How practicemakessense in healthcare operations: Studying sensemaking as performative, material-discursive practice

Abstract

This article aims to move sensemaking theory forward by exploring a post-humanist view of how sense is made in material-discursive practices. Answering recent calls for novel theoretical views on sensemaking, we adopt a relational ontology, assuming subject and object to be ontologically entangled, and viewing agency as a circulating flow through material-discursive practices. Employing this perspective, we study how sensemaking unfolds at the emergency ward of a Nordic university hospital. By working through the concepts of material-discursive practices, flow of agency and subject positions, we produce an account of sensemaking that decenters the human actor as the locus and source of sensemaking, and foregrounds the performativity of practices through which certain ways of acting become enacted as sensible. This allows us to propose an alternative to the traditional view of sensemaking as episodic, cognitive-discursive practices enacted within and between separate human actors. With this view, what makes sense is understood as a material-discursive practice and related subject positions, which owing to their specific positioning in the circulating flow of agency emerge as sensible. Consequently, every actor is not just making sense, but is also already being made sense of; positioning and being positioned in the flow of agency.

The emergence of sensemaking through socio-material practices

“…Third, following Grant and Marshak (2011, p. 221), 'questions such as how, precisely, do discourses construct social reality, especially regarding organisational change' were considered. During this stage, material-discursive practices were sought as a complementary approach to the more traditional view, which considers sensemaking as a purely cognitive or socially constructed process that occurs among interacting people (Hultin and Mähring, 2017; J o u r n a l o f O r g a n i z a t i o n a l C h a n g e M a n a g e m e n t Nicolini, 2012). As a result, three practices were identified, each of which prompted sensemaking among the personnel: facilitated meetings, a status board, and video analysis.…”

“…However, there is an emerging opposing viewpoint that adopts a relational ontology and approaches sensemaking as an ongoing process influenced by practices and materiality (Hultin and Mähring, 2017;Nicolini, 2012;Orlikowski and Scott, 2015). This paper examines sensemaking as a simultaneous, holistic process.…”

“…This paper examines sensemaking as a simultaneous, holistic process. A practice lens is helpful for understanding and describing practices as socially constructed activities within specific contexts, including socio-materiality (Hultin and Mähring, 2017;Schatzki, 2001).…”

“…Socio-materiality in this study means that sensemaking emerges not only through human actors but also through social and material practices (Hultin and Mähring, 2017;Scott and Orlikowski, 2014). The aim of this study was to understand the practices that generate sensemaking within a multiprofessional team during an organisational change.…”

Brilliant health service management: challenging perceptions and changing HR practices in health services

“…Despite the many definitions of quality, it can be difficult to grasp in measurable terms that can be operationalised (Ross and Perry 1999). This is particularly the case in health-care, where efforts to objectify, commodify and standardise practices are often juxtaposed by the processes of care, including the relational, the experiential and the affective (Dadich and Olson 2017;Hultin and M€ ahring 2017;Lee et al 2013;Timmermans and Almeling 2009). The involvement of different stakeholders, including policymakers, managers, clinicians and patients, gives rise to disparate expectations and standards (Mosadeghrad 2013).…”