out to do it.

EMRs can be used to provide checklists, reminders and crosschecks. Working in teams and having huddles can provide mutual support. Having the collective discipline to stick to these principles when they are most needed is critical. Having “practiced” as a team with “learning” (debriefing) as part of the process is helpful.

The best medicine for task saturation, of course, is to avoid it from happening in the first place. Nevertheless, it happens enough in healthcare that it would be best to be prepared. How does one avoid task saturation? There have been examples where variability has been reduced despite the notion that variability in demand and volumes can’t be controlled in health care. Surge plans, flexible staffing, flexible roles, and early warning systems are all examples of preventing task saturation.