There is an encouraging shift happening - organizations are becoming flatter and more self-governing. Over the last ten years, I have had the opportunity to work with and write about a number of such organizations1. Fredrick Laloux’s book, Reinventing Organizations2, describes over fifteen self-governing organizations across the world (Gore, FAVI, Buurtzorg, Sun Hydraulics) where employees make the decisions about what work they do and how they do that work. And numerous books have been written about individual companies that are self-governing3. This change is driven by the increasing complexity of issues organizations face, for which there are no known answers and the recognition that those who are impacted by an issue, often the frontline workers, are also the people who have the knowledge and perception to develop an in-depth understanding of that issue. The shift is also influenced by the desire of workers to be associated with organizations where they can co-create what the enterprise stands for. To be flatter and self-governing requires organization leaders to turn to and believe in the knowledge and wisdom that is embedded in the workforce.
Such organizations establish new norms, not only about who makes the decisions but, equally about who is called upon to make sense of what is happening; and the practices of bringing groups together to enable collective sensemaking. Taylor & Emery explain, “Sensemaking is a way station on the road to a consensually constructed, coordinated system of action.” Thus, sensemaking is the necessary step before coordinated action can take place. In organizations made up of specialized domains, sensemaking requires bringing those domains together in conversation to develop as complete an understanding as possible of the current situation the organization is facing. Thus, collective sensemaking is a conversational event where people intentionally come together for the purpose of using their varied perspectives and cognitive abilities to make sense of an issue or problem they are mutually facing, that will allow them to act collectively.
Weick, in describing a high-performing crews on carrier decks says, “when they interrelated their separate activities, they did so heedfully, taking special care to enact their actions as contributions to a system rather than as simply a task in their autonomous individual jobs. Their heedful interrelating also was reflected in the care they directed toward accurate representation of other players and their contributions. And heedful interrelating was evident in the care they directed toward subordinating their idiosyncratic intentions to the effective functioning of the system.”
An organization cannot follow Weick advice to “enact their actions as contributions to a system” unless members are able to hold a mental representation of that system in their minds. Sensemaking conversations provide the opportunity to build such representations.
Following is an example of collective sensemaking in a hospital setting that I had the privilege to work with. This Patient Safety Learning Pilot (PSLP) was conducted with microsystems in six hospitals and involved using MERS-TH (an error reporting system) and the development of causal trees based on the Eindhoven classification system for errors. The following description is of a sensemaking conversation that was convened by the Director of Patient Safety, at St Anthony’s in Crown Point, Indiana. In the Director’s words:
“We held a sensemaking session on a medication error that originated in the pharmacy. A patient was given a blood pressure medication that the physician had put on hold. The patient had come from the regular floor to our rehab unit. No harm occurred as a result of this error; however, we were interested in this particular error because we were in the process of implementing barcoding throughout the hospital. The unit where the error occurred was trialling the barcoding system so both the pharmacy and the rehab unit had put in new processes for these orders.
Before the sensemaking session occurred, I, as the Director of Patient Safety, and the Director of Pharmacy conducted a root cause analysis on the error and based on that developed a causal tree using the MERS framework. The causal tree had the consequent event as: “Norvasc 10mg administered to patient when order was written to hold – no harm to patient” followed by eleven antecedent events.
The sensemaking meeting brought together ten people, including the Director of Pharmacy, two pharmacy technicians and two pharmacists, one of whom had been involved in the error. We also had the nursing unit director from the floor where the error occurred, the VP of administration, the management engineer and the nursing informaticist who had expertise in barcoding. In addition, two nurses from the floor had agreed to come, but at the last minute were not able to do so. The meeting lasted about an hour and a half and was held toward the end of the shift to allow some people to come in early and others to stay after their shift.
I facilitated the sensemaking session, having participated in the earlier training given by Dr. Dixon. At the beginning of the meeting, I attempted to set a tone of openness. I explained that the intent of the sensemaking session was to educate ourselves on how we do things and more specifically how this error had occurred and I acknowledged that we all make errors including myself. I recalled an error I had made and asked if the others, whom we had arranged in a circle, would be willing to share a personal experience they had with an error and to say something about what it meant to them. Nearly everyone in the circle did so and this beginning proved valuable in demonstrating to everyone present that we were all on equal footing. The beginning also served to introduce those present to each other, which was important because one of our barriers to fixing medication errors has been that people from the floor don’t know many of the people from pharmacy.
I had printed the antecedent events from the causal tree on individual sheets of paper and these were placed one at a time on a wall chart. I explained to the group that this was just our rendition of what had occurred and that what I was looking for was input from them as to the correctness of the items or the sequence. As I placed each component on the tree, the group talked about that item, providing feedback, correcting, and adding new items. I used post-it notes to write additional information or steps. Having the items on individual sheets to be posted and changed proved much less threatening than using PowerPoint. It emphasized the tentativeness of what we had already produced illustrating that it was changeable.
The discussion evolved slowly as the group began to open up. As the meeting continued it became clear to me that the members were really trying to make sense of each other’s reasoning and contributions. Rather than all the questions coming from me, they began to ask questions of each other. For example, one pharmacist asked, “How do you know what medication you’ve put in?” The other pharmacist responded, “I check them off.” The first pharmacist was surprised because he had not been checking them off. Moreover, one of the techs explained that he thought the check meant that the pharmacist had already done a double check, so had not been re-checking those items.
As another example of the openness of the discussion, when I put up the antecedent event that read, “Must first reactivate transfer meds to rehab in computer,” which I had developed from my discussion with one of the pharmacist, the other pharmacist said, “I don’t just reactivate the screen, somebody else enters them all in manually.” So even the pharmacists were discovering differences in how they did things and that often lead to a discussion about which practice was safer.
One of the ways this meeting seemed different from a typical Root Cause Analysis that I have conducted was that the sensemaking meeting had a tone of curiosity, rather than the urgency to get the form completed and the meeting over with. I found myself exploring more in this meeting, trying to get at the staff’s understanding rather than just get the facts. I found myself honestly curious about what happened and did not feel compelled to make judgments. In this meeting, we primarily tried to understand what had happened and to reflect those changes on the causal tree. In the end, I felt great satisfaction knowing that the discussion did indeed go beyond the surface of the event. The casual tree we ended up with added several items including the recovery and in addition, added the causal codes that were useful when we were ready to create our action plans.
In two subsequent meetings, we created an action plan to address the issues we had uncovered in the sensemaking meeting and based on the same incident we conducted four subsequent FMEA meetings. So the sensemaking meeting proved a rich source of understanding for our continuing improvement work. The safety culture re-survey conducted in the pharmacy showed a positive change which, in part, was as a result of the conversation we had in the sensemaking meeting.”
This healthcare example illustrates only one of numerous possible formats for collective sensemaking, but it is illustrative of the role of the convener, how trust is built, the use of drawings or objects, the difference between a sensemaking conversation and a decision making conversation, and of the positive outcomes that can occur. I describe other examples from organizations focused on technology, finance, oil and NASA in other blog posts:
- Using Collective Sensemaking to Put Caring Back in Healthcare https://www.nancydixonblog.com/2015/05/using-collective-sensemaking-to-put-caring-back-in-health-care.html
- Leveraging Collective Knowledge: NASA’s Constellation Program https://www.nancydixonblog.com/2010/07/leveraging-collective-knowledge-nasas-constellation-program.html
- How to Make Use of Your Organization’s Collective Knowledge – Part 1 https://www.nancydixonblog.com/2011/01/how-to-make-use-of-your-organizations-collective-knowledge-accessing-the-knowledge-of-the-whole-orga.html
- A Book That Will Blow Your Mind About How to Make Use of The Knowledge In Organizations: A Review of An Everyone Culture: Becoming a Deliberately Developmental Organization
- https://www.nancydixonblog.com/2017/08/a-book-that-will-blow-your-mind-about-how-to-make-use-of-the-knowledge-in-organizations-a-review-of-.html
References
- Dixon, N. M. Glimpses of Organizations in the Act of Learning. In The Oxford Handbook of the Learning Organization.
- Laloux, F. (2014). Reinventing organizations: A guide to creating organizations inspired by the next stage in human consciousness. Nelson Parker.
- Robertson, B. J. (2015). Holacracy: The new management system for a rapidly changing world. Henry Holt and Company.; Sheridan, R. (2015). Joy, Inc.: How we built a workplace people love. Portfolio; Kegan, R., & Lahey, L. L. (2016). An everyone culture: Becoming a deliberately developmental organization. Harvard Business Review Press.; Turco, C. J. (2016). The conversational firm: Rethinking bureaucracy in the age of social media. Columbia University Press.
- Weick, K. E. (1995). Sensemaking in organizations (Vol. 3). Sage.