In the Moment: A Phenomenological Case Study of the Dynamic Nature of Awareness and Sensemaking
By Faith B. Power
B.A. 1981, Marshall University M.A. 2004, The George Washington University
A Dissertation Submitted to
The Faculty of The Graduate School of Education and Human Development of The George Washington University in partial fulfillment of the requirements for the degree of Doctor of Education
May 15, 2011
Dissertation directed by
Clyde V. Croswell Professorial Lecturer in Human and Organizational Learning
The Graduate School of Education and Human Development of the George Washington
University certifies that Faith B. Power has passed the final examination for the degree of
Doctor of Education as of February 24, 2011. This is the final and approved form of the dissertation.
In the Moment: A Phenomenological Case Study
of the Dynamic Nature of Awareness and Sensemaking
Faith B. Power
Dissertation Research Committee:
Clyde V. Croswell, Professorial Lecturer in Human and Organizational
Learning, Dissertation Director
David Schwandt, Professor of Human and Organizational Learning,
Committee Member
James Leslie, Assistant Visiting Professor of Human and Organizational
Learning, Committee Member
ii Dedication
This dissertation is dedicated to my family, friends, and colleagues who have been extraordinarily supportive throughout this journey. To my husband, Curtis, who has been incredibly supportive, patient, and encouraging: I could not have taken this journey without you. To my son, Curtis, whose zest for life and intellect motivates me every day:
I hope to one day encourage and support you during your own quest. To my mother, who taught me to work hard, never give up, and always give my best: I am grateful for your support, guidance, patience, and encouragement during my educational adventure. To my
Divine Creator, thank you for your eternal love and gracious acceptance. In memory of
Dr. and Mrs. Curtis G. Power, Jr., whose intellectual curiosity inspired me and whose presence I felt throughout my academic journey. To my brother-in-law, Bill, whose courageous battle with cancer challenged me to persevere and finish the work I began.
iii Acknowledgments
This journey would not have been possible without the assistance, guidance, and support from many people. I would like to acknowledge my chair, Dr. Clyde Croswell. I am thankful for your dedication, commitment, and unselfish support to your students and to the process of others’ growth and development. Your unwavering support, guidance, and positive encouragement were invaluable to my understanding of the subject.
I would also like to thank my dissertation committee members. Dr. David
Schwandt, your cutting clarity and wealth of knowledge were critical to this process. Dr.
James Leslie, Dr. John Goss, and Dr. William Neal, your constructive feedback and interest in the topic were very motivating and invaluable to my academic journey. How fortunate I was to work with a committee committed to my success.
I am grateful to my cohort members for their support, encouragement, and friendship. Of particular note, I want to thank Dr. Bob Hamilton, Pat Press, and Eliot
Jardines for their empathy, advice, and comic relief at the right moments.
I am indebted to Dr. William Shendow for being instrumental in helping to inspire my doctoral journey. Many years ago you saw the promise of a young woman and provided encouragement and support. I will be forever grateful for the confidence you placed in me.
Finally, I am grateful to Nancy McGuire and Sue Simmons, as they helped me navigate the many administrative channels in academia. I offer blessings to these two very skillful and caring women.
Aside from these direct contributors, many people along the way shaped my thinking about sensemaking. Without their influence, I could never have formulated this
iv research. In the words of Isaac Newton, “If I have seen further it is only by standing on the shoulders of giants.”
v Abstract of the Dissertation
In the Moment: A Phenomenological Case Study of the Dynamic Nature of Awareness and Sensemaking
Sensemaking plays a central role in determining human behavior within organizations (Weick, 1979, 1995; Weick, Sutcliffe, & Obstfeld, 2005). Sensemaking is an effort to give stability to the organizational environment by paying attention to it. We pay attention and extract a particular cue, then link it with some other idea that clarifies the meaning of the cue. In essence, individuals decide what to pay attention to. The complexities of today’s organizations call for an expanded view of the sensemaking process, one that takes into account the subjective, present-moment aspects of the phenomenon (Maitlis & Sonenshein, 2010).
This phenomenological case study was conducted in situ at a regional healthcare system and explored how individual awareness contributes to one’s ability to make sense of his or her environment, revealing the interdependent, reciprocal, and mutually constitutive processes at work in this psychosocial and biologically embodied phenomenon. Specifically, present-moment sensemaking is the confluence of awareness and intentionality; intersubjectivity is a form of intercorporality through which common meaning is created; and embodied responses, which emerge as autonomic impressions
(physical and emotional responses), are reflective of the way in which sensemaking manifests in subjective experience and can be understood as embodied wisdom.
This researcher developed a model of present-moment sensemaking that revealed the relationship between self-organizing, embodied wisdom, and decision making, which
vi are the inseparable outcome of the interaction of intentional behaviors, cognitive conception, and affective perception.
vii Table of Contents
Page
Dedication ...... iii
Acknowledgments ...... iv
Abstract of the Dissertation ...... vi
List of Figures ...... xi
List of Tables...... xii
CHAPTER 1: INTRODUCTION ...... 1 Problem Statement...... 1 Significance of the Study...... 7 Purpose of the Study...... 12 Research Question ...... 12 Conceptual Frame...... 12 Awareness...... 13 Mindfulness ...... 18 Sensemaking ...... 20 Assumptions ...... 22 Summary of Methodology...... 23 Delimitation of the Study...... 25 Limitations of the Study ...... 26 Summary...... 26 Definition of Terms ...... 27
CHAPTER 2: LITERATURE REVIEW ...... 32 Sensemaking as a Psychosocial Process...... 32 Sensemaking as a Biological Process...... 38 Awareness...... 46 Mindfulness ...... 54 Summary...... 63
CHAPTER 3: RESEARCH METHODOLOGY ...... 64 Qualitative Research Design...... 64 Rationale for Choice of Approach ...... 64 Assumptions...... 66 Phenomenology...... 67 Sensemaking and a Phenomenological Enactive Approach ...... 68 Overview of Study Design...... 72 Site and Participant Selection ...... 73 Precipitating Event...... 74 Data Collection ...... 76 Group Exposure to the Precipitating Event: Journaling and Recording...... 77
viii Individual Interviews ...... 78 Data Analysis...... 79 Verification and Trustworthiness ...... 81 Triangulation...... 82 Peer Debriefing and Member Checking ...... 83 Epoché ...... 84 Ethical Considerations...... 84 Summary...... 86
CHAPTER 4: PRESENTATION AND ANALYSIS OF DATA ...... 88 Section 1: Themes...... 89 Section 2: Textural Descriptions ...... 92 Alice: Individual Textural Description ...... 93 Jane: Individual Textural Description...... 96 Jim: Individual Textural Description...... 99 Joanne: Individual Textural Description...... 101 Karen: Individual Textural Description...... 103 Larry: Individual Textual Description ...... 105 Lisa: Individual Textural Description...... 108 Sue: Individual Textural Description...... 110 Terri: Individual Textural Description...... 112 Victoria: Individual Textural Description...... 116 Section 3: Structural Descriptions ...... 118 Alice: Individual Structural Description...... 119 Jane: Individual Structural Description ...... 122 Jim: Individual Structural Description...... 126 Joanne: Individual Structural Description ...... 128 Karen: Individual Structural Description...... 132 Larry: Individual Structural Description...... 134 Lisa: Individual Structural Description...... 138 Sue: Individual Structural Description...... 140 Terri: Individual Structural Description...... 142 Victoria: Individual Structural Description ...... 147 Section 4: Textural-Structural Descriptions ...... 150 Alice: Individual Textural-Structural Description...... 150 Jane: Individual Textural-Structural Description...... 153 Jim: Individual Textural-Structural Description...... 154 Joanne: Individual Textural-Structural Description...... 156 Karen: Individual Textural-Structural Description...... 158 Larry: Individual Textural-Structural Description...... 160 Lisa: Individual Textural-Structural Description...... 162 Sue: Individual Textural-Structural Description...... 163 Terri: Individual Textural-Structural Description...... 166 Victoria: Individual Textural-Structural Description...... 169 Section 5: Composite Description ...... 171 Awareness...... 172 Focus Response...... 173
ix Personal Experiences ...... 175 Desire for More Information...... 176 Reaching Out to Others...... 176 Action Planning ...... 177 Emotional and Physical Responses...... 178 Summary...... 179
CHAPTER 5: FINDINGS RELATED TO SENSEMAKING ...... 180 Characteristics of Classical Sensemaking ...... 181 Characteristics of Postmodern Sensemaking...... 184 Awareness...... 184 Focus Response...... 187 Past Experiences ...... 188 Desire for More Information...... 191 Reaching Out to Others...... 193 Action Planning ...... 194 Physical and Emotional Responses...... 195 Summary...... 197
CHAPTER 6: CONCLUSIONS AND FUTURE IMPLICATIONS ...... 198 Conclusions...... 198 Awareness...... 199 Intersubjectivity ...... 200 Embodied Responses ...... 203 Implications ...... 206 Theory...... 206 Research...... 209 Awareness ...... 210 Intersubjectivity ...... 210 Embodied Responses ...... 211 Practice...... 211 Self-organizing...... 211 Decision Making ...... 214 Embodied Wisdom...... 216 Summary...... 221 Epilogue...... 222
REFERENCES ...... 225
APPENDIX A: Recruitment Email...... 248
APPENDIX B: Research Information and Consent Form ...... 249
APPENDIX C: Participant Recruitment and Screening Guide ...... 252
APPENDIX D: Journaling Instructions ...... 253
APPENDIX E: Interview Protocol ...... 255
x List of Figures
Page
1-1. Conceptual Framework: Present-Moment Sensemaking ...... 13
2-1. Process of Awareness...... 50
2-2. Growth of Mindfulness-Based Studies...... 55
3-1. Modified van Kaam Method ...... 81
6-1. Embodied Wisdom...... 207
6-2. Present-Moment Sensemaking...... 219
xi List of Tables
Page
4-1. Participant Profile...... 88
4-2. Invariant Meaning Horizons...... 89
4-3. Emerging Patterns: General Experience of Precipitating Event ...... 90
4-4. Emerging Patterns: Making Sense in the Present Moment ...... 91
4-5. Emerging Patterns: Focused/Unfocused ...... 91
4-6. Emerging Patterns: Reaching Out to Others ...... 92
4-7. Emerging Patterns: Additional Sensemaking information...... 92
xii CHAPTER 1:
INTRODUCTION
Viewed as a significant process of organizing (Weick, 1979, 1995; Weick,
Sutcliffe, & Obstfeld, 2005), the concept of sensemaking continues to be of considerable interest to researchers because of its central role in determining behavior within organizations. Weick et al. (2005) observed, however, that “the seemingly transient nature of sensemaking belies its central role in the determination of human behavior”
(p. 409). This notion that sensemaking is “transient in nature” seems closely aligned to
Freeman’s (2000) perspective that meaning is a momentary state of mind that individuals experience through “observation of our own actions and those of others” and is closely linked to individual awareness. “Awareness is an experience, which in neurodynamic terms is a transient state” (Freeman, 2000, p. 116).
While sensemaking is central to the process of organizing, Weick et al. (2005) suggested that it is sufficiently subtle and fleeting as to be overlooked as a vital aspect of human behavior inside organizations. Their observation led this researcher to explore the transient nature of sensemaking and awareness and their role in shaping human behavior.
This study examined the moment-to-moment, experiential nature of sensemaking, with a focus on explicating the “present-moment” quality of awareness in relation to sensemaking that has been largely overlooked.
Problem Statement
Organizations operate in increasingly complex, dynamic, and ambiguous environments. “Social, technical and political variables are interacting in confusing and
1 unpredictable ways, defying conventional empirical analysis” (Wright, 2004, p. 5). Such environments create a significant “amount of meaningless noise which the individual has to select and transform into meaningful, sensed communication” (Pitasi, 2002, p. 1). In these complex environments, the past may not be sufficient to tell us with certainty what action to take in the present moment.
Dominant scholarly perspectives view retrospection as a central and distinguishing characteristic of sensemaking (Weick, 1979, 1995). Retrospective sensemaking, as viewed by Weick (1979, 1995), is based on the belief that organizational behavior is not so much rational as it is rationalized; hence, individuals construct interpretations of organizational experiences and actions by reflecting on them. In essence, individuals construct accounts to explain their behavior after they have already acted (Weick, 1995). This perspective was derived from Alfred Schutz’s (1967) phenomenological work on the nature of “meaningful lived experiences.” Schutz (1967) posited that each individual constructs his or her own “world” through certain “building blocks and methods,” which are given to each of us though socialization with others and by our own individual experiences. These building blocks and methods form a cognitive prestructuralization of the world. This view of sensemaking suggests that intentions and motives do not exist prior to action. At the time of his writings, Schutz’s “philosophical sociological” and intersubjective conceptualization of meaningful lived experience, however, failed to take into account more recent theoretical and empirical developments around subjectivity and consciousness, namely the enactive approach (Maturana &
Varela, 1987; Varela, 1996; Varela, Thompson, & Rosch, 1993; Rudrauf, Lutz, Cosmelli,
Lachaux, & Le Van Quyen, 2003; Thompson & Varela, 2001; Thompson, 2005, 2007).
2 As a sociologist, Schutz, not unlike Parsons (1978), overlooked the adaptive or biological nature of human behavior in his explanation of enaction. “As yet, there is no enactive account of social cognition” (De Jaegher & Di Paolo, 2007, p. 6).
The enactive perspective views cognition as subject to the kinds of experience that come from having a physical body with multiple sensorimotor capabilities. Further, these sensorimotor capacities are themselves embedded in an encompassing biological, psychological, social, and cultural context. The use of the term “action” is used to emphasize the sensory and motor processes—perception and action—as fundamental to lived cognition (Varela et al., 1993). In fact, Varela et al. (1993) posited that “the two are not merely contingently linked in individuals; they have also evolved together” (p. 173).
Thus, the enactive approach can be said to consist of two central ideas: “1) perception consists in perceptually guided action and 2) cognitive structures emerge from the recurrent sensorimotor patterns that enable action to be perceptually guided” (Varela et al., 1993). Understanding how enacted couplings emerge between individual sensory motor systems and the environment may help to explain how action can be perceptually guided in organizations.
Increased attention has been placed on understanding the relationship between how individuals make sense of information and how they act to influence organizational outcomes (Thomas, Clark, & Gioia, 1993). For individuals to see relationships more clearly in organizations and to be prepared for the unexpected, they must weaken or neutralize their tendency to normalize (Weick, 1993, 2005a, 2005b, 2006; Weick &
Roberts, 1993; Weick & Sutcliffe, 2001). This calls for more mindful approaches to solving problems, rather than automatic thinking (Weick, 2005a), which is the hallmark
3 of organizational routines and training. “You have to think in a more mindful, less automatic manner” (Weick, 2005a, p. 56). According to Weick (2005a), in a reactive world, “a highly refined planning system is less crucial than the capability to make sense out of an emerging pattern” (p. 58) and, thus, “the cognitive properties of human groups may depend on the social organization of individual cognitive capabilities” (p. 53). The complexities of today’s organizations call for an expanded view of the sensemaking process (Weick et al., 2005), a view that takes into account enaction, which has been seen as the sentient, prereflective qualities of human experience (Varela et al., 1993; Depraz,
1999; Thompson, 2005, 2007).
According to Thompson (2005), “the human mind is embodied in our entire organism and embedded in the world, and hence is not reducible to structures inside the activity—self-regulation, sensorimotor coupling and intersubjective interaction” (p. 408).
Further, cognitivism has provided only a limited account of mentality in the sense of subjective experience (Thompson, 2007). Most notable, the cognitive and social approaches to sensemaking do not give “attention to the body that houses the thinking mind and interacts with other bodies and material things” (Bakke & Bean, 2006, p. 57).
In the words of Merleau-Ponty, the neurophilosopher, “To perceive is to render oneself present to something through the body” (Merleau-Ponty, 1962, p. 241).
Recently, Weick et al. (2005) represented sensemaking as being more present- moment oriented than current research has shown. In fact, Weick (2007) made the point that “capturing more of the present moment is important to offset our tendency to rely too heavily on the specious clarity of rolling 20/20 hindsight” (p. 17). Further, the transient nature of sensemaking and awareness, which appear to obscure their influence on human
4 behavior, represents how human beings focus their mental attention (Freeman, 2000; Fiol
& O’Connor, 2004). Weick and Putnam (2006) have called for further exploration of the attentive properties like enaction that move underneath the conceptual processes of sensemaking.
Interestingly, Anderson, Lau, Segal, and Bishop (2007), in the first-ever study relating mindfulness to attention, tested the hypothesis that mindfulness involves sustained attention, attention switching, inhibition of elaborative processing, and nondirected attention. The conclusion of this study was that mindfulness might be more closely aligned with changes in the quality of awareness of present-moment experiences than basic attentional abilities. This conclusion suggests that mindfulness is necessary to maintain awareness of current experience.
Focused mental attention (Fiol & O’Connor, 2004), moment by moment, appears analogous to becoming aware (Depraz, Varela, & Vermersch, 2003). The concept of awareness is generally thought of as a “human’s capability of perception and the cognitive effort related to an apperception task” (Muller, 2007, p. 109). Awareness, according to Depraz et al. (2003), is “coming to know in the first person” (p. 2).
Maturana and Varela (1987), Varela et al. (1993), Varela and Shear (1999a, 1999b), and
Depraz et al. (2003) offered a living systems view or biological perspective of awareness that posited that neural systems within human beings provide more information than cognitive areas of the brain can assimilate. These neural systems are cognitive systems and, as such, suggest that awareness is present at organic levels that are not typically considered to be aware. A central idea around mental acts (i.e., awareness, visioning, imagining, etc.) in the living systems approach is that the various cognitive systems
5 “require a frame or window of simultaneity that corresponds to the duration of the lived present” (Varela & Depraz, 2005).
The lived present, according to Varela and Depraz (2005), is a “transient coherency-generating process of the [human] organism” (p. 212). In other words, neural events coalesce in such a way as to provide a “synchronous glue” that allows for a reference point to emerge, become stabilized, and express the behavioral synchronicity of neural and cognitive systems and then to provide a reference point from which a transiently stabilized sense of perception emergences (Varela & Depraz, 2005).
The multiple dimensions of sensemaking have garnered a great deal of attention in managerial and organizational cognition and research, producing numerous theoretical, methodological, and empirical works on its characteristics, how it has emerged, and how it functions in organizations (Allard-Poesi, 2005). Interestingly, Allard-Poesi (2005) examined methodological approaches used in sensemaking research and discovered that sensemaking researchers relied on grounded approaches that sought to capture people’s understanding and “through systematic comparison techniques aim to reveal regularities and systematic associations in the structuring process of sensemaking and organizing”
(p. 171). Consequently, sensemaking research involves a fundamental paradox—“it defines reality and meaning as socially constructed, yet it seeks to disengage from that experience and objectify it” (Allard-Poesi, 2005, p. 171). Allard-Poesi (2005) presented an important point, one that has implications for this researcher: “In seeking to disengage itself from subjective experience and objectivity, sensemaking research undermines, and may even lose, the fluid, tensional and fundamentally problematic view of sensemaking and organizing it attempts to convey” (p. 177).
6 While sensemaking has been conceived as both a cognitive and social process
(Weick, 1995), to date, the enactive, participatory, and phenomenological nature of sensemaking has remained relatively underresearched in organizational science (De
Jaegher & Di Paolo, 2007). By exploring sensemaking and awareness as a present- moment experiential process, this research attempted to expand our understanding of sensemaking as a dynamic, nonlinear, present-moment–oriented phenomenon.
Significance of the Study
The notion of complexity (Schwandt, 2008) has emerged in human and organizational studies, creating a shift from seeing reality as static models, theories, and stable patterns to seeing reality as a stream of direct experiences that are emergent and often unpredictable. This shift encourages us to see organizations as complex adaptive systems, which often generate novel behavior (Buckley, 2001; Marion & Uhl-Bien, 2001;
Schwandt, 2008). Reuben McDaniel, in a personal communication to Weick, summed up the current state of reality in this way:
Because the nature of the world is unknowable (chaos theory and quantum theory) we are left with only sensemaking. Even if we had the capacity to do more, doing more would not help. Quantum theory helps us to understand that the present state of the world is, at best, a probability distribution. As we learn from chaos theory, the next state of the world is unknowable. And so we must pay attention to the world as it unfolds. (Weick, 2006, p. 1728)
Thomas et al. (1993) posited that because modern organizational environments have become more complex and dynamic, meaningful interpretation for patterns of ambiguous information has become a key role for top management and is seen as vital
(Maturana, 1978) to the success and survival of organizations. Similarly, Chia (2005) held that a manager’s chief skill is his or her ability to become aware:
7 Managing is firstly and fundamentally the task of becoming aware, attending to, sorting out, and prioritizing an inherently messy, fluxing, chaotic world of competing demands that are placed on a manager’s attention. It is creating order out of chaos. It is an art, not a science. Active perceptual organization and the astute allocation of attention is a central feature of the managerial task. (p. 1092)
According to Bartunek (1984) and Gioia and Chittipeddi (1991), interpretation is important in developing, sustaining, and generating newly adaptive (Schwandt, 2008) cognitive frameworks necessary in developing strategic action and change in organizations. How we shape the field of collective attention for organizational members plays an important role in organizational decision making.
Weick (1995) posited that the “substance of sensemaking starts with three elements: a frame, a cue, and a connection” (p. 110). Frames, according to Weick, are past moments of socialization, and cues are present moments of experience. When an individual constructs a relationship between a past and present moment, meaning is created (Varela et al., 1993). Thus, Weick (1995) concluded, the content of sensemaking
“is found in the frames and categories that summarize past experience, in the cues and labels that snare specifics of present experience, and in the ways these two settings of experience are connected” (p. 111)—and are constitutive of future orientations and contexts.
Past moments of socialization within organizations tend to be composed of procedures, routines, training, and systems that are designed to reduce the need for creative human involvement in the moment, in an effort to reduce error, unwanted variation, and waste and to impose order (Weick, 1995). Routines, training, and procedures, which are forms of distributed cognition, depend on a pattern match between situation and response (Weick, 2007). As such, individual perceptions are globally
8 constrained by the environment, organizational routines, and systems within which they operate (Langer, 1989a, 1989b; Weick, 2005a, 2005b). Paradoxically—and with quantum complementarity—in the same moments, local participatory sensemaking as enaction (De
Jaegher & Di Paolo, 2007) specifies or enables the global operation (Varela & Depraz,
2003).
Routines can be important tools for creating reliable performance; however, they are not without limitations. Prelearned responses (i.e., training, plans, systems, tightly controlled couplings, processes, strategies, etc.) can color perception. Individuals within organizations are less likely to detect stimuli (cues) for which they are unprepared
(Clarke, 1993; Weick, 2005a, 2007), and individuals have “affective attitudes”
(Davidson, Scherer, & Goldsmith, 2003, p. xiii) that potentially predispose them to see situations in particular ways (Fiol & O’Connor, 2003; Weick, 1979, 1993, 1995, 2005a,
2005b, 2007). When faced with emergence and complexity, as is often the case in 21st- century organizations, misperceptions and overreliance on mental models can impair organizational sensemaking and thereby reduce reliability and mindfulness (Weick &
Putnam, 2006; Weick & Sutcliffe, 2001; Weick et al., 2005).
Routine-based reliability implicitly assumes that systems and routines are rationally constructed, stable, repeatable, and reliable. If this is untrue, as recent studies suggest (March, Schulz, & Zhou, 2000; Repenning & Sterman, 2002; Elsbach, Barr, &
Hargadon, 2005), then organizational rules, processes, and systems, rather than solving the reliability problem, may in fact aggravate it by adding greater complexity, complications, and more unreliable components. Recent scholarship in organizational sensemaking has posited that highly situated cognition or contextualizing (Elsbach et al.,
9 2005; Bamberger, 2008) is a solution to individual and organizational reliability problems
(Weick & Roberts, 1993; Weick & Sutcliffe, 2001; Weick et al., 2005; Weick, 2005a,
2005b, 2006). Situated cognition, according to Elsbach et al. (2005), “is thinking that is embedded in the context in which it occurs” (p. 423). The nature of “situated cognition in organizational settings tends to be transitory, arising as the interactions of existing cognitive structures (i.e., schemas) and momentary context” (Elsbach et al., 2005, p. 424). As such, situated cognition is identified as “transitory perceptual frames that arise from the interactions of cognition and context and, in turn, direct individual’s attention, interpretations, and actions” (Elsbach et al., 2005 p. 424). Further, after reviewing 15 years of empirical case study research on cognition, Elsbach et al. (2005) suggested that “schemas and contexts appeared to come together during the cognitive processes of sensemaking” (p. 423). The view that situated cognitions are transitory or temporally bounded outcomes is contrary to other, more predominant views that cognitions based on existing schemas are relatively rational and, thus, produce predictable outcomes.
Contrary to the necessity of routines, which are potentially mindless, Kabat-Zinn
(1994), Weick (2006), Weick and Putnam (2006), and Langer (2000) introduced the notion of and need for more mindful approaches to organizing. Mindfulness-based approaches focus on reducing or eliminating situated cognition (i.e., routines, training, processes, and tightly controlled processes) as the cause of errors. Unlike routine-based approaches, a mindful response “to a particular problem is not an attempt to make the best choice from among available options, but to create options” (Langer, 1997, p. 114).
Mindfulness is about bringing insights and wisdom (Wallace, 2004, p. 11) to bear on
10 individual and organizational functioning (Weick & Putnam, 2006). “Mindfulness reveals the reality of impermanence and the necessity for continuous organizing to produce wise action” (Weick & Putnam, 2006, p. 275). From an organizational perspective, what appears to be emerging from the literature is that while routines are necessary structuring mechanisms, they are not sufficient to the tasks of reducing ambiguity and bringing certainty to complex environments. Scholarly thinking (Putnam, 2001; Weick &
Sutcliffe, 2001; Weick et al., 2005; Weick, 2005a, 2005b, 2006) suggests that a greater emphasis on awareness and clearer thinking will generate structuring in the moment to meet emerging needs and ultimately enhance organizational performance.
Sensemaking is an interpretive process in which people assign meaning to ongoing events (Weick, 1979, 1995). Sensemaking structures the unknown. The desired end result of sensemaking is for people to hold a better understanding of the uncertainties they face as they look upon the future (Weick, 1995). Kierkegaard’s belief was that life is most clearly understood backwards, but lived forward (Conway & Gover, 2002). The path to the future, however, is through the present (Tolle, 2005; Kabat-Zinn, 2005). By explicating present-moment aspects of sensemaking, new properties may be revealed that may strengthen the sensemaking perspective and bring more conscious awareness
(Depraz et al., 2003) to an organizational phenomenon that is “often implicit, tacit, preconscious, mindless, and taken for granted” (Weick, 1995, p. 114). This study attempted to offer new insights into how individuals make sense of information and how their actions influence organizational outcomes.
11 Purpose of the Study
Dominant scholarly perspectives focus on sensemaking as an ongoing process of reality construction through retrospection (Weick, 1979, 1995). Recent scholarship has indicated that sensemaking may be more “future oriented, more action oriented, more macro, more closely tied to organizing, meshed more boldly with identity, more visible, more behaviorally defined, less sedentary and backward looking, more infused with emotion and with issues of sensegiving and persuasion” (Weick et al., 2005, 409). The phenomenology of everyday organizational experience, however, involves the present
(Gioia & Mehra, 1996), but the literature remains relatively silent on the nature and process of sensemaking as a present-moment experience. The purpose of this study was to explore the present-moment aspect of sensemaking by examining how individual awareness contributes to one’s ability to make sense of the environment.
Research Question
The research question in this study explored the present-moment aspects of sensemaking by examining how awareness contributes to an individual’s ability to make sense of his or her environment. The research question was as follows: What is the role of individual present-moment awareness in sensemaking?
Conceptual Frame
The study was designed to examine individual awareness in the present moment and describe its dynamic coemergence with sensemaking. Figure 1-1 conceptualizes the two central constructs of this study: awareness and sensemaking.
12
Figure 1-1. Conceptual framework: Present-moment sensemaking.
Present-moment sensemaking is operationalized as a continuing, moment-to- moment process that conscious individuals experience as they live through events occurring around and to them.
Awareness
Awareness is defined as a conscious awareness of one’s internal and/or external environment, which is placed on present-moment experience, rather than past or future events (Cardaciotto, 2005). “Awareness is an experience,” according to Freeman (2000),
“which in neurodynamic terms is a transient state” (p. 116). Awareness is the medium through which we experience our daily activities, and it is both a cognitive process experienced phenomenologically and a neural biological process (Varela et al., 1993). It is through our experiences that we “create an understanding of the present, from which
13 action flows without need of reflection” (Freeman, 2000, p. 125). Therefore, it is through a neurophenomenological lens that this study explored the present-moment aspects of sensemaking.
Neurophenomenology is rooted in the tradition of phenomenological philosophy and has been influenced by analytic philosophy of mind and cognitive science, most specifically by the enactive approach (Thompson, Lutz, & Cosmelli, 2005).
Phenomenology, in general, can be understood as a means to examine and provide disciplined characterizations of the “phenomenal invariants of lived experience in all of its multifarious forms” (Lutz & Thompson, 2003, p. 32). The phenomenologically enactive approach was coined by Francisco Varela to describe and unify several related ideas: (1) individuals, as human beings, are autonomous agents that actively generate and maintain their identities and, thus, define their own cognitive domains; (2) the nervous system is an autonomous system, actively generating and maintaining its own coherent patterns of activity; and (3) cognitive structures emerge and coevolve from the sensorimotor couplings of body and nervous system with the environment (Varela, 1996,
1999c; Varela et al., 1993; Thompson, 2004, 2005, 2007; Lutz & Thompson, 2003;
Thompson et al., 2005). The enactive approach, which is analogous to phenomenology, emphasizes that the individual defines his or her own point of view on the world
(Thompson et al., 2005).
Neurophenomenology is, thus, a research methodology that marries first-person domain data (subjective experience) to third-person domains of brain, body, and behavior as a strategy for describing and quantifying the physiological processes relevant to consciousness (Lutz & Thompson, 2003). Herein, one can begin to better understand the
14 whole embodied mind approach. One of the goals in neurophenomenological method, according to Lutz and Thompson (2003), is to “facilitate the subject’s becoming aware of previously inaccessible or phenomenally unavailable aspects of his or her mental life”
(p. 33). Subjects play an epistemological role in explaining and characterizing experiential data, e.g., awareness (Thompson et al., 2005).
From a neurophenomenological approach, Chalmers (2007) posited awareness as a functional concept that is linked to conscious experience. “Wherever we find consciousness, we find awareness” (p. 362). Specifically, awareness is the “cognitive underpinnings of experience” (p. 362) and, as such, there is a “direct correspondence between consciousness and awareness” (p. 362). Chalmers encouraged us to think of awareness as “direct availability for global control” (p. 362). By this Chalmers meant that “the contents of awareness are to be understood as those information contents that are accessible to central systems, and brought to bear in a widespread way in the control of behavior” (p. 362). Chalmers (2006, 2007) and Freeman (2000) contended that the isomorphism between the structures of consciousness and awareness constituted the principle of structural coherence. As such, this principle reflects the “central fact that even though cognitive processes do not conceptually entail facts about conscious experience, consciousness and cognition do not float free of one another but cohere in an intimate way” (Chalmers, 2006, p. 241).
Thompson et al. (2005) posited that for an experience to be given as one’s individual experience is to be aware. Further, for one to be aware of an experience is to be self-aware and to be acquainted with an experience from within, i.e., first-person perspective. In other words, “perceptual experience involves a non-intentional and
15 implicit awareness of one’s lived body, an intransitive and pre-reflective bodily self- awareness” (Thompson, 2005). According to Thompson and Zahavi (2007):
Such self-manifesting awareness is a primitive form of self-consciousness in the sense that (i) it does not require any subsequent act of reflection or introspection, but occurs simultaneously with awareness of the object; (ii) does not consist in forming a belief or making a judgment; and (iii) is passive in the sense of being spontaneous and involuntary. (p. 76)
Awareness manifests through the process of epoché, which is a prereflective moment where all beliefs and assumptions about how the real world operates are suspended. One’s own consciousness during epoché is subject to immanent critique as a means to gain a firmer grounding in consciousness by enabling one to see the world without the framework of science or the psychological assumptions of the individual
(Varela & Shear, 1999a, 1999b; Depraz et al., 2003; Thompson & Zahavi, 2007). The process of epoché can be viewed as a practiced mental gesture of shifting one’s attention from how an object appears to one’s experience of the object (Thompson & Zahavi,
2007). The mental gesture of epoché and momentary suspension of judgment allow awareness to emerge and concurrently contain the properties of awareness.
At its core, awareness is the process of turning inward and suspending one’s habitual patterns of thinking; redirecting one’s inward attention to the source of thought when something new arises; and letting go of assumptions and memories. This process results in the changing of the quality of one’s attention from looking for to letting come,
“to receive that which manifests itself there” (Varela & Shear, 1999a, 1999b; Varela,
Depraz, & Vermerche, 2000; Depraz et al., 2003).
From a bioadaptive perspective (Maturana & Varela, 1980), awareness is seen as an “end stage experience that results from the filtering and processing of the several
16 possible experiences going on in our bodies and brains” (Vaneechoutte, 2000, p. 10). The bioadaptive view is that “knowledge is the result of an ongoing interpretation that emerges from our capacities of understanding. These capacities are rooted in thstructures of our biological embodiment but are lived and experienced within a domain of consensual action and cultural history” (Varela et al., 1993, p. 149). In other words, these capacities are what enable us to make sense of our world (Varela et al., 1993). According to Vaneechoutte (2000), human awareness is possible because of our use of symbolic language as a means to “take distance of the current aware experience, and to observe it as if we were a third person looking at ourselves” (p. 16). Hence, awareness is often referred to as a “second-person” process, not as a first- or third-person phenomenon.
Symbolic language allows us to code and store experiences in our brains, separate from the places where our experiences themselves are stored and, as such, provides us with an internal separate frame of reference (Vaneechoutte, 2000).
For the purpose of this study, awareness is defined in a bioadaptive manner
(Maturana & Varela, 1980) as the enaction of embodied mind (Varela et al., 1993) that is experienced, moment by moment, during perception of the environment and is understood as a transient experience (Freeman, 2000). This definition takes into account key bioadaptive axioms: (1) living systems are autonomous; (2) experience is an intrinsic characteristic of biochemical processes; (3) the relationship of human systems with their environment is one of unity and coevolution (dependent origination); and (4) the phenomenon of awareness is transient (Varela et al., 1993; Maturana, 1975; Maturana &
Varela, 1987; Freeman, 2000).
17 An important consideration for this study is how one creates the conditions for awareness to manifest itself. Recent scholarship and empirical research (Kabat-Zinn,
1990, 2003; Weick & Putnam, 2006) suggest that mindfulness may play a significant role in the emergence of awareness. Mindfulness has been adopted by the psychological community as an approach for increasing awareness and responding to mental processes that contribute to emotional distress and maladaptive behavior (Bishop et al., 2004).
Moreover, it is becoming increasingly evident that, as mutually constraining and mutually specifying processes of mind (Varela & Depraz, 2003), cognition and emotion
(affectivity) are inextricably linked. And further, in affective science (Davidson et al.,
2003), affectivity and emotion have valence, both positive and negative, which serves to constitute our life and the organizations in which we participate (Varela & Depraz, 2005).
Recently, mindfulness has been examined by the organizational science community as a possible aid in achieving accuracy in rapidly changing decision environments (Fiol &
O’Conner, 2003; Weick, 2005a, 2005b, 2006; Weick & Sutcliffe, 2001; Weick &
Putnam, 2006). Mindfulness appears to be a practice that sets the conditions for awareness to emerge.
Mindfulness
Mindfulness has been described as a process of bringing a certain quality of attention to moment-to-moment experiences (Kabat-Zinn, 1990). Bishop et al. (2004) posited mindfulness as a “mode of awareness that is evoked when attention is regulated”
(p. 234). This study adopted Kabat-Zinn’s (2003) definition of mindfulness as
“awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (pp. 145-146). This
18 kind of mental state, according to Kabat-Zinn (1994), “nurtures greater awareness, clarity, and acceptance of present-moment reality” (p. 4).
Mindfulness is not, as perceived in the popular literature, a relaxation or mood management technique, but rather is mental training, practice, and discipline—not unlike an art form—to reduce cognitive vulnerability to reactive modes of mind and, as such, is a skill that can be developed and realized with practice (Varela et al., 1993; Bishop et al.,
2004; Lutz & Thompson, 2003). According to Varela et al. (1993), Bishop et al. (2004), and Lutz and Thompson (2003), mindfulness practice can bring insight into the nature of one’s own mind in operation and a decentered perspective on thoughts and feelings
(affectivity) so that they can both be experienced in terms of wholeness, intersubjectivity, and their transient nature. For the purpose of this study, mindfulness is viewed as a
“process of regulating attention in order to bring a quality of nonelaborative awareness to current experience and a quality of relating to one’s experience within an orientation of curiosity, experiential openness, and acceptance” (Bishop et al., 2004, p. 234).
Bishop et al. (2004) posited that the practice of mindfulness brings awareness to current experience by allowing individuals to observe and attend to the changing field of their thoughts, feelings, and sensations, from moment to moment, by regulating the focus of attention. This ability is described as leading to “a feeling of being very alert to what is occurring in the here-and-now . . . as a feeling of being fully present and alive in the moment” (Bishop et al., 2004, p. 232). Sustained attention, according to Bishop et al.
(2004), is the “ability to maintain a state of vigilance over prolonged periods of time”
(p. 232).
19 Mindfulness appears to be a means to cultivate awareness of what exists in the present moment (Kabat-Zinn, 1990), thereby allowing an individual’s innate ability to recognize thoughts and emotions as they arise (Bishop et al., 2004). Mindfulness offers a direct, intimate experience with whatever is happening internally and/or externally to an individual over a prolonged period of time (Bishop et al., 2004). Recent scholarship suggests that mindfulness might be more closely aligned with changes in the quality of awareness of present-moment experience than basic attentional abilities (Anderson et al.,
2007).
Sensemaking
Weick (1995) initially conceptualized sensemaking as both an individual and social process through which meaning is formed, with that meaning constraining identity and action. Sensemaking contains seven core properties that distinguish it from other explanatory processes such as understanding, interpretation, and attribution. Sensemaking is retrospective (Weick, 1979, 1995; Gioia & Chittipeddi, 1991; Thomas et al., 1993;
Nathan, 2004; Weick et al., 2005); we begin to make sense of something as we have experienced it. Sensemaking is also prospective (i.e., future oriented) and thereby connected to action; the end result of sensemaking is that individuals will hold a better understanding of the uncertainties they face as they look upon the future (Weick, 1995;
Nathan, 2004; Weick et al., 2005). While sensemaking is both retrospective and prospective, it also takes place through the filter of one’s current experience (Weick et al., 2005); to stay in the flow of experience is to focus on the “here” and “now” of life— the present. Thus, sensemaking is about bringing meaning into existence, meaning that is
20 stable enough for one to act into the future and to give one a sense of remaining in touch with the continuing flow of experience (Weick et al., 2005).
Weick’s notion of action and remaining in touch with the flow of experience is embedded in his concept of “enacted environments,” whereby individuals produce part of the environment they encounter by bracketing and constructing portions of the flow of experience (Weick, 1979, 1995; Weick et al., 2005). Enactment is intimately bound up with the concept of “ecological change” [“global transformation”] (Varela & Depraz,
2005), which consists of discontinuities, differences, or variations to the flows of experience that cause individuals to pay attention to their environment (Weick, 1979;
Weick et al., 2005). Weick et al. (2005) suggested that through action and/or discourse, an individual responds to his or her external environment and thereby creates a version of it and acts out a relationship with it (i.e., enacting it), which the environment responds to with enactment of its own. In other words, there is a dynamic, self-organizing relationship of mutual influence between an individual and his or her environment.
Weick’s constructs of “enactment” and “ecology of change” seem parallel to Maturana and Varela’s (1987), Varela et al.’s (1993), and Thompson’s (2004, 2005, 2007) bioadaptive concept of “enactment” and “mutual specification” or “codetermination,” and, more specifically, Thompson’s (2007) “dynamic co-emergence.” In this view, sensemaking in its bioadaptive nature—the enactive approach—during localized reflexivity also generates meaning (if only tacit or prereflective) that moment by moment can also specify rather than constrain identity and action, thereby enacting the environment, global identity, and action.
21 In the bioadaptive nature of enactment, the foundation of an individual’s nervous system is to
couple movement [action] and a stream of sensory information in a continuous circular fashion [flow of experience]. . . . The nervous system establishes and maintains a sensorimotor cycle, whereby what the animal [human being] senses depends directly on how it moves, and how it moves depends directly on what it senses. (Thompson, 2005, p. 418)
The bioadaptive nature of enactment, then, is one’s awareness of seeing and hearing, smelling, tasting, touching, and even awareness of one’s own thought processes (Varela et al., 1993). At the biological level, sensemaking is “the point at which [human] cognition and environment become simultaneously enacted” (Varela et al., 1993, p. 177).
Weick et al. (2005) suggested that the concept of enacted environments warrants further attention and development; the bioadaptive approach may offer insights into how enaction operates as a process of sensemaking.
Assumptions
This study’s focus combined the complementarity of Weick’s sensemaking perspective (Weick, 1979, 1995; Weick et al., 2005; Weick & Putnam, 2006) and
Varela’s concept of embodied mind (Varela et al., 1993; Depraz et al., 2003; Thompson,
2004, 2005, 2007). Additionally, this study carried several assumptions: organizing is a pluralistic and fluid process (Hollander, 1992) and correlational, interactive, and random
(Marion & Uhl-Bien, 2001; Thompson, 2007; Schwandt, 2008); people and organizations are living systems—they create themselves, self-organize, and have a sense of awareness
(Maturana & Varela, 1987; Depraz et al., 2003); time has a subjective quality because it exists through lived experience (Varela, 1999b; Varela & Shear, 1999a, 1999b; Lutz &
22 Thompson, 2003; Thompson, 2007); and living entails sensemaking (Maturana & Varela,
1987; Varela et al., 1993; Varela, 1999b; Thompson, 2004, 2007). Individuals are “hard wired” to process internal and external information as a means to adapt and survive
(Borkovec, 2002). Individuals are influenced by these biological, environmental conditions and processes and, thus, individual awareness and one’s ability to make sense are subject to these biological and environmental factors.
Additionally, given the implications and theoretical framework of this study, this research was grounded in a constitutive ontology (Maturana, 1978) to better account for how emergence operates, in addition to a transcendent ontology, which obscures or neglects emergence. Further, through communications in living systems—defined by
Maturana and Varela (1980) as the coordination of behavior—meaning is a process in language, and constitution is “the process of providing an ever clearer meaning”
(Strasser, 1969). Moreover, following Bateson (1979), information was defined in this study and in communication as “any difference that makes a difference” to sentient, sensemaking human beings. This means that smell, taste, touch, sight, hearing, awareness, emotioning, and languaging (Maturana, 1978) are all sensemaking, sensegiving phenomena.
Summary of Methodology
The purpose of this study was to explore the present-moment aspects of sensemaking by examining the role of individual awareness and how it influences one’s ability to make sense of his or her environment. Such an exploration requires a research approach that can explore the connection between mind and consciousness, which is the structure of human experience itself (Lutz & Thompson, 2003; Varela, 1996, 1999b;
23 Varela & Shear, 1999a, 1999b; Thompson & Varela, 2001; Thompson, 2004, 2005,
2006). The case study research and method selected for this study of human experience was phenomenology, which operates through a complex system of ideas associated with the works of Husserl, Heidegger, Sartre, Merleau-Ponty, and Schutz (Creswell, 1998).
Phenomenology strives to “bracket” reality and discover the true meaning of the phenomenon under study through first-person accounts (Moustakas, 1994). First-person methods, such as phenomenology, are used to explore aspects of individual experiences that would otherwise remain unnoticed, such as transient affective states or quality of attention (Harrington & Zajonc, 2006). Phenomenology, according to Moustakas (1994),
“is the first method of knowledge because it begins with ‘things themselves’; it is also the final court of appeal” (p. 41).
A single case study approach, following Lincoln and Guba’s (1985) naturalistic inquiry, was used within an organizational setting to bound the study by time, location, individuals, and event and, thereby, provide a “naturalistic basis for generalization”
(p. 120). The study took place at a large healthcare organization and involved a consequential “precipitating event” (bracketing) that the participants in the case study were all exposed to at the same time, including the researcher. This “precipitating event” was a crucial aspect to the study, as “consequential interruptions” are occasions for sensemaking (Weick, 1995).
Potential participants were approached via a written solicitation letter and an information sheet that instructed them on the purpose of the study, how the information collected from the study would be used, how their anonymity would be protected, and how to respond to the inquiry if they were interested in participating. After agreeing to
24 participate and signing an informed consent form, participants were provided with a journal and instructed to write down their thoughts as the event took place. Instructions were given to the participants on the value and method of writing down their thoughts in the journals and how they should go about writing down emergent thoughts. Shortly following the event, the participants were interviewed to gain insights into the processes they used to make sense of the event. Participants’ journals were also used during the interviews to probe for deep understanding around individual sensemaking processes.
The researcher used her experience surrounding the event as a means to explore, probe, and verify the data being collected.
In an effort to accurately interpret and analyze the data from the interview, the researcher conducted member checks (Lincoln & Guba, 1985) by providing the verbatim transcripts of the one-on-one interviews to the participants to determine the accuracy of the data. Using the experience of the researcher and the data collected through the participant interviews and journals, the researcher triangulated (Lincoln & Guba, 1985;
Miles & Huberman, 1994) the data sources to build a coherent justification for emergent themes. Additionally, this study was peer reviewed (Lincoln & Guba, 1985) to enhance the accuracy of the research. Finally, the researcher provided the organization’s management and study participants with a copy of the findings so they could verify for themselves the trustworthiness of the study, which gave an additional level of credibility to the research study (Creswell, 2003).
Delimitation of the Study
This phenomenological study was confined to observing and interviewing a single case, whose members were all employed by a large healthcare organization. Purposive
25 sampling (Lincoln & Guba, 1985) was used to select individuals within the healthcare organization for participation in this study.
Limitations of the Study
The study was limited by the nature of sensemaking, which is the subjective interpretation of data. How this researcher interpreted and made sense of the data may not accurately reflect the sensemaking of others. To counter this limitation, the researcher went beyond the use of personal observations and interviews to include member checking and peer debriefing as a means to check the accuracy of the findings and, thereby, increase credibility (Creswell, 2003). Further, the study was limited by the experience of the participants and the organizational context of the research site. Because qualitative research occurs in a natural setting, it would be difficult to replicate the study (Lincoln &
Guba, 1985). Additionally, the case study approach of this study limits the generalizability of the findings to other organizational settings. No qualitative study is thought to be generalizable in a statistical sense; the study’s findings can be thought of as transferable. The aim of phenomenological research is to understand the experiences of participants; it does not attempt to generate laws (Lincoln & Guba, 1985). The goal of this phenomenological research was to give the reader a deeper understanding of how sensemaking takes place in the present moment.
Summary
In an effort to explain the problem, purpose, and significance of the study, an overview of the literature was provided. The literature in this research spans sensemaking as a psychosocial process and as a bioadaptive process. As has been noted, dominant
26 scholarly perspectives have tended to view sensemaking using a psychosocial lens, which is rooted in social constructivism and sees retrospection as a central and distinguishing characteristic of the phenomenon. Yet, recent scholarship around sensemaking suggests that other key properties of sensemaking have been underdeveloped and should be explored—properties such as its present and future orientations (Weick et al., 2005;
Maitlis & Sonenshein, 2010). This research explored the present-nature aspects of sensemaking using a biological lens. In this way, the study took into account the sentient, prereflective qualities of human experience (Varela et al., 1993) and gave “attention to the body that houses the thinking mind and interacts with bodies and material things”
(Bakke & Bean, 2006, p. 57). It is to a review of this literature that we now turn in an effort to facilitate a deeper understanding of sensemaking, its biological roots, and awareness as a foundational process of mindfulness.
Definition of Terms
For clarity of understanding, the following is a list of terms that are used throughout this study.
Affective perception: An embodied position whereby one is affectively influenced in acts
of attending, judging, valuing, wishing, etc. (Thompson, 2007).
Atemporality: Concept that one cannot perceive time as a physical reality. Time is an
“observer effect.” The passage of time is actually the perception of material
change that runs into physical space. Time only exists when we measure it (Sorli
& Sorli, 2005).
Attention: The capacity to selectively process information that is available to us
(Harrington & Zajonc, 2006).
27 Awareness: A transient experience (Freeman, 2000), characterized as a process that
involves suspension, letting go, and redirecting one’s attention (Varela et al.,
1993) and being present with one’s mind and body to the experiences of everyday
life (Depraz et al., 2003).
Cognitive conception: One’s relationship to the world of symbols that represent thought
and beliefs about the world (Freeman, 2000).
Decision making: “The process of choosing between options” (Fellows, 2004, p. 159)
Dialogue: A shared inquiry, a way of thinking and reflecting with others. In essence, a
dialogue is a flow of meaning (Bohm & Peat, 1987; Isaacs, 1999).
Embodied wisdom: A form of cognition that comes from having a physical body with
sensorimotor capabilities that are themselves embedded in an encompassing
psychological, social, and cultural context.
Enaction: Cognition that emerges and coevolves upon experience that originates from
having a body with various sensorimotor capacities and by virtue of being
embedded in an encompassing biological, psychological, and cultural context
(Varela et al., 1993).
Intentional behaviors: The directing of an action toward some future goal that is defined
and chosen by an actor (Freeman, 2000).
Interaction: The mutual interdependence (i.e., coupling) of the behaviors of two social
agents (Stewart, Gapenne, & Di Paolo, 2010).
Intersubjectivity: Either (1) the experience of the bodily presence of the other—the face-
to-face experience of self and other or (2) the generative intersubjectivity of
28 communally handed down norms, conventions, and historical traditions
(Thompson, 2007).
Mindfulness: “Awareness that emerges through paying attention on purpose, in the
present moment, and nonjudgmentally to the unfolding of experience moment by
moment” (Kabat-Zinn, 2003, pp. 145-146). This kind of mental state, according to
Kabat-Zinn (1994), “nurtures greater awareness, clarity, and acceptance of
present-moment reality” (p. 4).
Mindlessness: Lack of awareness of self and one’s environment (Weick & Sutcliffe,
2001).
Objective reality: Existing independent of mind; being observable or verifiable especially
by scientific methods; expressing or involving the use of facts; “consisting in
taking the idealized formulations of mathematical physics as descriptions of the
way the word really is independent of the knowing subject” (Varela et al., 1993,
p. 17).
Phenomenological reality: Based on subjective experience. Moustakas (1994)
emphasized that the meaning of a phenomenon is in the act experience and not in
the object (p. 51).
Phenomenology: A study that describes the meaning of the lived experiences for several
individuals about a concept or a phenomenon (Creswell, 1998).
Presence: A state of awareness that leads beyond one’s preconceptions and historical
ways of making sense (Senge, Scharmer, Jaworski, & Flowers, 2004).
29 Present-moment sensemaking: A continuous, moment-to-moment process that conscious
individuals experience as they examine and process events occurring around and
to them (Power, 2006).
Present-time consciousness: An approach to temporality, in which lived experience and
its natural biological basis are linked by mutual constraints provided by their
respective descriptions (Varela, 1999b).
Self-organizing: Phenomena that determine their own form and processes through
dynamic coemergence, in which part and whole coemerge and mutually specify
each other (Thompson, 2007).
Sensemaking: To make something sensible (Weick, 1995).
Social constructive perspective of sensemaking: A view of reality as an ongoing
accomplishment that takes form as people make retrospective sense of the
situations in which they find themselves (Weick, 1995).
Social reality: A product of a given culture, which forms the basis for assumptions that
guide the actions of individuals within organizations (Schein, 2004). Weick
(1979, 1995) maintained that within organizations, a phenomenon is made real by
speaking and acting in ways that give it tangibility; in other words, we make
something real by establishing a language to talk about it.
Subjective reality: Relating to or determined by the mind as the subject of experience;
characteristic of or belonging to reality as perceived rather than as independent of
mind; phenomenal; arising out of or identified by means of one’s awareness
(Thompson, 2007).
30 Temporality: The condition of being bound in time, having three parts: (1) temporal
objects and events, which ground notions of temporality in physics and
computation, (2) acts of consciousness, which constitute the “internal time” of
acts of consciousness, and (3) absolute time constituting flow of consciousness,
where no internal-external distinction is possible (Varela, 1999b, 1999c).
Transient: A sensation of time as an irreversible stream, moving from past to future
experienced in the present (Varela, 1999b).
31 CHAPTER 2:
LITERATURE REVIEW
This review of literature provides a contextual framework for this study by presenting the theories and relevant research that support it. The literature review is presented in four sections: (1) sensemaking as a psychosocial process; (2) sensemaking as a biological process; (3) awareness as a process to access individual experience; and (4) mindfulness as a form of awareness.
Sensemaking as a Psychosocial Process
The concept of sensemaking is 40 years old, having been first introduced into the organizational literature by Karl Weick. Sensemaking literally means “the making of sense” (Weick, 1995, p. 4). Central to sensemaking is the notion that organizational members make sense of disruptions to the organizing process as a means to reduce ambiguity and uncertainty so that action can be taken (Weick, 1979, 1995). Ambiguity, according to March (1994), is different from uncertainty. Ambiguity is a lack of clarity or consistency in reality, causality, or intentionality. A different kind or quality of information can reduce ambiguity (Weick, 1995). Ambiguity can be thought of as multiple interpretations of what you are trying to accomplish (Hatch, 1997). In contrast, uncertainty is the inability to accurately predict an event (March, 1994), which can be brought about by too much information (Hatch, 1997). In both cases, the assumptions necessary for rational decision making cannot be met, and that acts as a trigger for sensemaking (Weick, 1995).
32 Sensemaking contains seven core properties that distinguish it from other explanatory processes such as understanding, interpretation, and attribution. Weick described these sensemaking characteristics in two seminal works, The Social Psychology of Organizing (1979) and Sensemaking in Organizations (1995). Weick’s sensemaking properties are as follows.
1. Grounded in identity construction. According to theorists, sensemaking processes result from the need within individuals to have a sense of identity (Turner,
1987; Weick, 1995). Accordingly, “controlled, intentional sensemaking is triggered by a failure to confirm one’s self . . . [and] occurs in the service of maintaining a consistent, positive self-concept” (Weick, 1995, p. 23). Additionally, “people learn about their identities by projecting them into an environment and observing the consequences. . . .
Individuals make sense of whatever happens around them by asking, what implications do these events have for who I will be?” (Weick, 1995, p. 23). Sensemaking, then,
“informs and constrains identity and action” (Weick et al., 2005, p. 409).
2. Retrospective. One of the central aspects of sensemaking is its retrospective quality, which is most notable in Weick’s work (1979, 1995; Weick et al., 2005).
According to Weick (1995), the notion of retrospective sensemaking was inspired by
Schutz’s (1967) analysis of “meaningful lived experience” (p. 24), where lived is expressed in the past tense to “capture the reality that people can know what they are doing only after they have done it” (Weick, 1995, p. 24). Sensemaking, then, involves the
“ongoing retrospective development of plausible images that rationalize what people are doing” (Weick et al., 2005, p. 409). In other words, we begin to make sense of something
33 as we have experienced it (Weick, 1979, 1995; Gioia & Chittipeddi, 1991; Thomas et al.,
1993; Nathan, 2004; Weick et al., 2005).
3. Enactive of sensible environments. Weick (1995) used the word “enactment” to emphasize that in “organizational life, people often produce part of the environment they face. . . . People are very much a part of their environment. They act, and in doing so create the materials that become the constraints and opportunities they face” (Weick,
1995, p. 31). In other words, there is no objective environment separate from one’s interpretation of it. Thus, we create or enact parts of the environment through selective attention and interpretation. Interpretation can shape the environment more than the environment shapes the interpretation. Individuals act and actions become part of the environment and thereby constrain future actions (Daft & Weick, 1984). Weick (1979) posited that “action, perception, and sense-making exist in a circular, tightly coupled relationship that resembles a self-fulfilling prophecy” (p. 159).
4. Social. Cognitive and social aspects of sensemaking are inextricably linked.
According to Weick (1995), “those who forget that sensemaking is a social process miss a constant substrate that shapes interpretations and interpreting” (p. 39). Individuals are integral to our efforts to make sense of events within our environment because what we say or think or do (action) is contingent on what others say and think and do (Schutz,
1967). Even when we are alone, we imagine the response of others to our actions or thoughts and adjust our thinking and behavior accordingly (Mead, 1934). Sensemaking requires interaction, conversation, and discourse “because this is how a great deal of social contact is mediated” (Weick, 1995, p. 41).
34 5. Ongoing. Individuals within organizations find themselves “in the middle of things” (Weick, 1995, p. 43). As we move from one situation to another, we make and revise assumptions and beliefs along the way. Sensemaking, therefore, is ongoing—it has no real beginning and no formal end; it is a process. To understand sensemaking, according to Weick (1995), “is to be sensitive to the ways in which people chop moments out of continuous flows and extracted cues from those moments” (p. 43). Individuals make sense of past events to develop a story that they understand, and as future events unfold, they revise their story (Weick, 1979, 1995; Weick et al., 2005). Sensemaking takes place in a continuing and dynamic way as events unfold and individuals continually seek to understand what events mean in relationship to them and the organization (Weick,
1979, 1995; Weick et al., 2005).
6. Focused on and by extracted cues. Sensemaking is created by individual focus and through extracted cues. Individuals notice certain things and not others. Individuals pay attention and extract cues from their environment, then link the cues with some other idea that clarifies the meaning of the cue, which then alters the more general idea to which they linked the cue, and so on. Extracted cues enable individuals to act in organizations, which increases their confidence and confirms their faith in earlier cues. In other words, “once people begin to act (enactment), they generate tangible outcomes
(cues) in some context (social), and this helps them discover (retrospect) what is occurring (ongoing), what needs to be explained (plausibility), and what should be done next (identity enhancement)” (Weick, 1995, p. 55).
7. Driven by plausibility rather than accuracy. “Sensemaking is not about truth or getting it right” (Weick et al., 2005, p. 415). Sensemaking is driven by plausibility, not
35 accuracy. Plausibility helps individuals explore what they see and energizes them to act.
Accuracy, on the other hand, tends to de-energize individuals as it results in a protracted search, taking them through multiple meanings and embellishment of events. According to Weick (1995), “Sensemaking is about accounts that are socially acceptable and credible.” (p. 61). In other words, “filtered information is less accurate but, if the filtering is effective, it is more understandable” (Starbuck & Milliken, 1988, p. 41) and it shortens the process.
Weick (1995) conceptualized sensemaking as both an individual psychological and social process by which meaning is formed that constrains identity and action.
Sensemaking in organizations is assumed to operate on retrospection (Weick, 1995)—we often begin to make sense of something as we have experienced it—and, yet, sensemaking is also prospective (future oriented) and, according to Weick et al. (2005), thereby connected to action. The concepts of action and protention are fundamental to the work of Schutz (1967), who posited that “every action is a spontaneous activity oriented toward the future” and is “a property of all primary constituting processes, whether these arise from spontaneous activity or not” (p. 57). While sensemaking is both retrospective and prospective, it also takes place through the filter of one’s current experience (Weick et al., 2005); to stay in the flow of experience is to focus on the “here” and “now” of life—the present moment. Thus, sensemaking is about bringing meaning into existence, meaning that is stable enough for one to act into the future and to give one a sense of remaining in touch with the continuing flow of experience (Weick et al., 2005). Nathan
(2004) further posited that sensemaking is about “strategic rationality and clear questions and answers that help remove ignorance” and about “contextual reality that has been built
36 from vague questions, muddy answers, and negotiated agreements” (p. 183). According to Weick et al. (2005), however, the present- and future-oriented properties of sensemaking are underdeveloped.
Sensemaking is also “infused with emotion” (Weick, 1995; Weick et al., 2005).
Weick (1995) and Weick et al. (2005) posited that “an interruption to a flow typically induces an emotional response,” and it “is precisely because ongoing flows are subject to interruption that sensemaking is infused with feeling” (Weick, 1995, p. 45). According to
Dougherty and Drumheller (2006), affect has been an undervalued property in sensemaking until recently. Magala (1997), Dougherty and Drumheller (2006), Bartunek,
Rousseau, Rudolph, and DePalma (2006), Maitlis and Sonenshein (2010), and even
Weick et al. (2005) called for a fuller understanding of the role of emotion in the sensemaking process.
Dougherty and Drumheller (2006) observed, “Organizations tend to be guided by a rationality/emotionality duality in which rational behavior is privileged over emotional behavior” (p. 215); thus, emotions are undervalued. Bartunek et al. (2006) showed a connection to the role of sensemaking and emotion in a change initiative from the change recipients’ point of view. According to Bartunek et al. (2006), there is “some relationship between affect and understandings of the intervention” (p. 203), and they speculated that it may be that affect experienced by individuals is a means to provide an affective undertone to the meaning of the intervention. Similarly, Croswell and Gajjar (2007) posited that “emotion is the energy of transformation,” and research following that line is providing empirical evidence that emotion and cognition, i.e., sensemaking, operate with complementarity (Luna, 2009).
37 Sensemaking is meshed with sensegiving and persuasion (Weick et al., 2005).
Gioia and Chittipeddi (1991) first coined the term “sensegiving” as a way to describe the
“process of attempting to influence the sensemaking and meaning construction of others toward a preferred redefinition of organizational reality” (p. 442). Sensegiving is also an interpretive process in which actors influence each other through persuasive language
(Bartunek, Krim, Necochea, & Humphries, 1999; Gioia & Chittipeddi, 1991). Language, too, can have affective influence or valence, and Maturana (1987) and Varela and Depraz
(2003) would add that actors influence each other through persuasive emotion and affectivity. Sensemaking has to do with meaning construction and reconstruction by individuals as they attempt to develop a meaningful framework for understanding (Gioia
& Chittipeddi, 1991). According to Gioia and Chittipeddi (1991), “sensemaking” and
“sensegiving” are “iterative, sequential and to some extent reciprocal” (p. 442).
Sensemaking as a Biological Process
Sensemaking as a biological process is rooted in the theory of enaction and the work of Humberto R. Maturana and Francisco J. Varela (1980) and colleagues
(Thompson, 2007; Varela et al., 1991). The enactive approach is a general theoretical framework on the nature of biological organisms that spans a variety of research. The framework has several key properties at its core, and five are most specific to this study:
1. Autopoiesis: An account of how biological autonomous systems constitute
themselves
2. Autonomy: The capacity of living systems to maintain their identity in spite of
fluctuations that affect them
38 3. Perception: A concept that involves the structural coupling between sensory
patterns and motor activity, which is the basis for embodied action
4. Sensemaking: The constant and necessary need to supplement the autopoietic
process with what it needs to keep going
5. Neurophenomenology: An approach to the study of subjective human experience
that takes into account the dynamic coemergence and relationship between the
subjective or first-person point of view and the objective point of view of
science—or, in other words, both practice and theory.
Maturana and Varela’s theories and research, combined with a philosophical commitment to an antifunctionalist view of phenomenology, provide the theoretical foundation for this study, which sought to bridge an explanatory gap between the biological and social sciences in the area of sensemaking.
The concept of autopoiesis has multiple implications for the analysis of living systems of all kinds—biological, cognitive, and social (Morgan, 2007). Maturana and
Varela (1980) viewed living beings as living systems or machines and defined autopoietic machines as a network of “looped” processes that ensures constant regeneration and specific unity in space. A more succinct definition by Maturana (1975) defined autopoietic systems as homeostatic systems that have their own organization, which they actively and constantly maintain. Autopoiesis is the “capacity for self-production”
(Maturana & Varela, 1987). It is autopoiesis that makes living beings autonomous
(Maturana & Varela, 1980, 1987; Varela et al., 1993; Thompson, 2007). If autopoiesis gives rise to living systems, then autonomy gives living systems form.
39 Autonomy represents the biological roots of individuality and by implication identity (Maturana & Varela, 1987; Varela et al., 1993; Thompson, 2007). As such, (1) autonomous systems are defined by the processes that realize them as entities; (2) the processes are responsible for the transformation and destruction of components in the entity; (3) the network of processes is regenerated through the entity’s interactions and the transformation of components; and (4) the processes constitute the machine (living system) as a concrete entity in the space in which it exists (Maturana, 1975; Maturana &
Varela, 1980; Varela et al., 1993; Thompson, 2007). Varela (1980, 1997), Varela et al.
(1993), Thompson (2007), and Rudrauf et al. (2003) posited that living systems strive to maintain an identity by subordinating all changes to the maintenance of their own organization as a given set of relationships. This is accomplished through circular patterns of interaction—change in one area of the system is coupled with change in other areas—setting up dynamic coemergence and continuous patterns of interaction that are always “self-referential.” A machine (i.e., living system) is self-referential in that it cannot enter into interactions that are not specified in the pattern of relationships that defines its organization. Further, a system’s interaction with its environment is a part of its own organization (Rudrauf et al., 2003); said another way, a system interacts with its environment in a way that facilitates its own self-production, but this self-production has boundaries.
A key feature of the framework of autonomy is the concept of “closure.”
Organizational closure (sometime called operational closure), according to Maturana and
Varela (1987), is a system’s material boundaries and “specifies the domain of interaction of the system with its surroundings, conditioning its possible ways of coupling with the
40 environment” (Rudrauf et al., 2003). To say that a living system is closed is not to suggest that it is isolated, but rather that living systems close in order to maintain themselves through stable patterns of relations and that it is this process of closure or self-reference that ultimately distinguishes a system as a system (Thompson, 2007;
Rudrauf et al., 2003).
Human beings, thus, are biophysically autonomous systems that are spatially and functionally distributed (Rudrauf et al., 2003), which means that humans and their environments are highly structured dynamical systems or “mutually embedded systems”
(Thompson, 2007). Closure does not mean that a system is materially and energetically closed to the outside world, in fact, quite the contrary. Autonomous systems exchange matter and energy with their surroundings (Thompson, 2007). An autonomous system is always structurally coupled with its environment (Maturana & Varela, 1987; Varela et al., 1993; Thompson, 2007); as such, each element or component of the living system combines the maintenance of itself with the maintenance of the other, thus “coproducing” their world (Maturana & Varela, 1987; Varela et al., 1993; Rudrauf et al., 2003;
Thompson, 2007). The notion that living systems influence their environments and are influenced by their environments is consistent with the view of Gregory Bateson (1972,
1979) and other ecological theorists who emphasize that “wholes” evolve as complete fields of relations that are mutually determining and determined. Following Maturana’s
(1978) understanding of structure’s two aspects—components and organization as relationships—Varela saw everything as connected with dependent origination, and as such, individuals are not separate nor separated from their environments. They (we) and our environment generate dynamic coemergence (Thompson, 2007). The inseparable link
41 or structural coupling between living systems and their environment is the foundation for
Varela’s concept of perception or embodied action (Varela et al., 1993).
Varela et al. (1993) described how perception and action, sensory and motor processes, and sensorimotor activities are inseparably linked (coupled) as the living system interacts with its environment. Perception is not simply embedded within and constrained by the surrounding environment; it also specifies, enables, and contributes to the enactment and constitution of the environment. The distinction between inside and outside a living system is eliminated by virtue of the fact that the “world and perceiver are one,” or in other words, “bound together in reciprocal specification and selection”
(Varela et al., 1993, 174). Thompson (2007) maintained that cognitive processes (e.g., perception) “emerge from the nonlinear and circular causality of continuous sensorimotor interactions involving the brain, body and environment” (p. 11). These cognitive processes represent the enactive or embodied view in cognitive science (Varela et al.,
1993) and bear similarities to the work of Walter Freeman (2000). Interestingly, this view is suggestive of Orton and Weick’s (1990) notion of systems design, whereby organizational components can either be loosely or tightly coupled, implying flexibility or neuroplasticity. The central idea of the embodied approach is that cognition is the exercise of skillful know-how in situated and embodied action (Varela et al., 1993;
Thompson, 2007). “Living systems are cognitive systems, according to Maturana and
Varela (1980), and living as a process is a process of cognition” (Thompson, 2004).
Varela eventually came to explain the “living is cognition” proposition as “living is sense-making” (Thompson, 2004, 2007).
42 Similarly, Alderfer (1987) posited an embedded intergroups relations theory, which holds that individuals within organizations have significant interdependent relationships with each other. Intergroup relationships, according to Alderfer (1987), have the following characteristics: group boundaries, power differences, affective patterns, cognitive formations (including distortions), and leadership behavior. Group boundaries determine membership within that group and can be both physical and/or psychological in nature. Two important concepts inherent in Alderfer’s (1980, 1987) embedded intergroups relations theory are permeability and embeddedness. Permeability refers to how a group regulates its transactions with other groups, of which groups can be overbounded, optimally bounded, or underbounded (Alderfer, 1980). Embeddedness refers to the idea of subsystems interacting within a “suprasystem” (Alderfer, 1980,
1987). In other words, intergroup relations are rooted in a larger system, that of the organization. The importance of Alderfer’s theory is that it brings together various theories relating to group relations and places them within an embedded framework, which dynamically coemerges in response to individual, group, and organizational events and effects. Alderfer’s theory parallels that of Maturana and Varela’s (1987) work, which posits that autonomous systems are always structurally coupled with their environments and “bound together in reciprocal specification and selection” (Varela et al., 1993).
Additionally, Orton and Weick’s (1990) work on the adaptive advantages of loosely and tightly coupled organizations is analogous to Alderfer’s (1980) underbounded and overbounded systems perspective.
43 Living, according to Varela (1997), is not just a matter of a cognitive process; it is also an emotive process of sensemaking—of bringing signification and value into existence. Thompson (2007) used the following representation to expand this proposition:
1. Life = autopoiesis. By this I mean the thesis that the three criteria of autopoiesis—(i) a boundary, containing (ii) a molecular reaction network, that (iii) produces and regenerates itself and the boundary—are necessary and sufficient for the organization of minimal life. 2. Autopoiesis entails emergence of self. A physical autopoietic system, by virtue of its operational closure, gives rise to an individual or self in the form of a living body, an organism. 3. Emergence of a self entails emergence of a world. The emergence of a self is also by necessity the emergence of a correlative domain of interactions proper to that self, an Umwelt. 4. Emergence of self and world = sense-making. The organism’s world is the sense it makes of the environment. This world is a place of significance and valence, as a result of the global action of the organism. 5. Sense-making = cognition (perception/action). Sensemaking is tantamount to cognition, in the minimal sense of viable sensorimotor conduct. Such conduct is oriented toward and subject to signification and valence. Signification and valence do not pre-exist “out there,” but are enacted or constituted by the living being. Living entails sense-making, which equals cognition. (p. 158)
Further, De Jaegher and Di Paolo (2007) maintained that sensemaking is an inherently active concept:
Living systems do not passively receive information from their environments, which they then translate into internal representations whose significant value is to be added later. . . . They [we] actively participate in the generation of meaning in what matters to them; they [we] enact a world [our own life]. (p. 488)
De Jaegher and Di Paolo (2007) supported Varela’s position that as an activity,
“sensemaking is intentional and expressive; it is essentially embodied in action” and, as such, “is directly affected by the coordination of movements [i.e., communication] in interaction” (p. 497). Hence, individuals are always engaged in sensemaking activities
(De Jaegher & Di Paolo, 2007). Moreover, according to Varela (1999b), in present-time consciousness we operate with double intentionality. Transverse intentionality is
44 immanent, moment-by-moment present (Senge et al., 2004), whereas longitudinal intentionality is more long-term, future oriented with a biological teleology more focused on adaptivity and conserving life, at least more so than mere short-term psychological goal attainment alone.
Further, Varela (1997) linked identity and sensemaking by positing that (1) an organism is fundamentally a self-affirming, identity-producing process based on autopoiesis; and (2) a self-affirming identity establishes logically and operationally the reference point or perspective for sensemaking and a domain of interactions. Varela
(1997) maintained that sensemaking arises from the constant and necessary need to supply the autopoietic process with what it lacks in an effort to keep going. Finally,
Varela (1997) stated that although autopoiesis is necessary for sensemaking in living systems, it is not sufficient; autopoiesis and adaptivity are jointly necessary and sufficient to account for the biological phenomenon of sensemaking. "Life is thus a self-affirming process that brings forth or enacts its own identity and makes sense of the world from the perspective of that identity” (Thompson, 2007, p. 153). The notion that we make sense of the world through the filter of our identity (i.e., one’s experiences) is complementary to
Weick’s (1979, 1995) characterization of sensemaking and is a juncture for understanding neurophenomenology.
Living beings cannot separate from their biophysical structure, and it is this point that led Varela to conceptualize a research methodology that complemented the subjective and biophysical roots of living systems (Varela et al., 1993; Rudrauf et al.,
2003; Thompson, 2007). First-person events are “the lived experience associated with cognitive and mental events” (Varela & Shear, 1999b). Neurophenomenology takes into
45 account a subjective point of view (e.g., situated cognition) by virtue of the fact that “life and mind includes that first-person dimension which is a trademark of our on-going existence” (Varela & Shear, 1999a). Varela and others at the Massachusetts Institute of
Technology contended that this first-person experience is the blind spot of normal science
(Harrington & Zajonc, 2006). Varela’s objective in developing a methodological approach to experience was (1) to introduce a disciplined interpretative framework to allow for the gathering of phenomenological data from the point of view of the subject and (2) to progressively and systematically reduce the gap between the mental (i.e., subjective) and the physical (i.e., objective) realms (Rudrauf et al., 2003; Varela & Shear,
1999a). Neurophenomenology comprises three central elements: (1) phenomenological accounts of the structure of experience; (2) dynamical models of structural invariants of experience; and (3) realization of these models in living systems (Thompson, 2007). If neurophenomenology represents a middle ground between subjectivism and objectivism
(Varela et al., 1993), how, then, does one attend to the world as it appears and as it phenomenally emerges? Jackendoff (1987) and Natsoulas (2002/2003) suggested that it is through awareness that both the mind and the outer (i.e., objective) world are revealed.
Awareness
Awareness is a direct pathway to some of our mental life and is, per se, a window on reality (Jackendoff, 1987; Natsoulas, 2002/2003). Awareness is a part of individual consciousness (Natsoulas, 2002/2003), but they are distinct concepts. The word consciousness is derived from the Latin root, conscio, which means, “what is known all together” (Bohm & Peat, 1987). Consciousness generally means “what the individual knows all together” or rather the total state of “knowingness” (Bohm & Peat, 1987).
46 Awareness is based on the word wary or aware, which means “watchfulness” or
“heedfulness” (Bohm & Peat, 1987). It is possible to have consciousness with little or no awareness. It is not uncommon for individuals to suddenly notice that their focus has been on thoughts or feelings that are unrelated to what they are doing. These unintentional mental states are examples of daydreaming, attentional lapses, or mind wandering (Smallwood & Schooler, 2006; Smallwood, McSpadden, & Schooler, 2007).
From a psychological perspective, awareness is viewed as a continuous monitoring of internal events and is the means by which humans observe (Deikman,
1996). Borkovec (2002) suggested that awareness offers an evolutionary adaptive function:
We are hard wired to process internal (e.g., primary emotional) and external information for use in our adaptation to our environment and in facilitation of our survival. These are exquisite systems, beautifully developed to serve those purposes. It makes sense, then, that my prime directive as a living organism is to accurately process new information as it becomes available to me. The only real information that is available is that which exists in the present moment. When I am paying attention to this information, I do not have to judge it, categorize it, memorize it, or think about how I might use it in the future. I merely need to pay attention to it; my information processing systems will handle the rest. The information stored will be stored in memory, and when a future event occurs in the present, I can trust that an adequate, adaptive response will be elicited, because this is precisely what these systems were designed to do. (p. 78)
From a sociological perspective, most notably Mead (1934), cognition requires awareness, which exists in a social milieu or mutual awareness. Central to the idea of mutual awareness is that the response of one individual to a stimulus can serve as a parallel stimulus to another individual exposed to the same initial stimulus and that this can lead to comparable responses from both individuals. In other words, mutual awareness implies the simultaneous and inseparable existence of two or more individuals and a level of action that is independent of them as individuals—hence the theory of the
47 social self. The self, according to Mead (1913, 1934), is central to all so-called mental experiences such as consciousness. Mead (1934) assumed that social relations are internal and that they modify the attitudes of interacting individuals. “The self acts with reference to others and is immediately conscious of the objects about it” (Mead, 1913). Further, the consciousness of meaning presupposes the existence of self-consciousness (Mead, 1922).
The content of consciousness is, however, social in origin. In other words, the consciousness of others precedes self-consciousness. In his analysis of the social self,
Mead (1913) contended that there is a “constant factor” of awareness of what we do, say, or think in the field of our consciousness. Awareness acts as a sort of inner response to one’s activities. Mead (1934) posited, “The self is not so much a substance as a process in which the conversation of gestures has been internalized within an organic form,” which suggests that awareness can be viewed as a process, which is closely aligned to the
Buddhist perspective.
The Buddhist conceptualization of awareness describes consciousness as a state that is aware of an object (Harrington & Zajonc, 2006). Buddhist tradition maintains that there are six types of awareness—five that are physical in nature (sight, hearing, smell, taste, and touch) and mental cognition. “Each type of sensory cognition is produced in dependence on a sensory basis, one of the five physical senses, and an object. This awareness arises momentarily and ceases immediately, to be replaced by another moment of awareness, and so on” (Harrington & Zajonc, 2006, pp. 126-127). The mind, according to Buddhist perspective, is not ruled by a “central unit but by competing factors whose strength [valence] varies according to circumstances” (Harrington & Zajonc, 2006, p.
127). This view seems to suggest a “synchronic perspective, e.g., Varela, in which
48 cognitive awareness and mental factors coexist and cooperate to carry out the same cognitive task” (Harrington & Zajonc, 2006, p. 128).
Awareness in the Buddhist tradition is said to be a form of scaffolding that sustains individual attention and can be cultivated through formal practice (Kabat-Zinn,
2003). The practice of cultivating awareness takes place through the directing of individual awareness to an object, thus enabling one to apprehend the nature of the object, and then repetitiously bringing one’s awareness back to the object when the mind wanders (Harrington & Zajonc, 2006). Smallwood et al. (2007) posited that “mind wandering involves a state of decoupled attention” and is related to daydreaming (p. 1).
Harrington and Zajonc (2006) suggested a complementarity between the Buddhist perspective and the cognitive scientific ways of investigating the mind:
The forte of Buddhism is its array of first-person methods for directly studying the mind by means of trained, introspective attention. The forte of science is its array of third-person methods for indirectly studying the mind, through rigorous investigation of the neural and behavioral correlates of mental phenomena. (p. 44)
The complementarity between Buddhist phenomenology and cognitive science became a cornerstone for Francisco Varela’s work on neurophenomenology. Neurophenomenology provides a bridge to the philosophical and scientific perspective of awareness and living systems theory.
Adapted from Husserl’s concept of epoché, which is stopping the flow of habitual thoughts and belief structures long enough to perceive the phenomena of the present moment, Depraz (1999), Varela et al. (1993), and Depraz et al. (2003) developed the structural dynamics of awareness, conceptualized as a three-step process for becoming consciously aware: suspension, redirection, and letting go. Becoming aware is the basic
49 process through which each individual can access his or her experience (Scharmer, 2000).
This process is illustrated in Figure 3.
Figure 2-1. Process of awareness. © Depraz et al., 2003.
The process of awareness, according to Depraz et al. (2003), is cyclical and begins with the suspension of habitual patterns of thinking. These habitual patterns are
“realist” prejudice that appears to the individual to be truly the state of the world.
Individual feelings and habitual patterns of thinking are part of a “complex web” called
‘ecology of thought’ and are the living network of memory and awareness that becomes the collective environment in which individuals live and work (Isaacs, 1999). Depraz et al. (2003) posited that suspension is a change in the attention which the subject gives to his own experience and which represents a break with a “natural or non-examined attitude.” Suspension requires individuals to move away from seeing their thoughts as certain and to expand their horizon to include different views of reality (Isaacs, 1999).
Suspending isn’t the process of ridding ourselves of existing mental models, but rather
50 becoming aware of our assumptions so that they have less influence on what we see
(Senge et al., 2004). “Suspension requires patience and a willingness not to impose preestablished frameworks or mental models on what we are seeing” (Senge et al., 2004, p. 31).
While we suspend our pattern of thinking, our mind will tend to fill up with emerging events, contents, patterns, and gestures, which Depraz (1999) characterized as a
“temporalization arising from the need for ceaseless renewal” (p. 100). Individual cognition is presupposed to break us away from taking the world as it is and “at every moment redirect away from its task of suspension and slipping into a habitual attitude”
(Depraz, 1999, p. 100; Varela & Depraz, 2005). This natural tendency for our minds to seek ceaseless renewal is analogous to mind wandering and perhaps even “mindlessness.”
Smallwood et al. (2007) described mind wandering as a state of decoupled attention where “in many everyday situations [individuals] suddenly notice that, for some time, we have been focusing on thoughts and feelings that are unrelated to what we are doing”
(p. 1). Mind wandering is also related to daydreaming (Smallwood et al., 2007). When our minds wander or when we find ourselves daydreaming we can redirect our thoughts in order to regain awareness (Depraz, 1999; Varela, 2000; Depraz et al., 2003; Varela &
Depraz, 2005). It is from this position or frontier that processes like mindfulness and awareness (Fiol & O’Connor, 2003, 2004; Weick & Putnam, 2006) entered the dialogue and practice of human and organizational learning and mainstream culture.
Individuals can redirect attention to the source of new thinking that is emerging by turning their “attention toward the source rather than the object” (Varela, 2000). In that process, the focus of attention shifts from the external object to the source of one’s
51 cognitive and perceptual activities; this shift is referred to as redirection (Depraz, 1999;
Varela, 2000; Varela et al., 2000; Varela & Depraz, 2005). Depraz et al. (2003) posited:
Once you’ve settled into the basic posture, you explicitly decide to ‘merely’ follow what is going on without engaging it. Since you have to keep breathing, your breath becomes a guideline or a track for your attention. Although this doesn’t mean all other sensations, thoughts, and emotions stop, you should consider them from afar, as an abstract observer would, like clouds in the background; the foreground is the breath as you follow it into the lungs and out the nostrils. This is in a nutshell just the sort of presence you’re trying to cultivate; you’re mindful of what’s happening in the present. As all kinds of experience appear within this attentive space, you explicitly avoid engaging in their contents, but rather pay attention to their arising, their emergence into full form, and then their subsiding into the background. (p. 33)
The suspension of habitual patterns of thinking creates a space for new thinking to arise. Often we become attached to the new thinking, which takes us out of the present moment (Senge et al., 2004). As new thinking emerges, we let go of the new thoughts and once again redirect our attention. Letting go is critical to the process, as it is only when we let go of the new thinking that emerges that we can again go back to suspension
(Depraz, 1999; Varela, 2000; Varela et al., 2000; Depraz et al., 2003; Varela & Depraz,
2005; Senge et al., 2004). The process of letting go is consistent with the meditative traditions called ‘nonattachment’ where one is no longer attached to mental states as being solid and where one does not superimpose qualities (i.e., judgments) such as pleasant, unpleasant, ugly, etc., on current experience (Harrington & Zajonc, 2006; Senge et al., 2004). The letting go is key to the process, as it allows us to let go of the redirection aspect of awareness so that we can move back to suspension (Varela, 2000).
The whole process of awareness—suspension, redirection, and letting go— involves looping through cycles (as presented in Figure 2-1), which Depraz et al. (2003) described in the following way:
52 As you watch your mind, you see it moving through various ‘positive’ or ‘negative’ states; it either swims with content or is empty as it can be, you’re either dull as dishwater or sharp as a tack or anywhere in between. You glimpse the constant impermanence of your thoughts, regardless of content and texture. You clearly see the composite nature of your mind and sense of self. You find yourself going in and out of an identification with a non-centered, non-ego space with various degrees of expansion. Now if your attentiveness begins to become discursive, you start all over again with your basic technique of focusing on your breathing, reminding yourself that your main goal is to distance yourself from your thoughts. (p. 33)
And, according to Varela (2000), this core process of awareness “goes through and through and through. It doesn’t necessarily go anywhere, you just keep doing it” (p. 5).
Varela et al. (2000) and Depraz et al.’s (2003) three-step process of awareness is consistent with the Buddhist tradition of the “three gestures of awareness,” suspension, redirection, and letting go, which is the basis for the practice of cultivating mindfulness
(Varela et al., 1993). Mindfulness gives us “access to the direct observation of mental phenomena” (Harrington & Zajonc, 2006) and, as such, allows us to access our experience (Varela, 2000). “Mindfulness practice keeps us in the present moment”
(Block-Lerner, Adair, Plumb, Rhatigan, & Orsillo, 2007).
Interestingly, Krishnamurti (1985) saw the mind and body as being separate.
Krishnamurti posited that the body does contain the brain and that the brain is part of physical matter (part of the nervous response of the body), but the mind is something totally different. The mind is part of an evolutionary process and, thus, it is not part of physical time. Thought, according to Krishnamurti (1986), is movement in the nervous system in the brain and is a material process and, as such, individuals can become aware of the actual structure and function of the process of thought, not merely its content.
Awareness from Krishnamurti’s (1954) perspective is “observation without condemnation” (p. 173). “Awareness is from moment to moment and therefore cannot be
53 practiced” (Krishnamurti, 1954, p. 174). If you practice something, according to
Krishnamurti (1954), it becomes a habit, and “awareness is not a habit” (p. 174). “A mind that is habitual is insensitive, a mind that is functioning within the groove of a particular action is dull, unpliable, whereas awareness demands constant pliability, alertness”
(Krishnamurti, 1954, p. 174). Krishnamurti’s perspective of awareness seems closely aligned with Kabat-Zinn’s (2003) view of mindfulness.
Mindfulness
Mindfulness is a concept that has as its origins the Buddhist tradition of contemplative practice, which uses the human mind, refined through practice, as its primary instrument of investigation into the nature of reality (Harrington & Zajonc,
2006). Buddhism and the practice of mindfulness are over 2,500 years old (Harrington &
Zajonc, 2006), but it is only recently that Buddhist-style mindfulness has been studied by
Western science. Different domains of mainstream psychology began empirically studying mindfulness some 30 years ago (Cardaciotto, 2005). Mindfulness has begun to be used in psychotherapy as a treatment option (Kabat-Zinn, 1990; Williams, Teasdale,
Segal, & Soulsby, 2000; Baer, Smith, & Allen, 2004; Cardaciotto, 2005). Research also suggests that mental well-being can be improved through the use of meditative practice
(Ramel, Goldin, Carmona, & McQuaid, 2004). Mindfulness research is demonstrating other healthful benefits such as reduction in blood pressure, chronic pain insomnia, posttraumatic stress disorder symptoms, and substance abuse (Lebow, 2005; Ludwig &
Kabat-Zinn, 2008).
There is a growing interest in the study of mindfulness (Miller, 2008). In 2000, the National Institutes of Health financed three studies on the effects of mindfulness, and
54 it is now financing more than 50 (Miller, 2008). More recently, mindfulness has been examined by organizational scientists as a means to “disrupt bandwagons, improve coordination, reduce the likelihood and severity of organizational accidents, aid information system design, produce creative solutions, heighten adaptation, foster entrepreneurship and reduce stress” (Weick & Putnam, 2006, p. 280). To examine the growth of empirical studies of mindfulness, Kabat-Zinn (2009) plotted the number of scientific papers with the word “mindfulness” in the title over a 25-year period, from
1982 until 2007, and found an exponential growth in the number of studies in the last 8 years (see Figure 2-2).
Figure 2-2. Growth of mindfulness-based studies. From Kabat-Zinn (2009).
Kabat-Zinn (2009) suggested that there is a growing trend in “bringing streams of
Western psychology, psychiatry, psychotherapy, and medicine together with the stream of dharma in its most universal manifestation.” Dharma in a psychological sense is
“phenomenon”—something that occurs, arises, or is found in experience (Varela et al.,
55 1993). The construct of mindfulness is jointly informed by Eastern and Western thought, but mindfulness means something different in Eastern and Western perspectives (Weick
& Putnam, 2006).
Eastern concepts of mindfulness developed as a result of techniques used in
Buddhist meditation, starting around 500 B.C. by Siddhartha Gautama Buddha in India
(Shambhala Sun, n.d.). Buddhism spread to Asia, where it evolved into Zen Buddhism.
Zen Buddhism teaches an attitude of nonattachment meditation to develop enhanced self- awareness and focus on the present moment (Senzaki & McCandless, 1987). Gradually,
Zen Buddhism made its way to America, where in the 1950s and 1960s psychotherapists began to use meditative techniques as a treatment option (Prebish & Tanaka, 1998). The gradual adoption of Buddhism in Western psychotherapy and with the American public spawned a mixture of diverse Buddhist traditions (Cardaciotto, 2005).
In contrast to the Eastern perspective, Western notions of mindfulness began to develop around empirical investigations in social psychology in the 1980s by Ellen
Langer, who referred to it as a “creative cognitive process” (Bishop et al., 2004). Langer
(1989a, 1989b) identified two states of mind that involved cognitive and affective factors: mindfulness and mindlessness. Langer (2000) posited that “mindfulness is a flexible state of mind in which we are actively engaged in the present, noticing new things and sensitive to context” (p. 220) and can also be understood as the process of drawing novel distinctions (Langer, 1989b). Of particular note for this study, Langer (2000) stated,
“Actively drawing these distinctions keeps us situated in the present” (p. 2). Additionally, the process of drawing novel distinctions can lead to various consequences, such as (1) a greater sensitivity to one’s environment, (2) more openness to new information, (3) the
56 creation of new categories for structuring perception, and (4) enhanced awareness of multiple perspectives in problem solving (Langer, 2000). “The subjective ‘feel’ of mindfulness,” according to Langer (2000), is that of “a heightened state of involvement and wakefulness or being in the present” (p. 2).
Mindfulness has also been examined as a domain of constructs that describe one’s ability to observe temporal streams of thoughts and feelings, which include introspection and observing self (Deikman, 1982, 1996), presence (Bugenthal, 1987; Senge et al.,
2004), reflective functioning (Fonagy & Target, 1996, 1997), and deautomatization/ decentering (Safran & Segal, 1990). These constructs generally have described a process of stepping outside of the automated mode of perceptual processing and attending to the details of cognitive activity that might otherwise escape awareness (Bishop et al., 2004).
Other constructs related to mindfulness are psychological mindedness (Conte &
Ratto, 1997; McCallum & Piper, 1987), insight (Tolor & Reznikoff, 1960), and self- awareness (Fingarette, 1963). These constructs relate to the capacity of individuals to see relationships among thoughts, feelings, and actions to understand the meanings and causes of experience and behavior (Bishop et al., 2004). While these constructs also involve self-observation, they highlight the ability of individuals to imagine complex mental images of their own mind and behavior. These constructs are closely aligned with the embodied mind approach of Francisco Varela.
Eastern practices met Western science in the form of Francisco Varela. Varela, a mathematician and cognitive neurobiologist, worked in the area of cognition and was a practitioner of Buddhist meditation and philosophy (Harrington & Zajonc, 2006). Varela et al. (1993) posited that there can be no comprehensive science of the mind without
57 understanding subjective experience, specifically the subjective experience of one’s own mental processes as they are lived in the first person. Varela’s perspective was that “adept contemplative phenomenologists” could become a new kind of scientific collaborator or partner in investigating the mind by means in the West of mindful practices, which is in fact now under way and has been in practice in the East for over 2,500 years (Harrington
& Zajonc, 2006). “Mindfulness means that the mind is present in embodied everyday experience; mindfulness techniques are designed to lead the mind back from its theories and preoccupations, back from the abstract attitude, to the situation of one’s experience itself” (Varela et al., 1993, p. 22). Mindfulness for Varela is a process of “experiencing what one’s mind is doing as it does it, to be present with one’s mind” (Varela et al., 1993, p. 23). Conversely, mindlessness is a “dissociation of mind from body, of awareness from experience” (Varela et al., 1993, p. 25). Mindfulness is achieved, according to Varela et al. (1993), by allowing “the mind to become an instrument for knowing itself” (p. 24).
Knowing one’s mind is a two-state process, involving (1) calming or taming the mind and (2) developing insight (Varela et al., 1993). Mindfulness, then, for Varela was a way to tame the mind so that individuals could penetrate their experience and discern what the experience was and how it arose (Varela et al., 1993). Varela offered a complementary approach, combining the Buddhist practice of contemplative mental discipline (i.e., mindfulness) and first-person scientific methods, to investigate the mind. Varela’s embodied mind approach has garnered interest by other researchers as well.
Harrington and Zajonc (2006) chronicled the 2003 conference at the
Massachusetts Institute of Technology, which involved the Dalai Lama, other Buddhist monks, scholars, and Western scientists discussing neuroscientific connections
58 surrounding meditation, awareness, and attention. At this conference, Varela was recognized as having defended the “general proposition that Buddhism offers a way of
‘inner’ knowing that complements or completes the ‘outer-oriented’ [i.e., objectivist perspective] approach of Western science” (Harrington & Zajonc, 2006, p. 8). How does this embodied approach (i.e., subjective) complement Western science?
According to Harrington and Zajonc (2006), “First-person methods increase an individual’s sensitivity to his or her own experience through systematic training of attention and self-regulation of emotion” (p. 22). Attention is paramount for what we actually experience in the world. These two researchers, respectively psychologist and quantum physicist, based their point of view on William James’ work in Principles of
Psychology, where he stated, “For the moment, what we attend to is reality” (Harrington
& Zajonc, 2006). Harrington and Zajonc (2006) defined attention as “the capacity to process selectively information that is available to us” (p. 28). Attention is also a means to override habitual reflexive responses, such as emotions (Harrington & Zajonc, 2006).
We attend to reality, according to Harrington and Zajonc (2006), through mindfulness and meta-attention. Mindfulness is the “ability to sustain voluntary attention continuously on a familiar object, without forgetfulness or distraction” (Harrington &
Zajonc, 2006, p. 41), whereas meta-attention, also a mental faculty, has the function of monitoring the quality of attention. Meta-attention is the ability to reflect upon the content of one’s mental state (Schooler, 2002). Through these two faculties, mindfulness and meta-attention, a sense of stability and vividness is brought to our conscious mind. It seems that it is the control of attention that allows individuals to marry the data from their inner experience with that of an outer experience and reconcile or make sense of the two
59 experiences (inner and outer), leading to a more accurate grasp of reality (Harrington &
Zajonc, 2006). Mindfulness is about realizing “the interdependence that exists between the stream of consciousness—which is like a continuously flowing river . . . and ceaselessly changing phenomena” (Harrington & Zajonc, 2006, p. 77).
With an Eastern, Western, and an embodied approach to mindfulness, how, then, are we to understand the construct of mindfulness? Sternberg (2000), in an article that asked the question, “How should mindfulness be understood?”, considered three views: cognitive ability, personality trait, and cognitive style. Using Langer’s (1997) definition of mindfulness, Sternberg (2000) related a variety of mindfulness constructs in the psychological literature as a means to understand the construct. Sternberg’s (2000) analysis revealed that mindfulness has characteristics of all three but seems closest to being a cognitive style; however, “construct validation is needed in order to address this and related questions” (p. 11). For the purposes of this study, mindfulness was viewed as a process of investigative awareness that involves observing the ever-changing flow experience (Bishop et al., 2004), by paying attention on purpose, in the present moment, nonjudgmentally (Kabat-Zinn, 2003). This view of mindfulness is aligned with that of
Varela et al. (1993), Kabat-Zinn (1990, 1994, 2003), Senge et al. (2004), and other researchers.
Kabat-Zinn (2003) posited that mindfulness can be thought of as a “consciousness discipline” that may help to inform human experience:
Its role in deep inquiry and the cultivation of insight have led some to argue that mindfulness provides a unique perspective that can inform critical issues in cognitive science, neurophenomenology, and attempts to understand the cognitive underpinnings of the nature of human experience. (p. 146)
60 A more recent construct of mindfulness, “presencing,” took shape with Senge et al. (2004). Presencing, which is a blend of two words—sensing and presence—can best be understood as a “deep listening, of being open beyond one’s preconceptions and historical ways of making sense” (Senge et al., 2004, p. 11). Senge et al. (2004) posited a model of presence that is entirely consistent with Depraz’s et al. (2003) “three gestures of awareness”—suspension, redirection, and letting go. By practicing presence, we become more aware of our moment-to-moment experiences, which focus our attention on what is and what is seeking to emerge. Senge et al. (2004) took into account the bioadaptive nature of individuals by challenging the notion that we can only make sense of events or actions as they happened in the past. A recent study by Anderson et al. (2007) also supported these similarities around mindfulness.
Anderson et al. (2007) designed a study to test the hypothesis that mindfulness involves sustained attention, attention switching, inhibition of elaborative processing, and nondirected attention. This study found that mindfulness might be more closely associated with changes in the quality of awareness of present-moment experiences than with basic attentional abilities. Of particular note, this was the first study relating mindfulness to attention; previous studies examined only the effects of meditation experience on attention and did not include an independent measure of mindfulness.
Bishop et al. (2004) proposed an operational definition of mindfulness. The definition comprises two components: (1) the self-regulation of attention so that it is maintained on immediate experience and (2) the adoption of an open, curious, accepting awareness of experience in the present moment. Specifically, Bishop et al. (2004) posited that mindfulness involves sustained attention to maintain awareness of current
61 experience, attention switching to bring attention back to the present moment when it wanders, inhibition of elaborative processing to avoid dwelling or ruminating on thoughts or feelings that are outside of the present moment, and nondirected attention to enhance awareness of present experience, unfiltered by assumptions or experience. Bishop et al.
(2004) were supportive of Kabat-Zinn’s conception of mindfulness.
Kabat-Zinn (1990) characterized mindfulness as a process of bringing a certain quality of attention to moment-by-moment experience. Mindfulness, as defined by Kabat-
Zinn (2003), is “awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (pp. 145-146). This kind of mental state is a practice that according to Kabat-
Zinn (1994) “nurtures greater awareness, clarity, and acceptance of present-moment reality” (p. 4) and can be cultivated and developed through meditative practice (Kabat-
Zinn, 2003). Mindfulness, which subsumes cognition, is universal (Kabat-Zinn, 2003).
“We are all mindful to one degree or another, moment by moment. It is an inherent human capacity” (Kabat-Zinn, 2003, p. 145) and, as such, individuals can be trained to engage in mindfulness.
Kabat-Zinn (2003) and Bishop et al. (2004) posited that mindful practices, whether within the various Buddhist traditions or within the psychological domain, were not limited to the operationalization of a particular technique. Mindful techniques are
“the map, rather than the territory” (Kabat-Zinn, 2003). Kabat-Zinn (2003) posited that mindfulness develops and deepens over time but requires an ongoing commitment to its practice and cultivation in every moment.
62 Summary
This chapter has considered the literature on the major topics relevant to this study. It presented the seven core characteristics of classical sensemaking and then added the emerging view of sensemaking as a biological process, with the properties of autopoiesis, autonomy, and perception, in the context of neurophenomenology and the emotive process of sensemaking. The complementary Eastern and Western views of awareness were reviewed, along with the cyclical cycle of suspension, redirection, and letting go. Finally, the topic of mindfulness—paying attention on purpose, in the present moment, nonjudgmentally—was examined, including its many empirically tested benefits. The next chapter describes the research design and methods used to conduct the research. The rigorous design is drawn from phenomenological interview techniques to inform the data and conclusions using first- and second-person accounts.
63 CHAPTER 3:
RESEARCH METHODOLOGY
The purpose of this study was to explore the present-moment aspect of sensemaking by examining how individual awareness contributes to one’s ability to make sense of his or her environment. One research question was examined: What is the role of individual present-moment awareness in sensemaking?
This chapter begins by providing an overview of the research design, explaining why a qualitative phenomenological case study design was chosen and why it was appropriate for the study. The chapter then reviews the methods from site selection and data collection to data analysis. Finally, steps to assure trustworthiness of the study, epoché, and ethical considerations are discussed.
Qualitative Research Design
Rationale for Choice of Approach
Selection of a research method for this study was guided by several factors: (1) the nature of the research question; (2) the exploratory nature of the study; (3) the need for a detailed view of the phenomenon; and (4) a need to accommodate the study of individuals in their natural setting (Creswell, 1998). This study was exploratory and, as such, asked, “What is the role of individual present-moment awareness in sensemaking?”
Based on research to date, there was a void in studies associated with awareness and present-moment aspects of sensemaking and, therefore, a detailed view of this phenomenon was necessary to aid future research in this area. Because sensemaking is
“enactive of social environments” (Weick, 1979, 1995) and because in “socially
64 interactive situations, coordination affects individual sensemaking” (De Jaegher & Di
Paolo, 2007), capturing individual sensemaking within a naturalistic environment was key. Based on these factors, a qualitative research method was selected as the best fit for the study.
A qualitative research approach, according to Creswell (2003), “is one in which the inquirer often makes knowledge claims based primarily on constructivist perspectives” (p. 18). Qualitative research is exploratory in nature and is used when the researcher does not know the variables to examine (Creswell, 1998, 2003). Creswell
(1998) defined qualitative research as follows:
Qualitative research is an inquiry process of understanding based on distinct methodological traditions of inquiry that explore a social or human problem. The researcher builds a complex, holistic picture, analyzes words, reports detailed views of informants, and conducts the study in a natural setting. (p. 15)
The study was further approached as a type of phenomenological case study based on the following: (1) the researcher’s belief that an understanding of a phenomenon is best achieved through lived experience; (2) the researcher’s desire to explore sensemaking at a deeper level than has been presented to date; and (3) the understanding that lived experience is irreducible, i.e., “it cannot be reduced or derived from the third- person perspective” (Varela et al., 1993; Varela & Shear, 1999a; Lutz & Thompson,
2003; Thompson, 2007).
A phenomenological case study approach, following Lincoln and Guba’s (1985) naturalistic inquiry, is used within an organizational setting to bound the study, by time and location, and to move toward a “naturalistic basis for generalization” (p. 120). Yin
(1981, 1994) suggested that case studies are used for exploratory purposes when “how” or “why questions” are posed, when the researcher has little control over events, and
65 when the focus of research is on a “contemporary phenomenon within some real-life context” (Yin, 1994, p. 1). Merriam (2001) posited that a case study approach can be selected as a means to reveal knowledge about a phenomenon that may be “missed by standard statistical approaches,” that may occur infrequently, and that is nonobvious or counterintuitive. The study was framed by an organizational event (bracketing) that the participants in the case study were all exposed to at the same time, including the researcher. This event was used as a precipitating event that perturbed or punctuated the experience of the participants and, thus, created conditions for sensemaking processes to emerge. The precipitating event formed the basis of the phenomenological interview phase of the study.
Assumptions
All research is driven by certain methodological assumptions that have their origins in the philosophical underpinnings of a research approach. In the case of qualitative research, these basic assumptions are related to the nature of reality, the relationship of the researcher to what is being researched, the role of values in the study, and the process of research (Creswell, 1998, 2003). According to Strasser (1969), Lincoln and Guba (1985), and Creswell (1998, 2003), the assumptions that guide qualitative research are that (1) reality is subjective and multiple; (2) systematic procedures recognize both coconstruction of reality and the researcher as the instrument of data collection; (3) the inquiry is oriented to inductive and generative analysis; and, most importantly, (4) evaluative procedures are used to judge the value of the research. While many scholars of methodology contrast the naturalistic assumptions (qualitative) with conventional or positive assumptions (quantitative), Creswell (2003) did not believe this
66 was necessary, as “qualitative research is legitimate in its own right and does not need to be compared to achieve respectability” (pp. 75-76).
Phenomenology
Phenomenology operates through a complex system of ideas associated with the works of Husserl, Heidegger, Sartre, Merleau-Ponty, and Schutz (Denzin & Lincoln,
1994; Creswell, 1998). At the heart of the phenomenological approach is the notion of
“bracketing” reality and discovery of the true meaning of the phenomenon under study.
Most notably, Husserl is credited with establishing a rigor in the development of knowledge through the elimination of supposition and all possible doubt in understanding phenomena (Moustakas, 1994; Creswell, 1998).
Phenomenology can be broadly thought of as “providing a disciplined characterization of the phenomenal invariants of lived experience in all of its multifarious forms” (Lutz & Thompson, 2003, p. 32). Phenomenal invariants are categorical features of experience that are describable across and within the lived experience (Lutz &
Thompson, 2003); disciplined characterization is a phenomenological mapping of experience that uses ‘first-person methods’ for increasing an individual’s sensitivity to his or her own lived experience (Varela & Shear, 1999a, 1999b; Depraz et al., 2003; Lutz
& Thompson, 2003). Moustakas (1994) characterized phenomenology as the “first method of knowledge because it begins with ‘things themselves.’” As such, phenomenology,
step by step, attempts to eliminate everything that represents a prejudgement, setting aside presuppositions, and reaching a transcendental state of freshness and openness, a readiness to see in an unfettered way, not threatened by the customs, beliefs, and prejudices of normal science, by the habits of the natural world or by knowledge based on unreflected everyday experience. (Moustakas, 1994, p. 41)
67 As a set of assumptions is associated with qualitative research in general, so a set of assumptions guides how phenomenological research should be conducted. Moustakas
(1994) offered specific guidelines for phenomenological research:
1. Phenomenology focuses on the appearance of things, a return to things just as they are given, removed from everyday routines and biases, from what we are told is true in nature; 2. Phenomenology is concerned with wholeness, with examining entities from many sides, angles, and perspectives until a unified vision of the essences of a phenomenon or experience is achieved; 3. Phenomenology seeks meanings from appearances and arrives at essences through intuition and reflection on conscious acts of experience, leading to ideas, concepts, judgments, and understanding; 4. Phenomenology is committed to descriptions of experience, not explanations or analyses. Descriptions that retain, as close as possible, the original texture of things, their phenomenal qualities and material properties; 5. Phenomenology is rooted in questions that give a direction and focus to meaning, and in themes that sustain an inquiry, awaken further interest and concern, and account for our passionate involvement with whatever is being experienced; 6. Subject and object are integrated—what I see is interwoven with how I see it, with whom I see it, and with who I am; 7. Intersubjective reality is part of the phenomenological process; 8. The data of experience, my own thinking, intuiting, reflecting, and judging are regarded as the primary evidence of scientific investigation; 9. The research question must be carefully constructed in order that the primary words appear immediately, capture my attention, and guide and direct me in the phenomenological process of seeing, reflecting, and knowing. (pp. 58-59)
A phenomenological approach was well suited to this study, as the research design engaged the interpretation that emerged from participants’ observations of their experiences of awareness within the sensemaking process.
Sensemaking and a Phenomenological Enactive Approach
This study was consistent with the phenomenological perspective of Allard-Poesi
(2005) and Petitmengin (2006), which is as follows: (1) the study of sensemaking is an active and subjective sensemaking process in itself, (2) participative action research is a
68 means to fully engage in sensemaking by coresearching sensemaking with others (vs. on or against others), (3) in order to study cognition it is essential to take into account its subjective dimension as it is lived from the inside (Varela et al., 1993), and (4) an interview method is necessary that enables an individual to become aware of his or her subjective experience and describe it with great precision.
The interpretive nature of sensemaking is such that it places the researcher in the role of “making sense” of the phenomena associated with sensemaking (Weick, 1995;
Allard-Poesi, 2005). The interpretive paradigm as defined by Burrell and Morgan (1979) is divided by degree of subjectivity along four strands: hermeneutics, solipsism, phenomenology, and phenomenological sociology.
Phenomenology, a first-person–oriented research method (Moustakas, 1994), is the most likely methodological lens through which to study the role of individual awareness in sensemaking. Phenomenology is the reflective study of the essence of consciousness as experienced from the first-person point of view (Moustakas, 1994;
Creswell, 1998). Phenomenology takes the intuitive experience of phenomena as its starting point and tries to extract from it the essential features of the experience and the essence of what we experience through the use of imagination and universal structures
“to obtain a picture of the experience” (Creswell, 1998, p. 52).
Varela (1996; Varela et al., 1993), Thompson (2004, 2007), Gallagher (2005), and numerous other researchers in the theory of mind have brought to light the classical challenge of marrying mental and physical properties of experience. This challenge, commonly known as the “mind-body” dualism issue, emerged from the thinking of
Descartes and his perspective that the mind and body are separate (Varela et al., 1993;
69 Thompson, 2007). Descartes based his belief in the duality of mind and body on the fact that the mind can wander—that we are unaware, at times, of where we are and what our body or mind is doing (Varela et al., 1993; Thompson, 2007). Varela (1996, 1999bc;
Varela et al., 1993), Thompson (2004, 2005, 2007), Vermersch (1999), Depraz et al.
(2003), Gallagher (2005), and other scholars of the mind have posited a view that the mind and body can be brought together through the training of one’s mind toward mindful states. According to Varela et al. (1993),
We can develop habits in which body and mind are fully coordinated [i.e., communication]. The result is a “mastery that is not only known to the individual meditator himself but that is visible to others—we easily recognize by its precision and grace a gesture that is animated by full awareness. (p. 28)
As a cognitive biologist, Varela’s view spanned the biological boundaries of psychology and sociology, which alone currently limit or conceal our understanding of sensemaking as an affective, autonomic, adaptive biological process.
Thompson (2004) clarified Varela’s perspective that mind and body are one by explaining the importance of intentionality of consciousness as “a priori openness to reality, by virtue of which we are able to have any comprehension of anything.” In this sense, Varela’s (1999b) explanation of double intentionality of present-time consciousness, mentioned earlier, is vital to phenomenological research. Experience is thus, in a certain sense, “irreducible” (p. 383). Phenomenology, then, by Varela and
Thompson’s standards, is “not a convenient stop on the way to a real explanation, but an active participant in its own right” (p. 383). Most specifically, and most importantly, it is
Thompson’s view (quoting Varela) that “life and mind share a common pattern or organization, and the organizational properties characteristic of mind are an enriched version of those fundamental to life” (p. 385). “Living isn’t simply a cognitive process,”
70 according to Thompson (2004), “it’s also an emotive process of sense-making, or bringing signification and value into existence” (p. 386).
From the perspectives of Varela and Thompson, a new form of phenomenology developed—neurophenomenology. This phenomenological perspective has a constitutive ontology (Maturana, 1978) that seems to resolve the mind-body issue that has plagued scholarly research and, most specifically, seems vital (Maturana, 1978) for this particular study. At the same time, the basic grounding of neurophenomenology is the “irreducible nature of conscious experience” (Varela, 1996, p. 336). “It’s irreducible because of its ineliminable transcendental character: lived experience is always already presupposed by any statement, model, or theory, and the lived body is an a priori invariant of lived experience” (Thompson, 2004, p. 394). Neurophenomenology, then, is guided by the embodied approach to cognition (Varela et al., 1993; Thompson, 2004, 2007), which posits that mental processes, including consciousness, are distributed phenomena of the whole active organism (i.e., not just the brain) embedded in its environment (Thompson
& Varela, 2001). In other words, subjective reality and objective reality are not separate.
They operate with complementarity, and that is the process reality we call mind. While not by neurophenomenological design, this study followed a rigorous phenomenological, enactive approach (Varela et al., 1993; Moustakas, 1994; Petitmengin, 2006; Thompson,
2007). Based on the previous discussion, this study employed two ontologies— constitutive and transcendent (static)—which means this study used a hybrid research methodology.
71 Overview of Study Design
Thus, this study was a qualitative phenomenological case study conducted in a naturalistic setting. This case study was situated in the context of a real-world practice, occurring in the moment, in an organizational setting (Bamberger, 2008).
The unit of analysis for this study was the individual, in the context of the participating subjects observing an organizational event. The methodology accounts for the nondual, holistic role of the coresearchers as both participants and observers within the study (Miles & Huberman, 1994; Moustakas, 1994; Petitmengin, 2006). This is what generates sensemaking in the present.
The study’s epistemological perspective was subjective or nonpositivist.
Following Maturana (1978), Strasser (1969), and Varela et al. (1993), the study employed a constitutive ontology, wherein constitution is “the process of providing an ever clearer meaning” (Strasser, 1969). Maturana’s (1978, 1987) constitutive biological perspective holds that living systems cannot refer to an external, independent reality. This unique perspective reflects an epistemology in which individuals draw forth reality—they do not construct it, nor does it exist independently of them. Thus, one can extrapolate from
Maturana’s (1975, 1978, 1987) constitutive perspective that sensemaking occurs in individuals from moment to moment, either as a change triggered by interactions or
‘perturbations’ coming from the environment and/or through an individual’s own internal processes. The individual level of analysis is also consistent with the epistemological and ontological perspectives of this case study.
To the extent possible, researcher biases, assumptions, and beliefs were suspended by epoché (Moustakas, 1994; Isaacs, 1999; Senge et al., 2004; Depraz et al.,
72 2003), in order to focus mental attention (Fiol & O’Conner, 2004) on the descriptions of the the participants with an eye towards revealing the essence of their lived experiences.
Site and Participant Selection
The focus of this phenomenological study was on the perceptions and meanings constituted by the coresearchers. Therefore, it was necessary to conduct the study in a naturalistic setting (Lincoln & Guba, 1985) or in situ. Thus, one central site was used for the precipitating event and the follow-up, in-depth phenomenological interviews. The organization where the study took place was a large, multidisciplined healthcare organization. Sensemaking involves finding structure in a seemingly unstructured situation (Weick, 1995) and is an integral part of the work of health care individuals and teams. Further, individual in health care settings are often require to make sense of emerging situations in the moment, without benefit of reflection. There is little understanding of the process of individual sensemaking in dynamic organizations where time-critical decisions are the rule, rather than the exception. A healthcare system was selected because of its dynamic nature, reliances on individual performance and time- sensitivity to decision making.
The researcher used purposeful or purposive (Lincoln & Guba, 1985) sampling to select “information rich” subjects who could provide the greatest insight into the research question (Miles & Huberman, 1994). Four criteria were used to select participants:
1. Ability, willingness, and comfort in participating in the study, which involved
engaging in interviews, maintaining a journal, taking part in member check
meetings, and devoting sufficient amounts of time to see the study through
73 2. Interest in the phenomenon being studied: individual awareness and present-
moment aspects of sensemaking
3. Employment by the same organization, at the same time
4. Have a functional role concerning the precipitating event
Creswell (1998) recommended “long interviews with up to ten people” (pp. 65,
113) for a phenomenological study. Ten individuals agreed to participate and gave their informed consent. They were recruited through an e-mail request that was created by the researcher and disseminated by a member of the health care system (see Appendix A), along with an attached research information and consent form (see Appendix B). The prospective research participants were selected by health members who selected the precipitating event and who were familiar with the role responsibilities of individuals within the system. The researcher spoke with interested individuals by phone (see
Appendix C) and later met collectively with all those who expressed an interest in participating in the study. At that time, participants were asked to review the research information and were given an opportunity to ask questions. The 10 participants were selected based on the criteria that had been established.
Consistent with Moustakas’ (1994) perspective that a researcher and participants in a phenomenological study are involved in an interpersonal relationship (i.e., subject and object are integrated), the participants in this study were considered coresearchers.
Precipitating Event
The precipitating event was selected as a result of a meeting by the researcher and health system’s liaison based on two key criteria: 1) the event must carry gravitas for the participants and 2) the details of the event should not be well known by the participants.
74 The precipitating event involved a member of executive leadership delivering a tape- recorded message to the study group that reflected declining healthcare ratings. The message, which participants heard for the first time (although a few had heard part of the message through another means), was as follows:
Good morning. I wanted to share with you some of our HealthGrades data for 2010, and the data here talks about a number of areas in clinical data. Just to give you an overview, the information on HealthGrades’ methodology include s some risk and severity adjusted, but it’s not the industry standard 3M. HealthGrades only uses only Medpar data, also which is Medicare and Medicaid, and in all of our internal studies we use all-payer data.
But unfortunately, pieces of premiere heart and vascular services declined [to] “do not seem indicative of a quality heart vascular program.” Our CABG [coronary artery bypass graft] mortality, for example, now is a one star; this is a rating of one, three, or five, one being the worst. In 1-month and 6-month postdischarges, only three stars, which means average. You know, all along for years, the last 5 years, our heart attack program has been five stars. It’s now three stars all the way across the board. Valve replacement is now one star all across the board, which is very disappointing. In other loss, in the orthopedic and bariatric areas also came out this year and we lost a distinguished clinical excellence award, which we had received 4 or 5 years in a row, I believe.
And so this site is accessed by approximately 5 million people per year. The information allows them to shop around for all the best possible elective surgery and procedure and helps maintain community goodwill, so we definitely struggled this year with these ratings. So as I said, ratings are five star best, three star is expected, one star poor.
So let me give you a little further update here. Valve obstruction, for example, in terms of mortality, some of our mortality scores went from, went from five stars to three. Community-acquired pneumonia declined from five stars to three. So that’s not very good. CABG hospital declined from three stars to one. GI [gastrointestinal] bleed mortality went from five stars to three; heart attack in all areas declined from five stars to three. We had 70 deaths, and we would have needed 60 for five stars and we had 70 at our current volume. Heart failure 6- month postdischarge mortality declined five stars to three, and then pancreatitis declined from five star to three. Valve replacements all from three to one star. So disappointing data, to be sure. It certainly shows us we have some opportunities here for improvement.
And finally, the overall HealthGrades award for distinguished hospital award for hospital excellence, which we had won for the last 3 years in a row, we missed in 2010. That’s their care excellence award. We missed in 2010. The general surgery
75 excellence award we missed in 2009 and 2010. Orthopedic surgery excellence we missed in 2009 and 10. Certainly it’s a loss of marketing opportunity for us as a heart attack survival loss of five stars after 5 years in a row of being five stars and the need of avoidance of complications we lost five stars and the CABG mortality data are all down as well to one star. So unfortunately this year not the good news we’ve had in the past. So I just wanted to share this with you today. Thanks a lot.
This event was chosen since it was believed to be significant for all participants.
Patient-centered outcomes have become the primary means of measuring the effectiveness of healthcare delivery over the past 30 years (Kane, 2006). It is commonly acknowledged that patient reports of their health and quality of life and their satisfaction with the quality of care and services are as important as other clinical healthcare measurements (Hudak, McKeever, & Wright, 2003). Healthcare organizations are operating in extremely competitive and complex environments and, as such, patient outcomes and satisfaction are key to gaining and maintaining market share. Without acceptable levels of patient outcomes and satisfaction, healthcare systems may not get full accreditation and will lack the competitive edge enjoyed by fully accredited systems.
The need to improve patient outcomes and satisfaction was recognized as a critical requirement by all staff members across the healthcare organization where the study was conducted.
Data Collection
Data were collected using face-to-face, in-depth semistructured interviews, observations, field notes, journals, and follow-up dialogue with participants. The study was conducted with two phases of data collection: (1) group exposure to the precipitating event and (2) individual interviews. A final phase of participant debriefing is discussed later in this chapter under the Verification and Trustworthiness section. Before each
76 phase, the researcher explained the purpose of the study and went over the rights of the study participants.
Group Exposure to the Precipitating Event: Journaling and Recording
In the initial study phase, 10 participants were brought together to listen to a tape of an executive describing patient outcome information about one of the organization’s healthcare programs. The participants were asked to take about 20 minutes to process the information (i.e., to think about, ask questions and journal). Participants were instructed that they could ask questions of those present in the room, should they so desire. The initial phase, which included opening instructions by the researcher, a period of questions and answers by participants, message delivery, and participant processing, lasted about 2 hours.
Participants had already been given a journal and journaling instructions (see
Appendix D) and were asked to write about their thoughts and reactions as the precipitating event unfolded. According to Brody and Park (2004), the self-directed attention involved in narrative writing heightens awareness in a manner similar to other mindfulness methods. “When you write in a journal, . . . what you have is a record of your awareness” (p. 147). Further, journal writing is a technique to promote reflection
(Schon, 1987). Reflection is a way of overcoming the divergence between theory and practice (Clarke, 1986) and a way to develop knowledge embedded within practice
(Benner, Tanner, & Chesla, 1996). Other kinds of reflective strategies that are used to capture and document individual awareness include critical incidents (Smith & Russel,
1991; Bennet & Kingham, 1993) and diaries (Bennet & Kingham, 1993). This study employed a journal, which is similar to a diary, and a precipitating event, which is similar
77 to a critical incident, to capture individual awareness for use in data collection.
Participants’ journals were used during the interviews to probe for deeper understanding around individual sensemaking processes.
The initial study phase was audio and video recorded. The follow-up interviews were scheduled with each participant at the conclusion of the initial study phase session.
Individual Interviews
One-on-one interviews with each of the study participants began by viewing selections from the videotape of the initial study phase to place the interview questions in context. Several neutral questions followed to put coresearchers at ease and help them become comfortable with the researcher, such as questions about how long they had worked for the organization and their role with the organization. To add structure to the interview sessions and to move the process along, the researcher used open-ended questions, while remaining open to asking additional questions or adding probes when needed for clarification, to deepen meaning, or to continue along an emerging path of interest that seemed key to the study (see interview protocol in Appendix E).
Dialogue was the primary instrument of communication during the interviews.
Dialogue, as described by Isaacs (1999), is a shared inquiry, “in essence a flow of meaning” (p. 19), whose intention is to understand the topic of inquiry. During the course of dialogue, participants described how they experienced sensemaking and awareness by reflecting on their conversations and experience. The dialogic process generated rich, detailed descriptions of how individual awareness influenced present-moment sensemaking. The dialogic process was supported by selected aspects of Petitmengin’s
(2006) protocol (i.e., question development, interview process, tone of inquiry, and
78 stabilizing attention), using semistructured questions augmented by deeper probing questions.
During the interviews, the researcher took notes. The purpose of these notes was to aid the researcher in the gathering of data by capturing key words, phrases, or gestures and to record the researcher’s observations of the coresearchers as they responded to the questions or statements. At the conclusion of the interviews, coresearchers were asked if they had any questions and were thanked for their time and participation. The participants were told what to expect after the interview (i.e., review of the interview transcript and participant debriefing). The interviews, which were an average of 2 hours long, were audiorecorded and transcribed.
Data Analysis
The data gathered in this study were subjected to an extensive coding and clustering (Creswell, 1998) process and then interpreted. According to Creswell (2003),
“The process of data analysis involves making sense out of the text and image data” (p.
190). Moustakas (1994) viewed data analysis as “illumination,” or the process of clustering the horizons into themes and organizing the horizons and themes into coherent textual descriptions of the phenomenon. Coding of the data was used as a means to reduce any bias in the interpretation of the data. A coding system was developed to identify emergent patterns and themes in the data that reflected the essence of the nature of participants’ sensemaking experience.
After reading each complete participant transcript three times, the researcher listed every expression relevant to the experience. This step is referred to as horizontalization. Upon considering and weighing each horizon in the data to better
79 understand the experience being studied—subjecting each expression to examination to determine if it contained “a moment of the experience that is a necessary and sufficient constituent for understanding it” (Moustakas, 1994, p. 121) and whether the experience could be abstracted and labeled—the researcher refined the expressions’ list by deleting statements that were irrelevant or repetitive, leaving only the unique aspects of participants’ experience. This step is known as reduction and elimination, which enabled the invariant constituents of the present-moment sensemaking experience to emerge. The third step was to cluster the invariant constituents of the experience related to the thematic label. These clustered and labeled constituents were the core themes of the experience.
Next the researcher checked the invariant constituents and the themes against the complete record of the research participant. The researcher developed an individual textural description of the experience for the participant and then an individual structural description “based on the individual textural description and Imaginative Variation” (p.
121). The structural description provided a vivid account of the underlying dynamics of the experience, the themes and qualities that account for how “feelings and thoughts”
(p. 135) related to the phenomenon being studied were evoked. After developing individual textural and structural descriptions, further reduction took place by constructing a textural-structural description for each participant, incorporating the invariant constituents and themes of the individual textural and structural descriptions.
Finally, from the individual textural-structural description, the researcher developed a composite description of the “meaning and essences of the experience,
80 representing the group as a whole (Moustakas, 1994, p. 121). This process, based on
Moustakas’s (1994) revised Van Kaam method of analysis, is summarized in Figure 3-1.
` Figure 3-1. Modified van Kaam method (Moustakas, 1994).
Verification and Trustworthiness
In qualitative research, “validity does not carry the same connotations as it does in quantitative research” (Creswell, 2003, p. 195). Qualitative research does not use statistical numbers to support findings or significance levels to indicate what is meaningful and what is not (Worthen, 2002, p. 140). Instead, Creswell (2003) described validity in qualitative research as being “used to suggest determining whether the
81 findings are accurate from the standpoint of the researcher, the participant, or the readers of an account” (pp. 195-196). In other words, language and meaning are the data. Lincoln and Guba (1985) suggested that credibility is the “naturalist’s substitute for the conventionalist’s internal validity” (p. 296) and is one of four criteria that establish trustworthiness, the other being dependability, confirmability, and transferability.
Creswell (2003) offered qualitative researchers eight possible strategies for checking the accuracy of findings: (1) triangulation, which involves use of different data sources to build a coherent justification; (2) member-checking, where study participants
(coresearchers) are asked to review data findings to aid in determining accuracy; (3) use of rich, thick description to convey the findings; (4) clarification of any bias that the researcher brought to the study in a narrative form; (5) presentation of negative or discrepant information that is counter to themes that have emerged from the study; (6) prolonged time in the field to develop an in-depth understanding of the phenomenon being studied; (7) peer debriefing to further enhance the accuracy of the findings; and (8) use of an external auditor to review the entire study (p. 196). Creswell’s (2003) steps are parallel with Lincoln and Guba’s approach to establishing credibility (or trustworthiness) in a qualitative study.
In the effort to establish trustworthiness in this study, the researcher used triangulation, peer debriefing, and member checking.
Triangulation
Triangulation, according to Lincoln and Guba (1985), is represented by four different modes: “the use of multiple and different sources, methods, investigators and theories” (p. 305). This study used, consistent with Lincoln and Guba’s (1985)
82 perspective, different sources of data, different methods, and multiple investigators to assess findings. These three modes took the form of a prolonged engagement in the field by the researcher to establish context (Bamberger, 2008), minimize distortions, and build trust with participants (including coresearchers and others closely associated with the study). In so doing, the researcher used her experience surrounding the precipitating event and individual interviews as a means to both explore and verify the data being collected. The existence of first-person experience in the researcher, according to Varela and Shear (1999a, 1999b), is a legitimate source of additional evidence, which not only needs to be explicitly acknowledged but also practically cultivated. Different data collection methods were used, including observation, one-on-one interviews, individual journals, videotapes, and audiotapes.
Peer Debriefing and Member Checking
Multiple investigators were used to assist in the research, including the principal researcher, 10 coresearchers, and two peer debriefers—all acting as dependable corroborating sources that confirmed the data.
Participant debriefing sessions were an opportunity for participants to review the data collected as a means to test for factual accuracy. This phase consisted of each participant independently reviewing his or her particular verbatim transcript and verifying that the transcript accurately reflected his or her thoughts and feelings. With the exception of one participant, whom the researcher was unable to locate, all other participants felt the transcript accurately reflected their discussion during the one-on-one interviews.
83 Following Lincoln & Guba’s (1985) recommendation that peer debriefing is a
“process of exposing oneself to a disinterested peer in a manner paralleling an analytic session and for the purpose of exploring aspects of inquiry that might otherwise remain only implicit with the inquirer’s mind” (p. 308), two peer debriefer critically reviewed the methological impementation of this study. The peer debriefers and the researcher spoke frequently throughout the course of study, discussing the methodology, the data, and the framing of the study. Detailed examination took place with the coding scheme, individual interviews, interpretations and conclusion that were drawn from the data.
The researcher also provided the healthcare organization’s leadership, and any coresearchers who expressed a desire to review the research, a copy of the findings so they could verify the credibility of the study and benefit from its conclusions. This step provided an additional level of trustworthiness to the research study.
Epoché
The researcher engaged in disciplined and systematic efforts known as the epoché process (Moustakas, 1994, p. 26) to set aside prejudgments regarding the phenomenon being investigated. Prior to the precipitating sensemaking event and each interview, the researcher practiced awareness (Depraz et al., 2003) as a means to keep her mind open to what was unfolding. In addition, a journal was used to capture any biases, thoughts, or feelings prior to, during, and immediately after the interviews.
Ethical Considerations
“Regardless of tradition of inquiry, a qualitative researcher faces many ethical issues that surface during data collection in the field and in analysis and dissemination of
84 qualitative reports” (Creswell, 1998). Creswell (1998) offered insights on how to avoid or minimize ethical issues that arise out of data collection and analysis: researchers can protect the anonymity of the informants, either by assigning numbers or aliases to individuals; develop case studies of individuals that represent a composite picture, rather than an individual frame; avoid engaging in deception about the nature of the study; delete off-the-record comments by informants from the analysis; and avoid sharing personal experiences in the focus on “bracketing” (setting aside all prejudgments).
This research required collecting authentic, personal data in the form of feelings, thoughts, opinions, and points of view arising out of participants’ experience during the study. Deep, rich personal accounts were sought through a relationship of closeness and trust. This relationship creates an obligation on the part of the researcher to protect the information given to her by the coresearcher. In Creswell’s (2003) words, “The researcher has an obligation to respect the rights, needs, values, and desires of the informant(s)” (p. 201). This obligation extends to obtaining participants’ informed consent; disclosing the purpose, process, and nature of the study; accurately collecting data and reporting findings; showing integrity in interpreting data and drawing conclusions; and respecting participants’ right to withdraw from the study (Creswell,
2003).
The principal researcher took precautionary measures to address these ethical issues. First, this study was designed to eliminate possible risk to participants by disclosing the purpose of the study, seeking voluntary participation, and assuring confidentiality and anonymity. Written permission to conduct the study was obtained from the research site sponsor. Further, The George Washington University institutional
85 review board reviewed and authorized the study. The identification of participants and their employer was not made public. Instead, pseudonyms were used to refer to individual participants, and their employer was referenced as a “healthcare organization.”
Care was given to ensure that each coresearcher was given a digital folder that was coded to preserve his or her anonymity. In lieu of names, coded IDs were created immediately upon the subjects’ completion of the informed consent form, thus anonymizing the data used for data collection, merging, and analysis. The ID key was kept separate from the rest of the data. The data were stored electronically on a laptop and in hard copy. The data records were used only for the intended purpose of completing this research study. The audio and visual recordings, field notes, and journals were kept in a locked file drawer and will be destroyed 1 year after the study is completed.
Finally, the principal researcher had no supervisory role or any personal relationship with any participant in the study; was sensitive to the broader organizational environment in which each participant operated; and sought to access the personal experience of each participant by developing a trusting relationship by being respectful, committed, and professional throughout the study.
Summary
Chapter 3 has summarized the methodology and rationale for this phenomenological case study. A qualitative method was chosen as the best fit to address the research question because the data being sought could only be accessed through the lived experience of each participant.
The research question addressed—What is the role of individual present-moment awareness in sensemaking?—emerged as a result of awareness of the gap in the literature
86 around the present-moment aspects of sensemaking and the call to action from Weick and
Putnam (2006) to address awareness of mind as a new skill (p. 286) in sensemaking.
Much of the sensemaking research to date has used a social psychology lens to explore this phenomenon. The literature is almost silent in discussing sensemaking as a bioadaptive process of living systems. This study was meant to expand the work of
Weick (1979, 1995) and other sensemaking theorists and researchers.
Purposive sampling was used to select 10 coresearchers for this study. As described, data were collected through the use of in-depth, one-on-one interviews, observation, and journaling. Following data collection, the data were reviewed, coded, interpreted, and analyzed using the modified Van Kaam method (Moustakas, 1994; van
Kaam, 1959, 1966). From thick, rich descriptions of the lived experiences of each coresearcher, themes emerged to contribute new knowledge to the field of sensemaking.
87 CHAPTER 4:
PRESENTATION AND ANALYSIS OF DATA
This chapter presents the thoughts, perceptions, and lived present-moment sensemaking experiences of 10 participants who took part in the phenomenological case study (see demographics in Table 4-1). The purpose of this study was to explore the present-moment aspects of sensemaking by examining how individual awareness contributes to one’s ability to make sense of his or her environment. In the manner that I am using the term, present-moment sensemaking is the continuous, moment-to-moment process that conscious individuals experience as they live through events occurring around and to them. Awareness in this study is understood as a transient experience
(Freeman, 2000), which is characterized as a process of mind that involves suspension, letting go, and redirecting one’s attention (Depraz et al., 2003; Varela et al., 1993) and being present with one’s mind and body to the experiences of everyday life (Depraz et al., 2003).
Table 4-1 Participant Profile Coresearcher Years with pseudonym Gender Role organization Alice Female Clinical 11-20 Jane Female Clinical 6-10 Jim Male Clinical 0-5 Joanne Female Clinical 31-40 Karen Female Clinical 11-20 Larry Male Nonclinical 0-5 Lisa Female Clinical 0-5 Sue Female Clinical 21-30 Terri Female Clinical 21-30 Victoria Female Nonclinical 11-20
88 This chapter presents the results and analysis for the study, divided into five sections. Section 1 discusses the themes that emerged from the 10 interviews. Section 2 provides the individual textural descriptions; section 3, the individual structural descriptions; and section 4, the textural-structural descriptions. Finally, Section 5 presents the composite description of the meaning and essences of the experience under study, representing the group as a whole.
Section 1: Themes
Table 4-2 represents an overview of the invariant meaning horizons that emerged for all 10 interviews.
Table 4-2 Invariant Meaning Horizons Theme Specifics Awareness Personal interest in information Importance of information to role Connected to value system Engagement Focus response Being distracted Being focused Mind wandering Mindless Personal experiences Reflecting on past experience of self and other Desire for more information Observing body language of others Personal experience of self Personal experience of others Reaching out to others Making eye contact with others Speaking to coworkers Consulting with experts Need for action planning Mental development of a plan Embodied responses Affective responses Physical responses
89 Tables 4-3 to 4-7 focus on emerging patterns: the general experience of the precipitating event, making sense in the present moment, being focused/unfocused, reaching out to others, and additional sensemaking information.
Table 4-3 Emerging Patterns: General Experience of Precipitating Event Emerging pattern Coresearcher Anger (self or other) Alice, Terri Anxiety Alice, Lisa Blindsided Jim, Sue Burden Jim Consulting experience Jim, Joanne, Lisa, Larry Depressed/deflated Karen, Larry Desire to blame someone Terri Disappointment Alice, Karen Disbelief/distrust Jane, Jim, Joanne, Karen, Lisa Embarrassment Alice, Jim, Terri Fear (self or other)/scared (self and other) Alice, Joanne, Jim, Karen, Lisa, Sue Feeling flushed Jim Insecurity Alice, Sue Lack of surprise Larry, Terri, Victoria Loss Terri Nauseated Karen, Joanne, Sue Need for more information/accuracy Joanne, Karen, Sue, Terri Observer/disconnected Larry, Victoria Overwhelmed Jane, Karen Plan of action Alice, Joanne, Karen, Sue Relief Victoria, Larry Responsibility Alice, Jim, Sue Sadness Lisa Shock or surprise Alice, Jane, Jim, Joanne, Karen, Sue, Terri Sweating Jim Sympathy Larry, Victoria
90 Table 4-4 Emerging Patterns: Making Sense in the Present Moment Emerging pattern Coresearcher Something caught attention (interest) Alice, Joanne, Sue, Terri, Victoria Listening to what is going on Jim, Karen, Lisa, Sue, Terri (concentration) Assigning value to the information Jane, Jim, Joanne, Karen, Sue, Terri If important, analyze it Alice, Jane, Jim, Joanne, Karen, Larry, Lisa, Sue, Terri, Victoria If not important, file it away Jane, Jim Determining whether information makes Alice, Jane, Jim, Joanne, Lisa, Larry, Sue, sense with what I know Terri, Victoria Observing others Jim, Karen, Larry, Terri, Victoria Plan of action Alice, Jane, Jim, Joanne, Sue, Victoria Physical sensations Alice, Sue, Terri Individual and collective process Jane, Terri
Table 4-5 Emerging Patterns: Focused/Unfocused Emerging pattern Coresearcher Unfocused/distracted Alice, Jane, Jim, Joanne, Karen, Larry, Lisa, Sue, Terri, Victoria Internal focus Karen, Sue Internal and external focus Lisa, Terri, Victoria Being focused feels like: Better than unfocused Jim Dedicated listening Terri Heightened sense of alert Terri Zone/bubble Alice, Karen Sense of accomplishment Victoria Pleasant/good Alice, Joanne, Larry, Jane Engagement Larry Forward movement Sue Being unfocused feels like: Not good (spacey) Karen, Sue, Victoria, Lisa Uncomfortable Sue Freedom Joanne Meditative lightness Joanne Second person Joanne Regained focus by: Sense of responsibility Alice, Larry, Sue, Victoria Observing others Victoria, Jane Mental watchdog Joanne Anxiety/fear/anger Alice, Larry, Lisa Refocusing on the objectives Jane, Jim Active control Karen
91 Table 4-6 Emerging Patterns: Reaching Out to Others Emerging pattern Coresearcher Reached out to others: Spoke with coworkers Karen, Jane, Joanne, Jim, Larry, Sue, Terri, Victoria Spoke with family member Alice Observed/interpreted body language Karen, Jane, Joanne, Larry, Sue, Terri Did not reach out to others: Did not speak to others Lisa Reaching out to others provided: Security Karen Uneasiness Joanne Access to others’ perspective/experience Jane, Jim, Victoria Nuances that had not been considered Larry Aid in plan development Sue Comfort and reassurance Terri, Victoria
Table 4-7 Emerging Patterns: Additional Sensemaking Information Emerging pattern Coresearcher Want somebody else’s approval of what I am thinking Alice Might have felt differently if had more information Jim Feel as though work rules have been broken Joanne See sensemaking as “living in the gray”; experience is neither black nor Jane white, but somewhere in the middle Observation is important, serving as validation, providing a sense of the Larry level of agreement or hostility or disinterest or whatever is present As a visual person, would have reacted differently if received the Sue information in a written form as opposed to a spoken form; would have broken into the thinking mode much quicker Diminished sensemaking response as a result of fear of being judged by Terri others and lack of affect by others View sensemaking as a continuous process, with thought ⇒ emotion ⇒ Victoria decision ⇒ back to making sense again; each part of sensemaking has its own inherent process
Section 2: Textural Descriptions
Creswell (1998) posed individual textual descriptions as the “what” of the appearing phenomenon. The textural description is a means to clearly convey what was
92 experienced as an individual made sense in the present moment. What follows are textual descriptions for each coresearcher.
Alice: Individual Textural Description
The experience of making sense of the precipitating event for Alice began with a question: “What changed?” What in the process of taking care of heart and vascular patients had changed to produce these ratings? The question was followed by an examination of a laundry list of steps that “a heart attack patient goes through and trying to think of any glaring things that would jump out at me.” As Alice began to understand that the ratings for the program were not good, she had a sense that “this could really cost us more than just goodwill with our community.” Alice’s concern was directed at the potential for loss of services or patient volumes to a competing healthcare system. In
Alice’s words, “This could really be the ammunition that [City Hospital] needs to use against us.” Her thoughts then turned to her fellow healthcare professionals, individuals
“that have committed their entire career to providing excellent service.” She wondered,
“How do I look them in the face and say this is what this is?” Following her concern for her coworkers, she began to think about how the program could recover. What “steps do I need to take?”
Alice experienced multiple emotions throughout the precipitating event. Initially, she felt a sense of shock as she processed the healthcare-rating message. Shock turned into “a little bit of anger because I didn’t know why I didn’t know. We had this sharp increase in deaths in 2008. Why didn’t I know?” She was upset with herself because she
“hadn’t asked more questions” and because she “hadn’t been a little more forceful.” After the feelings of shock and anger, Alice indicated that she “just started feeling.” She
93 became fearful and anxious for herself, her staff, and the organization. As she contemplated her responsibility within the program, she felt a sense of insecurity. Alice also acknowledged a sense of frustration and disappointment, which was directed at her and others in the heart and vascular program. “We know what our surgical data is and we knew what it was gonna look like.” As her thoughts moved away from herself and others within the program to her community, her feelings shifted to that of embarrassment and hurt.
I’m in the community a lot at different events that the hospital sponsors, and I am always touting our heart and vascular program, . . . encouraging our community to feel good about coming here. So it’s a little embarrassing to know how to answer questions about why. You know, why are you not as good as you said you were? And I don’t want—I don’t want the system to have a black eye.
When Alice was asked specifically to explain how she made sense in the moment, she described it as “a flood of experiences coming to your immediate mind at like a high rate of speed. . . . It’s almost like liquid going through those frames of experiences.” She went on to describe sensemaking in the moment as “trying to pick out the ones [frames of experience] that will most benefit you at that moment, . . . understand and develop a plan of action, and deal with what’s at hand.” Alice believed she had a consistent sensemaking process that began with her ability to focus. “I think from the moment I need to make sense of something I focus.” She then had a series of experiences happening all at once.
“I start feeling the emotions and thinking of the steps and a plan and I’m doing and I’m acting, I’m feeling, I’m thinking. I think all of those things are happening at once.”
During her attempt to focus and make sense of an experience, Alice said she tried to keep things out of her field of focus.
94 I have these little things trying to come into the focus, and I’m just trying to keep the focus clear and, umm, uncloudy. And I guess that’s when my sense of urgency, I guess, and responsibility and the need to fix it . . . kicks in, and that’s when I’m planning or doing.
Alice felt that keeping her “line of vision clear” from emotions and other distractions allowed her to “plan and act at that same time.”
Alice described being focused as “just a rush, . . . an incredible amount of energy, focus, adrenaline.” She tried to put emotions aside while she made sense of an experience. “And I do try to, I guess in my own way, put the feelings that are going to deter me aside, thinking I’ll deal with that later.” While Alice recognized that she had emotions during sensemaking episodes, she acknowledged that she wasn’t always aware of the nature of those emotions.
You recognize you have emotions when you’re focused, but you don’t always recognize the nature of those emotions, . . . whether it’s fear, anxiety, or stress. . . . Like in an emergent situation that I’m dealing with . . . and I have that adrenaline rush, . . . sometimes I don’t know what it is. I get to a point: Am I feeling anxiety? Am I just feeling the energy? Am I feeling the rush? Am I feeling a little bit of fear?
Alice attributed this lack of awareness of the nature of her emotions to their “all coming at one time.” Alice went on to say, “I think I recognize them. I’m not going to say I don’t feel them. But I will say I recognize a concerted effort to try to put them aside.
But I can’t say I’m always successful at that.” Alice described herself as an internal focuser.
Alice became distracted during the precipitating event by a “thought about where was my resume and was it up to date.” She brought herself back to the moment at hand by telling herself to “stop it, . . . stop and focus.” She remembered feeling a sense of responsibility for her coworkers in the program, and the feeling of responsibility
95 triggered her desire to refocus her attention. “I thought about my resume and then I felt responsible for all these people. And that’s when I said stop it and came back to focus.”
Alice described what it was like to make sense of something as follows:
I feel like I am almost like in a zone; . . . periphery things do not even come into my field of vision. I don’t necessarily even hear, I guess, things going on around me unless I know I should be listening to them or for them. And it is almost, I guess the best I can describe it is just almost just coming into a bubble, I guess.
For Alice, a strong sensemaking response was triggered “if someone is in need or a situation is in need or if I feel needed or I feel—even if I get the inkling that someone needs me. I think that sets me into that mode.” She continued: “I think for me after that point I think is when I start feeling all the emotion attached to the moment.” She then moved into the need to develop a plan around what she was experiencing. “I immediately want to have a plan. The plan is . . . for me it’s my sense of security.” Finally, after developing a plan, she found herself in a state of acceptance and “goes with the flow.”
Alice acknowledged that she spoke with her husband after the precipitating event.
She did not feel that speaking with her husband changed her perspective or how she felt about the information she received. Speaking to her husband was an outlet that allowed her to safely “vent” about her experience of the precipitating event. “I need to vent and he allows me that opportunity.”
Jane: Individual Textural Description
As Jane experienced the precipitating event, she first tried to figure out “What did it really represent?” She attempted to put what she was hearing into a framework, “What are the definitions? I’m trying to put it in a framework, you know?” As she tried to develop a framework she felt “the numbers certainly don’t reflect what would be my
96 impression of where we are today.” The numbers created a sense of surprise. “I understand they’re not today’s numbers, but I think it’s sort of surprising a little bit.” She struggled to find a starting point “to be able to put an interpretation on these numbers.”
She became confused and somewhat disbelieving about what she was hearing. Jane’s other thought was “how much time was this going to take to delve into this, . . . to make sense of it and what was the relevance overall going to be.”
Jane described how she made sense in the moment as a process whereby she developed a framework. The framework was constructed as “you run through all the thoughts in your head that have to do with that [event] . . . that you can relate it to.” Then
Jane asked herself a series of questions:
Does the information make sense? . . . Does it make sense with what I know I’ve been working on and with the other data that I have? If it doesn’t, then why, you know? What doesn’t make sense about the data that fits in with what I have knowledge of? And you just start running through it: Does any of this make sense? What are the pieces that don’t make sense? So that to me, you know, does it fit with what we’re doing now, and then you start breaking it down. . . . It doesn’t totally make sense with where I see we’re at now, so why doesn’t it make sense, you know? Is it because the data is old? Is it because I’m looking at different things than what the data looked at?
Jane went on to describe the next part of her sensemaking in the moment process as “determining the importance of this [event] right now” and wondering, “What am I gonna do about it?” She asked herself additional questions, “Is it a piece of information to file? Or is it something I need to take because I’m gonna have to react to it and do something about it?” If Jane deemed the event important, she indicated “that you start making your list of what you need to do to resolve it.” If the event was not important,
“then you file it away. . . . It’s information. . . . I don’t need to act on it. . . . I’ll keep it as a frame of reference and move on to my next thing.” Jane indicated that by asking these
97 questions, she was “assigning a value to the importance of the information for how soon you need to resolve [it].” In processing information, Jane processed both internally and externally, but the process began for her internally.
I think I process it internally before I go out, but I always do both. You know, I don’t think I just take my own opinion ever on things, although I think I try to make sense of it first.
When asked if you can make sense solely by yourself, Jane responded by saying,
You can make sense of it; I can make sense of any situation myself—but, it’s only my sense then. . . . I’m not convinced it’s a whole sense if you don’t have everybody’s perspective or you don’t have other perspectives. So, you know, I can make sense of an individual event in my own mind.
She acknowledged that she did reach out to others to make sense of the content of the precipitating event and described it as “more info gathering rather than discussions.”
The experience of reaching out to others did not change her perspective of the precipitating event. Jane went on to explain that for her, making sense of things
always starts with does it make sense in my realm of knowledge and experience for me. . . . I think does it make sense to me first. . . . If it makes sense to me, then does it seem to make sense to everybody else? So it’s always an internal looking at how I respond to it before I validate it.
Jane went on to say that turning to others to make sense of something allowed you to access other frameworks. “But there’s other frameworks to look at the same thing.
Two people standing at the same moment in time . . . can get a very different impression under the circumstance.” She described reaching out to others as a growth process in her ability to make sense. “I think what it adds to my sensemaking process is the growth piece. . . . I can make sense of it, but I can grow so much more by getting what other
98 people make sense of it too.” Additionally, Jane described making sense and reaching out to others in the following way:
It’s not black and white for me [making sense], it’s like living in the gray. You know, it’s not I’m right and you’re wrong; it’s like I can make sense. . . but I’m not black and white enough that if I make sense it’s black and it’s my way and your sense can’t make any sense to me. . . . I think there’s always shades that you can do, and that’s probably some of why I run through my idea when trying to look for how does everybody else does it, because I don’t think making sense of things is black or white anymore.
Jane acknowledged becoming distracted during the precipitating event. “The chair was uncomfortable; . . . the chair was very distracting.” Jane described how she brought herself back to the present moment by “refocusing on the objectives: . . . Why am I here?
What am I supposed to be doing right now?” She indicated that “just being aware of people around you” helped her to refocus. Jane further described the feeling of being focused as “good. . . . It feels like you’re doing what you should be doing.”
A sensemaking response was triggered for Jane by “bounc[ing] it [something] around inside my head and have it come out making sense” and by asking herself,
“Should it be important to me and where does it fit?”
Jim: Individual Textural Description
The experience of making sense of the precipitating event for Jim began with a sense of fear in “walking into a room full of people, not really sure what this was about.
And, fear when I heard [executive’s] message because I thought I was going to lose my job.” Fear quickly mixed with surprise and disbelief as Jim heard the message from the hospital executive. “I’m in the program every day, and I just cannot see that we’re that
99 bad, . . . so I just wasn’t believing what I was hearing last week. I kept thinking: no way is this information true.”
As Jim started to reflect on the message, he experienced various emotions.
Initially, he felt a sense of burden. “I got a sense of burden when I started hearing the actual statistic and how we measured up in each of the areas, which made me realize we all had a lot of work to do to bring up the ratings.” His sense of burden turned into a sense of embarrassment as he contemplated his role in the outcomes of the program.
I see myself at the top of the food chain, and it is my responsibility to make sure the program is running well. . . . If I’m supposed to be the one to make stuff work and our ratings are down, . . . I’m embarrassed.
Jim’s emotional reactions (fear, surprise, disbelief, a sense of burden and embarrassment) produced a physical reaction that resulted in him “feeling flushed” and causing his top lip to sweat.
Throughout the message, Jim acknowledged having periods of being focused and unfocused. Jim described himself as having an internal focus. “I’m not looking to others to make sense of things. . . . I trust my own ability to make sense of what’s going on. I use my own experiences, and I think I have good judgment.” When he became unfocused, he brought himself back to the experience by “becom[ing] so intent on what
I’m doing or listening to that I just don’t hear or think about anything else.”
Jim equated his making sense of the precipitating event as being similar to common sense. He described common sense as “kind of like being analytical. I mean, when I’m faced with something I need to figure out, I analyze it.” According to Jim, common sense works by “thinking and reflecting” and “using all your experience at work or outside work to think about what you have just seen or heard.” He thought, however,
100 that “sensemaking seems to be somewhat different than common sense,” but he could not articulate what that difference was.
Jim indicated that he might have felt differently during the message if he had more information going into the session. “I think I would have been more focused on how to improve our quality of care and less focused on thoughts about losing my job.”
Joanne: Individual Textural Description
The experience of making sense of the precipitating event for Joanne began with a sense of shock and a feeling of being nauseated.
I was like this is—this cannot be. This just cannot be. . . . I was very shocked and —but then I had to tell myself to not get too upset. The more I thought, the more I got nauseated and I was like this is, this is not good.
Joanne tried to calm her sense of shock and nausea by telling herself to calm down and that “I don’t have enough information to . . . make a decision one way or another.” She proceeded to “take a couple of breaths and then just relax and gather data.”
Joanne then laid her eyes on “key players in the room” to “see what the reactions” were as a means to “see if this could really be real.” She then turned to “sorting in my own mind facts that I knew.” As the HealthGrades scores continued to be revealed, Joanne felt
“they didn’t make sense. And I know what our statistics are, and so I was like this does not make sense.” She then considered who she would “talk to to gather more data” and
“what kind of an impact this is on our organization.” Joanne experienced the precipitating event “fairly quickly in my mind.” Joanne felt she needed more time to make sense of the information, “so, I decided that another cup of coffee and joking about the cookies was the next route to go.” Her final step in making sense of the precipitating event was
101 considering what actions to take. “What are we gonna do? . . . This is all of our problem.
And so now what do we do? And then how do I get involved, and what’s my part of it?”
Joanne indicated that she experienced different emotions and physical sensations as she made sense of the precipitating event. Initially, she felt a sense of shock and she became “scared.” Underlying her sense of shock and being scared was the physical sensation of being nauseated. Finally, Joanne felt a sense of disbelief: “This just can’t be.” Mentally, she asked herself to remain calm and to “try to relax.” Joanne attempted to calm herself by taking “some really big internal breaths.” As she did this, Joanne felt a sense of “lightness.” As she turned to examine her own experience of the program, comparing her experience to the HealthGrades scores, she felt a sense of “power” and
“strength.” Joanne got up to get another cup of coffee and joked with others in the session and then “quickly” felt a sense of “lightness.” Finally, Joanne moved to thinking about a plan of action, which led to her feeling “real concentrated,” “real focused,” and
“creative.”
When Joanne was asked what triggered a sensemaking response, she described it as “interest, . . . and it’s connected to my values. . . . If it’s something that also connects to my value system, then I am engaged.”
Joanne became distracted during the precipitating event. She used what she termed her “watchdog” to refocus herself on the message being delivered by the hospital executive. The “watchdog,” according to Joanne, was “kinda like this, this eye. You know, which is the less dominant eye just goes and keeps watch.” The “watchdog” notified her when her mind wandered during the session and did so by “just like a little flip.” Joanne described being unfocused as a sense of “freedom” and being focused as a
102 meditative lightness and as if there is a second person. . . . That other person gets in there and it’s like—there’s this, the head is in it. I feel really intelligent, . . . like I feel like my chest is open and I feel like I have this, this enormous power, and I, I so don’t want to lose it—that. You know, I, the—the drive to keep the focus is like addicting.
Joanne reached out to others inside the healthcare system to make sense of the event “because you get a broader picture of what’s really going on,” and she was
“looking for validation.” In reaching out to others, “They made me just as uneasy, if not uneasier.” This unease came by others “telling me some stuff I really didn’t wanna hear.”
Joanne finished the one-on-one interview session by noting that “there are rules
[to your work universe], . . . and it sounds like the rules have been broken.”
Karen: Individual Textural Description
The experience of making sense of the precipitating event for Karen began with her listening to and trying to interpret the message. She “just keep thinking about the message and kept going over it and over it again.” Karen’s thoughts sometimes changed as she thought about the message. She continued to concentrate on the message, even as her thoughts changed. She did not make eye contact with others in the room “because when you do that it kind of takes away from your thought processes.” She thought about the individuals present in the room and wondered, “What are they thinking?” Karen also wondered, “Where am I in this?” She then started thinking about going out into the community and trying to attract people to the program, which led her to thinking about the need “to get your act together—in order to save people.” She continued to listen to the words of the message and indicated that she did not remember “smelling much” or hearing anything; “everybody was really quiet.” She continued to avoid eye contact by looking down at the table and listening to the executive’s voice and feeling as though
103 “that is the person that we need to hear from” and continuing to concentrate on his words in order to put together a meaning and “wanting desperately to have a good outcome.”
She continued to remain very quiet, and towards the end of the message, when it was apparent that the message was negative, she started to look around and she did not see a lot of eye contact from others. She tried to determine how all of the people assembled in the room were connected to the program.
Karen experienced multiple emotions during the precipitating event. Initially, she felt a sense of surprise, disappointment, fear, and a need for more information. Having worked for the system for nearly two decades, Karen believed that patients “should receive the best possible care, 100% of the time.” She became surprised, disappointed, and fearful when she heard the low heart and vascular scores, which made her realize that the hospital was not giving the best care possible and that lives were lost as a result. As the message unfolded, she developed physical sensations of a “knot” in her stomach and being “drained.” Towards the end of the message, Karen looked around the room and wondered, “What in the world can I do, or even can we do?” She also described looking around the room, with the presence of directors and managers (Karen was not hold a management positon), and thought, “What am I doing here?” As Karen surveyed the room to see how those present in the session were connected to the program, she saw the
“dejected” face of a coworker and began to feel overwhelmed, surprised, disappointed, and a “little distrustful.” And, finally, she felt the need for more information to help her make sense of the message.
Karen described herself as someone who had an internal focus and focused her attention by “active control,” which was “just concentrating on what I want to
104 concentrate on.” She went on to describe trying to quiet her mind so that “I’m just concentrating on what’s happening at the moment” and “listening, . . . not really dissecting anything.” Karen stated that being focused felt like she was in a “zone” and she was “very aware of what’s going on.” She indicated that being in the zone felt good:
“I get this totally focused zone that just feels good because I’m totally there,” and she had a “total understanding of what’s going on.” Karen associated being unfocused with “not feeling good. It doesn’t feel good to be in that other place [unfocused].” She went on to describe being unfocused as “freedom” and being focused as “responsibility.”
In making sense of the precipitating event, Karen acknowledged that she reached out to coworkers. She indicated that “it did feel better to talk to someone” and “it even felt a little more secure in trying to see what, what they thought of the message.”
Larry: Individual Textual Description
The experience of making sense of the precipitating event for Larry began with a sense of the ratings for the heart and vascular program. He was aware “that the trend line was down, not up.” He was not surprised by the message, as he had heard the information before the precipitating event. He surveyed other people in the room and assumed they, too, were aware of the trend line and thought, “Maybe it’s uncomfortable news, but not new news.” Larry felt it was a good thing that he was at the session to hear the message, as he was not on the clinical side where it had been discussed as an “agenda item.” “But here I am, it is the agenda item, and that’s good. It’s got the issue out on the table in front of everybody.” As the session began, Larry had a thought around hoping that the
“organization had a serious grasp of what moved us from superior to average or less and that there was an understanding of, of tactics to implement to move from average to
105 superior again.” He described that “in my head I was on the fence. Was this new information for everybody at the table, and if it is, all right. Now they can move forward trying to turn it around.” As the message unfolded, he had a sense of being “deflated” and being “depressed.” But he also felt a sense of “relief that it wasn’t my personal professional day-to-day problem.” The message also created in him a sense of urgency.
“What goes through my head is, there has to be urgency. We can’t be a gradual, you know?” He then thought, “How can I help these guys get where they want to go?” He described how in his “heart” he thought, “Okay, we’ve taken a dip. Nobody’s explained to me if it’s big or little.” He saw this experience as a “challenge by one of our senior organization people.” This thought moved him mentally to think about who was going to pull them out of this ratings slump. Larry indicated the need for a
charismatic figure who can, who can be the person that everyone rallies around and who steers the ship with the most authority. And I’m hoping that that person is working quietly behind the scenes to make that happen, but it’s not self-evident to me who can, who’s got the portfolio to do it.
Larry described not having any “first-hand experiences” with any of the clinical staff or patients and, as a result, he experienced the message in a different way from the clinical staff members in the session. “I guess I was looking at it for, it is what it is. They ran the numbers and this is what it tells us.” Larry acknowledged that throughout the message he was not “surprised. . . . It is what it is.” In his organizational role, he didn’t feel “the professional pressure perhaps that the clinical people felt because I wasn’t being, my department wasn’t being evaluated in this by these metrics, so I could stand a little bit on the edge.” He felt “more of an observer” because he saw himself as having a limited impact on “how the change was going to occur.”
106 When Larry was asked specifically to explain how he made sense in the moment, he described consulting his personal experiences. “I look at how it’s being handled and I think, hum, had I seen this before where I’ve worked before and how was it handled there? . . . So I guess it’s . . . my own personal experience.” He also described thinking about what “would an appropriate response be” and how his response would “be greeted by the people I interact with.” He felt the need to be “reflective” and “to think about how we respond.” He assessed what was going on and identified “the missing parts. What am
I not seeing in our model that I’ve seen in others that I think we would benefit from having?”
Larry described being distracted as something in his “mind” or “eyes” that triggered him to go “someplace else in my head,” and he would “run down that alley” and then think of something else. When he was distracted he became “anxious,” and some element of a “discussion will bring me back.” He described being focused or
“engaged” as “pleasurable.” “Engagement” for Larry was “lining up information in a way that fills in gaps, answers questions, informs me so that I can use that.”
Larry did not reach out immediately to others to help make sense of the precipitating event, as “there were very few people in the room that I had a personal relationship with.” He went on to describe the message as being “threatening enough” that he was “less inclined to make the first overture.” He later “talked to one or two other people” whom he had a personal relationship with, and they “brought up some nuances” that he had not thought of before. After speaking with these individuals, he felt “a little more hopeful that though there’s a wagon that has to be pushed up the hill, at least people are gonna get behind the wagon and start pushing it.”
107 When Larry was asked if there was something else he wanted to add around sensemaking in the moment, he responded by saying, “observation.” He went on to say,
“There’s always an audience for whatever you’re doing so you—you’re always picking up the vibe of the room.” Observation, according to Larry, brought “affirmation that you are on the right track, . . . that you’re approaching something the right way—. . . a validation function.” He concluded by saying that observation “gives you a sense of the level of agreement or hostility or disinterest or whatever is in the room.”
Lisa: Individual Textural Description
The experience of making sense of the precipitating event for Lisa began by comprehending the significance of the HealthGrades score and its impact on the organization.
I just started thinking that, like, all these numbers mean so much for the hospitals, like we want to provide the best care every single time, and listening to those numbers it—the hospital looks good in the papers and everything.
As she continued to listen to the message, she thought, “What’s going on? Why is this happening? What are other hospitals doing?” Lisa fought the idea that while she and others thought they were providing “the best care,” “something in the message seemed to ring true.” She felt fear and anxiety. Her thoughts then moved to, “What are we gonna do?” She doubted whether she would bring her family to the hospital for care. She felt fear for her family, a sense of sadness for the patients, and anxiety for the system and its image. She remembered starting to feel that she would rather not listen to the message any longer. With each score that she heard, she felt something was “not good” with the
108 system. Lisa believed these numbers pointed to mistakes that resulted in poor care. Her predominant feeling throughout the message was one of sadness.
When Lisa was asked specifically how she made sense in the moment, she said she listened, thought about what she was listening to, and examined her past experiences to help her make sense of things.
At times, Lisa became distracted during the precipitating event. Her mind kept going to a presentation that she needed to give as part of her practicum that same day.
When her thoughts turned to her presentation, she actively told herself to “come back to the room.” She then refocused her attention on what was happening in the room where she was seated for the session. She described herself as having both an external and internal focus, but her main mode was external. She believed she was easily distracted but that when she became distracted her brain told her, “No, come back.” Lisa felt lost when her mind wandered, which caused her to feel “anxious.” When her mind wandered,
Lisa also experienced fear that she would “not be able to answer [someone] properly.”
She described being focused as “feeling good.” She felt good about being focused because she felt that she “understands better and can apply [things] better.” She also experienced a sense of being relaxed when she focused.
Lisa did not reach out to others during or after the session because “I don’t work here [i.e., at this facility]. . . . I don’t think I revealed this to anyone.” She indicated that had she worked here, she would have reached out to others, as it was a normal part of her sensemaking process. She acknowledged that she would, however, most likely have waited for someone to bring up the subject to her.
109 Sue: Individual Textural Description
The experience of making sense of the precipitating event for Sue began with a sense of “What have I missed?” She pondered her perception of the hospital as being “a very good hospital,” one in which she had been employed for nearly 30 years. As she continued to hear the message and the low HealthGrades scores, she began to think about the community and the fact that this is where her family would come for care. The information “made me sick to my stomach.” She began to feel a sense of fear and uncertainty. “It kind of seemed like the bottom fell out.” Sue had been contemplating changing jobs and decided not to, but now the thought entered her mind that “I should have done something different.” She tried to rationalize the message as it continued to unfold. The message seemed to offer Sue “validation of some of the concerns that we had been expressing [within the organization].” “Now,” she thought, “there’s gonna be action.” She started to look around to see “how it [the message] affected my colleagues,
. . . and I wanted to know what were they thinking, that this was valid information, and like me, did it also have some fear for them as well.” Sue struggled with getting a handle on how she could “sort out the many conflicting emotions” she was feeling.
Sue felt a sense of satisfaction when the hospital executive used the phrase,
“We’ve got work to do,” as it made her feel that leadership had “a serious commitment to the care of the heart patients.” As she contemplated a plan of action on how to improve patient outcomes, Sue felt a sense of eagerness. “I was already ready to make a move.”
For Sue, coming to a point where she started to mentally work out a plan of action closed her sensemaking process.
110 Sue acknowledged that she became distracted during the precipitating event by her own mental thoughts.
Every time I started to drift off, I came back to outcomes. . . . Outcomes are what affect the patients. This is your community. It could be your mother. It actually was my mother-in-law. It could be your husband, it could be you, so you need to listen . . . and become personally involved.
Her personal and professional sense of commitment helped her refocus her attention on the message. Sue characterized focusing her mental attention as “your brain scrunches; . . . you know where you think—in the frontal part of your brain.” She went on to describe focusing her attention as “like my forehead is working hard. . . . It presses.
. . . It’s an actual feeling, . . . like you would feel a machine hum. It’s like I feel that part of me humming.” Sue described bringing “the information into herself.” “When I bring it into myself it’s kinda like the message is no longer just out there. It’s now a part of me.
It’s part of something that I will take on that will affect me.” Sue went on to say that focusing was like “a movement kind of thing. Yes, it’s a forward movement. . . . It’s almost like this part of me is trying to catch up to the frontal, you know?” Sue characterized being unfocused as “space” and “kind of like a cloud.” “And when I’m not focused, then it is more gut feelings.” Sue indicated that being unfocused made her feel uncomfortable because it is “almost like you were caught sleeping.” When Sue thought about being unfocused, she described it as follows:
It feels unwritten. It just feels like a blank. When I think of the sky, you know, I think of so many things up there, but you could see nothing. It would be a lot of nothing. And so it’s almost like in my head it’s just blank.
Sue described her focus as internal.
111 Sue reached out to others during the session. She started to look around to see
“how it affected my colleagues.” She also reached out to her coworkers after the session and, in doing so, “it made it less personal for me.” Speaking to others lessened feelings of
“fear,” “uncertainty,” and of “personal sickness.” The message seemed to take on more of a professional “responsibility.”
When asked if Sue had additional thoughts connected to sensemaking, she indicated that she would have reacted differently if she “had received the information in a visual format.” She described herself as a “very visual person.” She believed she would have “broken into the thinking mode much quicker” because something written would have given her something to focus on and she would have been less distracted.
Something written would have helped her “get her act together.” Sue also indicated having a better sense of what was going to take place prior to the event would have put her in a different sensemaking mode. Not having a sense of what was going to be discussed made her feel “a little blindsided.” Feeling blindsided created a negative feeling going into the session and made her question “how do I stand in this situation.”
Terri: Individual Textural Description
The experience of making sense of the precipitating event for Terri began with listening. She was “keyed up” and very “attentive” to the message that the hospital executive was giving. She was “surprised” and “somehow not surprised” by the message.
The message surprised her because “I thought we were doing a lot better.” At the same time, she was aware of “actions that they’ve taken in decreasing staffing and trying to make the budget” that may have resulted in the lower HealthGrades scores. This realization produced for Terri “a lot of emotions.” Terri experienced “a lot of anger and
112 embarrassment.” Terri wanted to find answers to “why would that have happened.” She looked “around the room a little bit,” trying not to “look at all the people’s faces because it wasn’t light-hearted.” Terri wanted to “see some of their expressions because it’s decisions that they made that ultimately impacted what we deliver.” Terri felt a sense that others in the room were “looking for someone to blame,” possibly her, for the low heart and vascular outcomes. Terri indicated that she processed what she heard in the message
“from all my experiences in that area,” and as she processed she became angry because she realized that “they’ve cut and focused differently,” which she believed resulted in poor outcomes. This realization moved her to look “for someone to blame, too.” She indicated that while she was “listening, thinking, emoting,” she wanted “accuracy.” She wrote down the scores as they were being given. “Somehow I wasn’t willing to just sit there and listen to this stuff and not have it to look back on and reflect on, so I was very much multitasking through.” Terri felt a sense of “grief, a loss of something.”
When Terri was asked specifically to explain how she made sense in the moment, she described it as being connected to attention, awareness, and interest. “Okay, let’s first, I’ll give you my attention, then we’re gonna get my interest.” Attention and interest were different aspects of sensemaking for Terri. For Terri, there were various degrees of attention. She may give some of her attention to “something,” but it was not until she became interested that she gave her “full attention.” “You could have some attention, but
I could be multitasking. So, if you have my interest, then you have my full attention.”
Attention and awareness seemed similar to Terri, and she explained by saying:
So, an example, until my dad died of a rare stomach cancer at 52 and until it took my sister’s life at 38, the same rare stomach cancer, I got to tell you, I had no interest nor any awareness of this. And I became motivated to learn everything that I could about this cancer.
113 Interest for Terri was associated with motivation to make sense of something.
“You can have my attention, but you’ll really get my heightened interest and . . . I have the motivation.”
After Terri became interested, she moved to processing what she had heard or seen, which then led to a response or reaction. “Now, after that, I then have to process what you just said, and then after I process what you said, I should have a response or a reaction.” Terri described a circular process, whereby she processed
what I just got back from you, and then I have to keep, and it can go on and on and in the stage, and I think the more we interact, . . . the more confident I am on either how I feel or you change how I feel.
This process was related to assessing what was going on in the moment, according to
Terri:
I would be processing whatever I heard, saw, felt, okay. So, once my interest goes, it would definitely have to be the assessment and I’d be looking at using those senses and then I would basically end up processing what I saw, felt, touched, smelled.
Terri acknowledged that she became distracted during the precipitating event. She used a variety of means to bring herself back to the task at hand:
I know that if someone’s talking and listening, the only way . . . I’m gonna get back on track is for me to make eye contact. . . . One of the ways when I’m making sense of things, the more I touch my face, the more I’m thinking. . . . I really try to straighten up. . . . I will try to sit myself, . . . make myself attentive. . . . I’ll force myself, so I am disciplined enough to get myself back on track.
Terri described focusing as both an internal and external process. “I think they happen simultaneously.”
114 Being focused to Terri was “a heightened sense of alert.” According to Terri, she had to have an interest in what was going on or “you won’t have my focus.” And, if she was interested, “now you will get my sense.” According to Terri:
Someone either had to tell me or something—I don’t care if it’s a splatter of blood and, and something I’ve seen on the floor in the hall—and so I would then, I have a response after I have interest. I have to assess it. No matter if it’s person, place, or thing, and I then absorb it.
Terri reached out to three people after the precipitating event, all of whom were members of the organization. Terri was seeking validation from others and for someone to say it was going to be okay. “I needed validation.” She wanted validation that she was correct in her perspective that changes to the heart and vascular unit resulted in the lower scores. Terri described the experience as follows:
That I was right. Not how I felt. I knew how I felt. I didn’t want them to say it’s okay; you should be mad or you should be angry; you should be sad. I, I just basically wanted someone to agree that what I thought and what the problem areas were, were accurate.
Terri believed that in making sense of things, “you have to somehow explore with somebody.” Terri’s perspective did not change after she spoke to others.
When asked if there was anything else around sensemaking that she wanted to share, Terri noted, “being judgmental.” She went on to say,
I think in people making sense and taking in and doing stuff, when you’re stifled by the fact that others are trying to read you or judge you so that they can either, I don’t know what they do, but I think that setting made a difference versus now, where I’m Terri and you aren’t judging me. You simply are seeking information. I am much freer to explore and make sense of things to a, a higher degree than what I did on my own. I think that’s what happens with counselors and therapists where someone isn’t going to judge you and explores with you.
115 Terri believed that the fear of being judged by others affected one’s ability to make sense. “I think to make sense, to take it to that next level, isn’t that humans don’t have their senses and aren’t able to pull things together. I think there’s something with judgment in there that either stifles us or takes us to that next step.” Terri associated a diminished sensemaking experience with not fully exploring something or expressing herself openly for fear of being judged by others.
Victoria: Individual Textural Description
The experience of making sense of the precipitating event for Victoria began with a feeling of “sympathy” for the “other folks sitting in the room who may have been hearing this for the first time.” Even though Victoria had heard the information prior to the precipitating event, she described it as feeling “worse” hearing the message from the hospital executive and listening to the lower scores, one after the other. Victoria went on to describe the experience:
It definitely felt worse, I think, coming from him and to sit, sit and hear them [the scores] sort of all in a row. . . . [The] long message was just sort of one blow after blow after blow, so it was—it seemed a lot worse, yes, to hear everything coming from him sort of all at once.
She noticed others around her “sort of tense up a little at the news. . . . I’m looking across the table at the person who’s sitting across from me and they seemed really anxious.” Victoria sat back and listened to the information as it was being delivered. “I was sort of trying to take it in.” She felt a sense of relief that “all of the cards are on the table now—now what?”
When Victoria was asked how she made sense in the present moment, she recalled an event that occurred some months prior, one that held significance for her. The
116 event was a meeting that one of the vice presidents for the system attended, a vice president who had previously managed her department and someone she knew well. She described how something about the vice president’s body language caught her attention and put her into a sensemaking mode. Victoria sensed that something negative was going to happen during this meeting. This sense of an impending negative event put her into an even stronger sensemaking mode. Victoria looked around the room at others in the meeting and thought, “What do they think it is?” She started running through her mind the possible scenarios of what it could be, based on her previous experience. As she considered possible scenarios, she also pondered what each of them might mean to her personally. As Victoria thought about the personal significance of each of these scenarios, she started to develop an action plan.
Victoria acknowledged becoming distracted during the precipitating event. She became distracted when a fellow coworker started talking about needing a cookie during the session. “I think I even made a note in my journal like the cookie thing with Larry. I was like, What are you talking about? . . . I’m trying to think about something and he’s talking about cookies.” Victoria described bringing herself back to focus on the message as a sense of responsibility. “My thing is just I, I think in most situations you feel a responsible—a sense of responsibility to do that.” She felt she had both an internal and an external focus.
While Victoria spoke to others after the session, it was not to make sense out of the event. She spoke to others about the event because she was asked what had happened in the session by other coworkers who were not present for the message. Victoria acknowledged that she typically did go to others as a way to make sense of something.
117 “Yeah, I think that’s my personality is to, to go to people close around me and talk it out.” In this process of reaching out to others to make sense of events, she described being able, by the retelling of the event, to change her own mind or that others may do so during the course of discussing something.
I think sometimes just sort of retelling a story to someone, you think of things you—different scenarios come out of your story and you maybe think of something a different way just hearing yourself retell it to someone else. And so maybe I could change my own mind or they could change my mind.
When asked if there was anything else around sensemaking that Victoria would like to share, she thought it was important to note that she was not “somebody who agonizes over a decision.” She went on to say, “I think I make decisions in my mind pretty quickly and not that I’m stuck on those decisions.” Victoria also noted in sensemaking, “You have to know your feelings.” She went on to say that she acknowledged and accepted that as she made sense of things, she had emotions. “So I think it may not be that I have control over the ability to feel sad or to feel angry, but I think I am able to recognize and accept it pretty quickly.” Victoria thought that, in certain situations, she had “the ability to choose, you know; if I’m feeling sad, I, I have the ability to decide, you know, yes, I understand I’m sad, I understand, you know, that that’s how my body is feeling, but I’m—but I think I, on some level, I have the ability to say:
Okay, stop.” Finally, Victoria believed that a thought “triggers an emotion” and that this was part of a continuous process within the larger process of sensemaking.
Section 3: Structural Descriptions
Creswell (1998) posed that individual structural descriptions are the “how” of the appearing phenomenon. The structural descriptions are meant to convey the subjective
118 experience of individuals as they made sense in the present moment. What follows are structural descriptions for each coresearcher in this study.
Alice: Individual Structural Description
The structures that were present during Alice’s sensemaking experience of the precipitating event were feelings of shock, anger (with self and others), responsibility, insecurity, frustration (with self and others), disappointment (with self and others), and embarrassment; the way she made sense in the moment; being focused; becoming distracted; and the triggers for a sensemaking response.
As Alice experienced the precipitating event, she first was struck with a sense of shock. She wondered what had changed to make the heart and vascular program decline in its ratings. She quickly tried to analyze what had changed in the program by examining the various steps “a heart attack patient goes through and trying to think of any glaring things that would jump out at me.” As the message progressed and Alice became aware of the impact on the healthcare system of the lowered scores, she became quite concerned for the reputation of the program and, consequently, for the healthcare system. As she pondered the business impact to the healthcare system, she began to personalize the message—“I hate the fact that I would let someone down”—and her thoughts then turned to coworkers who “have committed their entire career to providing excellent service.”
She wondered “how do I look them in the face and say this is what this is.”
After processing the message, Alice experienced a sense of anger directed towards herself. “I felt a little bit of anger because I didn’t know why I didn’t know. We had this sharp increase in deaths in 2008. Why didn’t I know?” She also felt anger at the process they used to track outcomes. After feeling anger, Alice indicated that she “just
119 started feeling” a series of emotions. She worried about how the competition would use lowered scores to position themselves. “We have that threat now in [nearby town], and so that immediately came to my mind: Is that this could really be the ammunition that [City
Hospital] needs to use against us?” This thought then triggered a sense of fear for herself, for her staff, and for the entire organization. She became anxious as she contemplated her responsibility to her staff, patients, and the community. As she contemplated her responsibility, she began to feel insecure. “At that point when I realized this is my responsibility and feeling that emotion of responsibility, I felt a little insecure.” As a means to cope with her sense of insecurity, Alice mentally started to develop a plan for how to improve the heart and vascular program. As she thought through the plan, she wondered, “How can I get senior leadership to make necessary changes?” This thought produced feelings of “incredible frustration and I guess also a little bit of disappointment.” These feelings suggest that she believed that either she and/or the leadership could not make the necessary changes to improve the program, and this thought created a sense of hurt and then embarrassment for her as evidenced in the comment:
I’m in the community a lot at different events that the hospital sponsors, and I am always touting our heart and vascular program, . . . encouraging our community to feel good about coming here. So it’s a little embarrassing to know how to answer questions about why. You know, why are you not as good as you said you were? And I don’t want—I don’t want the system to have a black eye.
In general, Alice described how she made sense in the moment as “a flood of experiences coming to your immediate mind at like a high rate of speed. . . . It’s almost like liquid going through those frames of experiences.” She was aware of trying to pick out frames of experiences “that will most benefit you at that moment” and that running
120 through her frames of experience would help her “understand and develop a plan of action and deal with what’s at hand.”
For Alice, a sensemaking response was triggered by a sense of need. “If someone is in need or a situation is in need or if I feel needed or I feel—even if I get the inkling that someone needs me, I think that sets me into that mode.” When she was in a sensemaking mode, Alice described feeling as though she were in a zone:
I feel like I am almost like in a zone. . . . Periphery things do not even come into my field of vision. I don’t necessarily even hear, I guess, things going on around me unless I know I should be listening to them or for them, and it is almost, I guess the best I can describe it is just almost just coming into a bubble.
Additionally, as she processed her experience, Alice started to feel emotions. “I think for me after that point, I think, is when I start feeling all the emotion attached to the moment.” Afterwards, Alice was compelled to develop a plan of action. Development of an action plan seemed to provide Alice with a sense of security. “I immediately want to have a plan. The plan is . . . my sense of security.” With the plan developed, Alice was free to “just take in what is going on at the moment” and to “go with the flow.”
Alice described what it felt like to focus as “an incredible amount of energy, focus, adrenaline.” When Alice was focused, she tried to keep things out of what she described as her “line of vision,” which appeared to be her mind. She described this:
I have these little things trying to come into the focus, and I’m just trying to keep the focus clear and, umm, uncloudy. . . . When I’m focused, I am trying to keep those other things out, those emotions or whatever else. . . . I guess I try to keep them out of my line of vision. I think what that allows me to do is plan—plan and act at that same time.
Additionally, during this period of focus, Alice attempted to set aside emotion, as this was one of the things that “clouded” her vision. “I think I recognize them. I’m not
121 going to say I don’t feel them. But I will say I recognize a concerted effort to try to put them aside. But I can’t say I’m always successful at that.”
Alice recalled becoming distracted during the precipitating event. Her mind wandered when she became insecure, and she started contemplating where she might find her resume and whether she needed to update it. At about the same time, she felt an
“incredible sense of responsibility for the people who have spent their entire career here,” which caused a sense of anger directed at herself for thinking about leaving. This sense of responsibility and anger seemed to bring her back to the present moment and to once again attend to the topic being presented. The emotions—responsibility and anger—were the catalysts that she used to regain her focus. “I do remember saying literally in my head: Stop that. You know, stop and focus.” These emotions seemed to bring her to awareness that her mind was wandering and allowed her to mentally force herself to pay attention to the present topic.
While Alice spoke to her husband about the event, she felt that it did not change her perspective on the information she received about the heart and vascular program.
Jane: Individual Structural Description
The structures that were present during Jane’s sensemaking experience of the precipitating event were development of a framework; sense of surprise, confusion, and disbelief; a feeling of being overwhelmed; the process of sensemaking in the moment; reaching out to others to make sense; being distracted; and triggers to sensemaking.
As Jane experienced the precipitating event, she was aware of trying to figure out
“What did it really represent?” She attempted to figure out the content of the message by developing a framework from which to make sense of the message that the healthcare
122 system’s executive delivered to the group. Jane indicated, “It’s hard to pull a starting point, like where do I start, . . . to be able to put an interpretation on these numbers.” This difficulty in finding a “starting point” produced a sense of confusion. As the message continued to unfold and the low outcome scores were revealed, Jane experienced a sense of surprise and then disbelief. “I was surprised . . . that so many of the things have decreased. . . . I was disbelieving a little bit.” These feelings seemed to stem from her first-hand experience of the program as it was currently functioning. “The numbers certainly don’t reflect what would be my impression of where we are today, and I understand they’re not today’s numbers, but I think it’s sort of surprising a little bit.” As she continued to contemplate the scores, her thoughts turned to the prioritization of this information within her existing responsibilities and how to devise a plan of action. “If you’ve got six projects on the table, what does this, where is this gonna fall in the line of importance to looking at these numbers and trying to figure out where we should go?”
This thought for Jane was “overwhelming.”
Jane described sensemaking in the moment as a process that began for her by building a framework from which to make sense of what was going on. That framework consisted of running “through all the thoughts in your head that have to do with that and you start bouncing them off to see if there is something that you have that you can relate it to.” She then moved to asking herself a series of questions, which began with “Does the information make sense?” and continued with “Does it make sense with what I know I’ve been working on and with the other data that I have?” If the information or event did not make sense, she then asked herself, “What doesn’t make sense about the data that fits in
123 with what I have knowledge of?” This course of thinking set into motion another series of questions:
You just start running through it. Does any of this make sense? What are the pieces that don’t make sense? So that to me, you know, does it fit with what we’re doing now? And then you start breaking it down.
These kinds of questions appear to act as a type of decision tree analysis that supported Jane’s sensemaking process and, ultimately, aided in determining the optimum course of action in situations having multiple possible alternatives with uncertain outcomes. “It’s more than my experience. . . . It’s an unknown, what’s, if there’s some other factor in there that they’re looking at that I’m not looking at. What’s missing from the puzzle?”
After the “analysis” phase, Jane moved to determining “what’s the importance of this right now and what am I gonna do about it?” Her words suggested that she set a value on the sensemaking experience, which then determined what course of action she would take. If she determined the experience had importance to her (value), “I’m gonna have to react to it and do something about it,” and she would start “making a list of what needs to be done.” If Jane determined the sensemaking experience was not important,
“then you file it away. . . . It’s information. . . . I don’t need to act on it. . . . I’ll keep it as a frame of reference and move on to my next thing.”
Jane described her sensemaking process as both an individual and a collective process: “I can make sense of any situation myself—but, it’s only my sense then. . . . I’m not convinced it’s a whole sense if you don’t have everybody’s perspective or you don’t have other perspectives.” While she was comfortable making sense of things on her own, she felt she gained greater insight by accessing others’ perspectives and experiences. She
124 felt that reaching out to others was a way to access other frameworks and doing so aided in her sensemaking experience as a personal growth opportunity. “I can make sense of it but I can grow so much more by getting what other people make sense of it too.” While she reached out to others after the precipitating event, Jane described the experience as
“more info gathering rather than discussions”; it did not change her perspective of the event. Jane explained: “[It] always starts with, Does it make sense in my realm of knowledge and experience for me? . . . If it makes sense to me, then does it seem to make sense to everybody else?”
The process of sensemaking began with her and then extended to others. Jane described the collective part of sensemaking as “living in the gray.” She felt that while it was important to form her own thinking around a given experience, that experience was neither “black nor white.” She went on to explain:
It’s not I’m right and you’re wrong. It’s like I can make sense, but I’m not. I’m not black and white enough that if I make sense it’s black and it’s my way, and your sense can’t make any sense to me.
She was very aware that her experience of any situation was limited by her knowledge, experience, and ability to make sense and that by reaching out to others she could extend her knowledge, experience base, and ability to make sense by accessing other individuals’ sensemaking “frameworks.”
Jane became distracted during the precipitating event because her chair was uncomfortable. She brought herself back to present-moment awareness by “refocusing on the objectives: . . . Why am I here?” and “by being aware of people” around her. Jane’s ability to focus, while internally motivated, was also supported by the presence and activity of others. Jane characterized feeling focused as feeling “good” and “like you’re
125 doing what you should be doing.” Jane appeared to have a strong task orientation. For her, being focused felt good because it allowed her to accomplish her work goals.
Jane described strong sensemaking responses as being triggered by “bounc[ing]
[something] around inside my head and have it come out making sense” and by asking herself, “Should it be important to me and where does it fit?” The value that Jane placed on an event or information appeared to be a tipping point at which she either filed the information away for future reference and the sensemaking process ended or she went on to analyze it with the goal of developing a plan of action for how to address the information or event.
Jim: Individual Structural Description
The structures that were present during Jim’s ability to make sense of an unexpected message from the president of his organization were feelings of surprise, disbelief, fear, embarrassment, burden, and responsibility; physical sensations; common sense versus sensemaking; and his ability to focus.
As Jim moved through the process of making sense of the message, he experienced several emotions—disbelief, fear, embarrassment, burden, and responsibility. Jim felt fear when he received the invitation to attend the meeting because he was unsure what the meeting was about and, finally, when he heard the message, he feared for his job. Jim felt a sense of surprise when he heard the message being delivered.
He felt that he and his coworkers were performing much better than the rating indicated.
The message seemed incongruent with his daily experience of the care he was delivering, which created a sense of surprise. “Is this happening? . . . Is this really for real? Well, uh,
I was thinking we were much better than the stuff I was hearing.” Surprise quickly turned
126 to disbelief. Jim’s feeling of disbelief stemmed from his first-hand experience of how he and others in his department provided care to patients as evidenced by his comment, “I’m in the program every day, and I just cannot see that we’re that bad. . . . So I just wasn’t believing what I was hearing last week.” As the message unfolded, the rating that the system received in the heart and vascular program embarrassed Jim. Jim’s sense of embarrassment flowed from his competitive nature, as he readily acknowledged. “I’m embarrassed. I am very competitive. . . . I didn’t like the fact that other hospitals had better ratings than we did. . . . It falls on me, . . . or at least I feel like it does, . . . to keep our ratings high.” Jim described his sense of burden and responsibility as coming from the leadership role that he played in the heart and vascular program and because it was part of his personality.
I see myself at the top of the food chain, and it is my responsibility to make sure the program is running well. . . . Pretty much anything that happens in the program I take to heart; . . . that’s the kind of person I am.
Jim’s emotional responses to the message produced physical sensations that he recalled a week later. “I remember feeling flushed and my top lip was sweating.”
Recalling physical reactions a week after the event suggests that Jim was strongly engaged in the sensemaking process during the precipitating event.
Jim described that he made sense of the precipitating event by using common sense. When asked to characterize common sense, he said it was something you are born with and that no one can teach you. He said that common sense “is kind of like being analytical.” He indicated that “when I’m faced with something I need to figure out, I analyze it. . . . I use my common sense to tell me what to do.” Common sense, according to Jim, involved thinking about things and reflecting on what they meant to him and what
127 he should do about them. Jim revealed that “if it is information that I don’t think applies to me, . . . I just let that information go in one ear and out the other. I know that doesn’t sound too good, but that’s what I usually do.” Jim indicated that when something seemed important to him, “I get really focused and I listen to what’s going on.”
When asked if sensemaking and common sense were the same, Jim indicated that
“sort of, but not exactly.” He went on to say,
I think you analyze in both sensemaking and common sense, but sensemaking is more, but I’m not really sure what else it is. It’s about thinking and reflecting, and that’s what I mean by analyze. . . . It’s about using all your experiences at work or outside work to think about what you have just seen or heard, and that’s like common sense, too.
While Jim initially suggested that common sense was sensemaking, as he continued to reflect and articulate his thoughts around the two abilities, he came to the conclusion that while there were similarities, sensemaking seemed to be somewhat different.
During the precipitating event, Jim was aware that his mind wandered off topic.
When asked to describe what it was like to be unfocused, he said it was as if his “mind runs, . . . a rush of thoughts . . . all mixed up at one time.” Conversely, being focused was
“as if I stop hearing and sometimes thinking. I become so intent on what I’m doing or listening to that I just don’t hear or think about anything else.” Jim described being focused as feeling better than not being focused.
Joanne: Individual Structural Description
The structures that were present during Joanne’s sensemaking experience of the precipitating event were feelings of shock; a sense of nausea, disbelief, and being scared;
128 the need to turn to others (during and after the event); the desire to remain calm; the sorting of facts (experience); the need for additional time to process information; development of an action plan; triggers of a sensemaking response; being focused and unfocused; and a feeling that rules were broken.
As Joanne experienced the precipitating event, she felt a sense of shock, disbelief, and being scared, which produced the physical sensation of being nauseated. She struggled to understand how the HealthGrades scores she was hearing fit into her knowledge and experience of the heart and vascular program. “I know what our statistics are, and so I was like, this does not make sense.” Joanne appeared to experience a period of cognitive dissonance (an uncomfortable feeling caused by holding two contradictory ideas simultaneously). She looked to others in the session to validate what she was hearing.
I knew that there were some key players in the room . . . so I could . . . see what the reactions. . . , maybe not to make sense, but just to see if this could really be real. I mean, could this really be real?
She attempted to calm herself by mentally saying, “I just need to calm down and, and relax and . . . take a couple of breaths and then just relax and gather data.” This gave her a sense of “lightness.” She then “started to gather her own data” by “sorting in my own mind facts that I knew.” Examining her own experiences gave her a sense of
“power” and “strength.” “I know without a shadow of a doubt that we’re getting EKGs
[electrocardiograms] within 4 minutes. . . . And so I know that that’s solid.” Joanne felt the need for more information to make sense of the HealthGrades scores she received during the session, and she was deciding who she was “going to talk to to gather more data from” and “what sources” she could go to. She got up to get another cup of coffee
129 and joked about the lack of cookies. The physical act of getting up (movement) and getting coffee seemed to parallel the transition of her mind from making sense to the need to acquire additional data. According to Joanne, the movement was used as a method to divert her mind so that she could search for answers. In Joanne’s words:
Because if you can divert your mind away from the tragedy at the moment, you, you can come up with really good answers. Your gut kicks in. . . . You give yourself time for the right answer to come. . . . It’s kinda like a in-the-moment meditation.
According to Joanne, joking was “a good escape mechanism for ED [emergency department] nurses. It buys you time, it gives you time to think, it gives you time to process.” Joking also served to lighten her mood and possibly the mood of others in the room. “That’s another lightness [humor] . . . that gets me very light very quickly, very quickly.” Joanne moved from processing the information and deciding whom she would go to for additional data to the development of an action plan. “What are we gonna do?
. . . This is not just [executive’s] problem. This is all of our problems. And so now what do we do? And then how do I get involved, and what’s my part of it?” Developing an action plan seemed to give Joanne a sense of control over a situation that was shocking to her and made her feel sick. “I just felt so nauseated and I was like this is just—this just can’t be. I think, I think I was just scared.” She went from being shocked and sick to “real concentrated,” “real focused,” and “creative.”
For Joanne, a strong sensemaking response was triggered by being engaged by something that interested her. Joanne’s interest was tied to something that “also connects to my value system, then I am engaged.” Joanne experienced a strong sensemaking response during the precipitating event, so strong that it produced physical sensations of illness and fear. These emotions were produced because the precipitating event connected
130 to her sense of values as a nurse and to the values of the organization. “I wanted to decide what this data really is and what this data really means, and what kind of an impact this is on our organization.”
Joanne described being distracted during the event, which led her to become unfocused. Her “watchdog,” which acted as a mental eye on her thinking, notified her that she was off task. Being unfocused for a time did not cause Joanne any discomfort; in fact, she described the feeling of being unfocused as a sense of “freedom.” Her comfort level with being unfocused seemed to stem from her confidence in her mental ability (the watchdog) to bring her mind back to the present moment. Focusing also was a pleasant experience for Joanne:
I feel really intelligent . . . like I feel like my chest is open and I feel like I have this—this enormous power, and I—I so don’t want to lose it; . . . the drive to keep the focus is, like, addicting.
Joanne reached out to others during the precipitating event by seeing “what the reactions” were and by speaking to others after the session. Reaching out to others to support her sensemaking process was an effort to gain a “broader picture” and
“validation” of the data. In both cases, reaching out to those in the session and those outside the session made Joanne feel “just as uneasy if not uneasier.” Others did not change her perspective of the precipitating event.
Finally, when asked if she had any concluding comments about the precipitating event, Joanne’s comment was that “there are rules and it sounds like the rules have been broken.” Joanne came to work at the healthcare system during high school, 30-some years earlier, and currently managed a significant department within the system. She felt a strong attachment to her role and to the organization. When she spoke of rules being
131 broken, she was personalizing the experience of the low HealthGrades scores. Joanne was articulating a sense of being violated. She took on her work in a way that she believed produced excellent results for her patients and the organization. “I know without a shadow of a doubt that we’re getting EKGs within 4 minutes. . . . And so I know that that’s solid.” Her department depended on other individuals within other departments to act in collaboration to achieve positive outcomes. She felt that others were not performing to the standards at which she was performing, thereby undermining the care she provided to patients.
Karen: Individual Structural Description
The structures that were present during Karen’s sensemaking experience of the precipitating event were a sense of surprise; feelings of disappointment, fear, distrust, and being overwhelmed; a need for more information; ways to make sense in the moment; being focused and unfocused; and reaching out to others.
As Karen experienced the precipitating event, she became “quiet” and “still” in an effort to concentrate on the message that was being delivered by the executive. She kept
“thinking about the message and kept going over it and over it again,” even as her thoughts sometimes changed during the message. As the scores were revealed, she experienced a sense of shock and disappointment. Her sense of shock and disappointment sprung from her almost 20-year history with the organization and her perspective that staff “should provide the best possible care, 100% of the time.” The message provided a different perspective for Karen. As she pondered this new perspective and how it was
“going to affect the hospital,” she become fearful. She remained quiet, avoiding eye contact with others as a way to maintain her concentration and focus. Occasionally, she
132 thought about the others in the room and why she was there in the room. She wondered,
“What are they thinking?” and “Where am I in this?” As the message continued, her thoughts moved to the larger community and her role in attracting patients to the program. These thoughts produced in her a need “to get your act together—in order to save people.” She continued to be very quiet and focused on listening to the voice of the executive as he delivered the message, so much so that she did not “smell much” or hear others in the room, but she wanted “desperately to have a good outcome” from the message. When it became apparent to her that the message was negative and no good outcomes were forthcoming, she then looked around the room and noticed the “dejected” faces of her coworkers and began to analyze the connection that each person had to the program. She felt overwhelmed as she contemplated what she and others could do to “fix the problems” and, once again, felt a sense of shock and disappointment over the message. She began to feel “a little distrustful,” which produced a need for more information to help her analyze the message.
In general, Karen described how she made sense in the moment as a process of becoming “quiet” and “still” and “listening.” She kept thinking about the message and went “over it and over it again,” even as her thoughts changed. She tended to avoid eye contact as she found it “takes away from your thought processes.” She concentrated intently on what was happening, forcing herself “to control her thoughts” so that she remained in the moment and was not distracted by changing thoughts or events outside her. Karen described herself as having an internal focus. The “zone,” as she referred to it, was a place that she went as a means to concentrate and remain focused on the moment at hand. As she remained in the zone, she had feelings of being “awake,” “clear,” and
133 having “total understanding of what’s going on.” Being focused felt good to her and stemmed from her sense of responsibility. Conversely, being unfocused “doesn’t feel good”; it felt like she was “spacey” and was connected to a sense of “freedom.” These feelings of “spacey” and “freedom” that are objectionable to Karen seem closely aligned to lack of structure in thinking and a sense of not having responsibility.
Karen acknowledged that she spoke with her coworkers after the precipitating event to help her make sense of the message. She described feeling better after speaking to her coworkers, as it made her feel “more secure in trying to see what they thought of the message.” Her sense of security arose from thinking through the problems in the program and beginning the process of developing a plan of action to address the problems. She also gained comfort from a sense of belonging to a group that needed to address problems as a collective as opposed to her addressing them alone.
Larry: Individual Structural Description
The structures that were present during Larry’s sensemaking experience of the precipitating event were feelings of not being shocked, urgency, deflation, depression, and relief; observer mode; standing on the edge; the process of making sense in the moment; and being focused and unfocused.
As Larry experienced the precipitating event, he was not shocked by the information presented. He had heard the information some months prior to this event and was aware that the “trend line was down, not up.” His prior knowledge of the information allowed Larry to move into an observer position during the session. He surveyed others in the room and assumed they, too, were aware of the information being delivered. This assumption led him to think that “maybe it’s uncomfortable news, but not new news.”
134 Larry felt good about being at the session where the HealthGrades scores were being presented. Up until this moment, Larry, who did not have a clinical background, had not been at a meeting where the HealthGrades scores had been discussed. “But here I am, it is the agenda item, and that’s good. It’s got the issue out on the table in front of everybody.”
On a deeper level, getting the “issue out on the table in front of everybody” seemed to provide some level of “relief” to Larry. This session seemed to signal to Larry that executive management was working on a plan to move the organization from “average to superior again.” As he pondered this idea, he wondered: “Is there somebody at the helm pulling us out of this dip?” As the message continued to unfold and the HealthGrades scores were revealed, Larry was able to observe the faces and body language of his fellow coworkers. He was struck with the realization that perhaps his assumption about this message not being new news was faulty. He continued mentally to be “on the fence” about this notion. Was this new information for “everyone at the table” or not? Larry continued to observe those in the room and decided that while some may have heard the news previously, some had not, and this was causing those people discomfort. “I was determining that the other people in the room might feel more discomfort than I felt.”
This observation and resulting realization produced a desire to “do something to help them.” This desire created a sense of urgency for Larry. He mentally ran through his previous experiences working at other healthcare organizations to see if he could find anything that might be useful to the program.
The factor that ran through my head is that this data is collected over 3 years and I’ve lived through it. . . . So what goes through my head is, there has to be urgency—we can’t be a gradual, you know?
135 Larry could not come up with anything. “I didn’t have anything concrete, you know; it really was not something that I could offer much immediate help.” This resulted in Larry feeling “deflated” and “depressed.” He seemed to ease these feelings by rationalizing the fact that he did not have “first-hand experiences with any of those people, . . . so I don’t have any of those emotional ties to any of the patients and I, I’m not informed by patient experiences.” He concluded the precipitating event by thinking,
“It is what it is.” His nonclinical role in the organization allowed him to feel less pressure to perform and, thereby, remain in an observer capacity throughout much of the session.
“In my role I didn’t feel the professional pressure perhaps that the clinical people felt because I wasn’t being, my department wasn’t being evaluated in this by these metrics so
I could stand a little bit on the edge.”
In general, Larry described how he made sense in the moment as consulting his
“own personal experiences.” “What have I seen before?” He examined his thinking and then decided what “would be an appropriate response” and “how would my response be greeted by the people I interact with.” He described his sensemaking processes as being situational: that depending on the situation one could be “more reflective.” He also described an “assessment period” where he tried to determine “just how intense is this message.” This “assessment period” seemed closely aligned to trying to find out how significant the message or event happening around or to him really was at the moment.
This “assessment period” would determine what course he would take moving forward, either taking action or not.
For Larry, becoming distracted was something that occurred in his “mind or eyes” that triggered him “to go someplace else in my head.” This seemed to suggest that a
136 thought or something that he saw in his environment would cause his mind to drift away from attending to what was happening in the present moment. Larry became “anxious” when his mind wandered. He indicated that being focused, or “engaged” as he called it, was “usually pleasurable.” Being engaged for Larry was like “pulling out the individual strands that might make up a ball of yarn. . . . It is lining up information in a way that fills in gaps, answers questions, informs me so that I can use that.” Being “engaged” was being aware of the present moment, being able to utilize his knowledge and experience to address information and events occurring in the present moment so that he could determine what next step to take moving forward.
Larry did not reach out to others to make sense of the precipitating event for four primary reasons: (1) he was “aware of it [the information] for a couple of months”; (2) there “were very few people in the room that I had a personal relationship with”; (3) the message was “threatening enough” that he was “less inclined to make the first overture”; and (4) his nonclinical background meant that his department was not being evaluated so he could “stand a little bit on the edge.” Larry later talked to “one or two” people whom he had a “personal relationship” with, and they “brought some nuances up” that he had not considered. His perspective did not appear to change as a result of speaking to others.
This was due to his stance of being “on the fence” about the HealthGrades scores as a result of having no “first-hand experiences with any of the people” in the session and
“not [being] informed by patient experiences.”
A strong undercurrent to Larry’s sensemaking process was that of “observation.”
Larry was clearly in an observation mode during the precipitating event, as evidenced by his continual scanning of individuals and his acknowledgment that he was sitting “on the
137 fence” during the session. In addition, he noted in our follow-up interview that “there’s always an audience for whatever you’re doing so you—you’re always picking up the vibe of the room.” For Larry, observation served as a “validation function” by giving him “a sense of the level of agreement or hostility or disinterest or whatever is in the room.”
Larry’s need to be in an observation mode may also have been driven by the fact that he had been employed by the organization for only little more than a year, resulting in a lack of personal relationships with coworkers and perhaps a sense of insecurity about injecting himself into a negative situation when he had not yet built credibility.
Lisa: Individual Structural Description
The structures that were present during Lisa’s sensemaking experience of the precipitating event were comprehension; disbelief; feelings of fear, anxiety, and sadness; the process of making sense in the moment; being focused; and becoming distracted.
As Lisa experienced the precipitating event, she tried to comprehend the significance of the HealthGrades scores to the hospital. She thought about how much she and others wanted to and thought they were providing “the best care every single time,” but listening to the HealthGrades scores made her wonder, “What is going on—why is this happening?” As Lisa continued to listen, she pondered how other hospitals were doing in terms of heart and vascular outcomes. She seemed to have some disbelief that the scores were correct because she recalled how the hospital positioned itself in the paper and “the hospital looks good in the papers.” Disbelief faded as she continued to listen; “something in the message seemed to ring true” to her. The something that rang true seemed to be the sheer number of poor scores that were handed out by HealthGrades.
“The numbers were constantly going into my mind and saying that something is wrong in
138 the system that’s causing all these numbers to go down.” She kept running them through her mind. Lisa began to think “about ways we could improve it.” As she started to doubt the quality of care at the hospital, she started to become fearful for her family and sad for the patients. “And so there may be mistakes. This may be the quality of care.” Underlying her sense of fear and sadness for her family and patients was anxiety for the system and its image. She was left with a predominant feeling of sadness.
In general, Lisa described how she made sense in the moment by listening to what was going on around her. She thought about what she was listening to and examined her past experiences to make sense of information and events.
Lisa described herself as someone who was easily distracted. When her mind wandered, she felt lost, and this feeling in turn produced a sense of anxiety and fear, which was associated with having not heard what was going on around her and the potential of not responding correctly to what might be asked of her. Because she felt fear and anxiety as a result of becoming unfocused, she had a negative reaction to becoming unfocused. When she was focused, she described it as making her “feel good.” She said she “understands better and can apply [things] better.” This in turn made her feel relaxed.
She believed she had both an internal and external sense of focus, but felt her dominant method of focus was externally driven. She could bring herself back into focus by first becoming aware that she was unfocused and then actively saying to herself, “No, come back,” which she did as she became distracted during the precipitating event by thoughts of a presentation she had to give later in the day.
Lisa did not reach out to others during or after the session for several reasons: (1) she did not work at the hospital, (2) she did not by nature bring up such topics unless
139 approached by others, and (3) since the message was so distressing to her, she was concerned it would be distressing and uncomfortable for others.
Sue: Individual Structural Description
The structures present during Sue’s sensemaking experience of the precipitating event were surprise, physical sickness (stomach), fear, uncertainty, present-moment sensemaking, being focused and unfocused, reaching out to others, the need for visual information, and being blindsided.
As Sue experienced the precipitating event, she was struck with a sense of surprise. “What have I missed? How is this different than what we’ve been presenting?”
She was unprepared to receive the information she was hearing in the message. She tried to understand the “disparity,” tried to “rationalize” what she was hearing. Her thoughts moved to the community and her family and she became “fearful and uncertain.” As the fear and uncertainty began to build, she became distracted by thoughts of her recent decision not to change jobs; now she wondered whether she had made the right decision.
Suddenly, one of the scores, “one star,” brought her sharply back to focus on the message being delivered. It started to feel “like the bottom fell out.” She felt sick to her stomach.
As the message continued, she tried to rationalize the lower scores by remembering that she had communicated to executive leadership some concerns over the program. She started to scan the room to see “how it affected my colleagues . . . and I wanted to know what were they thinking that this was valid information, and like me, did it also have some fear for them as well?” As the message continued, the lower scores seemed to validate her concerns. Now, she looked for indications that leadership heard her concerns and was prepared to take action. The indication came in the words used by the hospital
140 executive who delivered the message: “We’ve got work to do.” These words changed her frame of mind and feelings from fear and uncertainty to eagerness. These words signaled to her to start making a plan for action. “I was already ready to make a move.” When Sue reached the point mentally that she was actively working out a plan, it seemed to end her need to make further sense of the precipitating event.
Sue indicated that her present-moment sensemaking process began when she could personally associate it with herself. If she felt a personal connection to an event or information, this caused her to listen and observe what was occurring and to bring that information into herself. The information no longer existed outside of her, but rather became part of her. She then consulted her prior experiences and continued to think about the event or information to arrive at an understanding. She described this process as feeling like a forward type of movement.
Sue became distracted by her thoughts connected to her family and her previous decision to not leave the organization. “Oh, do I think I was shutting out the message?
Parts of it, yes.” Her sense of personal and professional responsibility brought her back to the moment at hand. The process of working on a plan of action appeared to have kept her focused until the end of the session.
Scanning the room for visual feedback during the precipitating event was a way for Sue to reach out to assess “how it affected my colleagues” and whether it brought on
“fear for them as well.” This provided some sense of security to Sue. She began looking for clues in the message that would indicate the leader’s commitment to take action.
Afterwards, she reached out to her fellow coworkers and discussed the message. The act of talking through the experience and relating her thoughts about the lower scores to her
141 coworkers allowed her to step into her professional role and, in so doing, took away the personal sting of the message. As she became able to view the message from her role perspective, it created distance between her personal and professional feelings, allowing her to feel more secure and confident that she could develop a plan of action to address the issues that resulted in the low scores.
Finally, Sue felt blindsided by a lack of knowledge going into the session. Lack of information seemed to make her feel insecure professionally and set up a negative feeling for what she was about to experience. The negative feeling going into the session was compounded by the negative information she received during the precipitating event. Sue
(and others) were not given visual information during the session. Lacking any reference point for her attention, she became easily distracted and found her mind wandering in various directions during the session. She forced herself to attend to the message by saying to herself:
Outcomes are what you do. Outcomes are what affect the patients. This is your community. It could be your mother. It actually was my mother-in-law. It could be your husband, it could be you, and so you need to listen.
These mental detours seemed to prolong her sensemaking process as she found herself coming in and out of the present moment and having to reacquaint herself with the moment at hand.
Terri: Individual Structural Description
The structures present during Terri’s sensemaking experience of the precipitating event were feelings of surprise, not being surprised (ambivalence), anger, embarrassment, comfort, reassurance, and grief; a desire to blame someone; a need for accuracy;
142 sensemaking in the moment (interest, motivation, and assessing); being focused and unfocused; reaching out to others; and diminished sensemaking processes (fear of being judged).
As Terri experienced the precipitating event, she identified “with every single area and factor that he [hospital executive] mentioned.” Terri’s ability to identify with each healthcare “area and factor” was a result of her almost 30-year history with the heart and vascular program. Hearing the lower scores, Terri was both “surprised” and “not surprised” by the information. Terri’s sense of ambivalence was triggered by her front- line experience of the program and by her awareness that recent budget constraints had resulted in changes to the program—changes that she felt would negatively impact patients. As Terri surveyed the room and looked at the expression of her coworkers, coworkers who had participated in the decisions to alter the program, she became “angry” and “embarrassed.” Terri began to feel as though others in the room were blaming her for the lower scores. This thought made her angry and produced in her a desire to blame others as well.
Terri’s long history with the organization produced a deep “association” and sense of “belonging and pride” in the organization, almost to the degree that she considered it her “second family.” These deep feelings for the organization resulted in her personalizing the information she received during the precipitating event, which led to her feelings of anger and embarrassment. “I have a sense of pride—pride, like this is my second family—and it would be like just hearing something shameful within your own family.” Her sense of “ownership” in the organization prompted her to listen carefully to the message and to write scores down to “get the accuracy of that content.” Writing down
143 the scores was also a way “to process” the information. Terri made “eye contact” with some of her coworkers; she felt the communication contained in their mutual eye contact suggested “heads will roll” over the lower scores. This eye contact provided a sense of
“comfort” and “reassurance that they heard what I heard.” Terri was left with a sense of
“grief, a loss of something” that arose from her deep sense of personal commitment to the organization. Terri felt that others present in the room appeared to “remove themselves” from the information as they sat “stone faced.” She described her affective style as
“rather expressive”; “I don’t have a flat affect.” This lack of affect in the session constrained Terri in her emotional response and diminished her sensemaking process.
Terri’s ability to making sense in the moment was connected to attention, awareness, and interest. Attention and interest were different aspects of sensemaking for
Terri. For Terri, there were various degrees of attention. She might give some of her attention, but it was not until she became interested that she gave her “full attention.”
“You could have some attention, but I could be multitasking. So, if you have my interest, then you have my full attention.” Terri suggested that awareness was necessary but not necessarily sufficient for sensemaking to take place. Attention and awareness seemed similar to Terri. Terri’s sense of interest was what triggered a strong sensemaking response. Without interest, Terri could be aware of something but not feel the need to fully explore it. Interest provided the motivation for Terri to switch from an attentive state to one of active sensemaking. She described this as a circular process where she processed “what I just got back from you, . . . and it can go on and on. . . . The more we interact, the more confidant I am on either how I feel or you change how I feel.” This
“processing mode” was equivalent to assessing what was going on in the moment. Terri
144 brought all her senses into play when she was making sense of something. “I would basically end up processing what I saw, felt, touched, smelled.”
During the precipitating event, Terri became distracted by thoughts of being blamed for the lower HealthGrades scores and by thoughts of how her coworkers’ decisions to make changes in the program may have contributed to the declining scores.
She found it easy to bring herself back to the present moment, as she was committed to finding out what areas were affected in the program, so that she could help to plan a strategy for improving outcomes in the heart and vascular program. In effect, her commitment represented a sense of “purpose” that helped to anchor her attention in the moment. “When I have a purpose, I’m less distracted.” She indicated that making eye contact with her coworkers also helped to bring her back to awareness of the moment as well as “straighten up” her posture and force herself to pay attention. “I really try to straighten up. . . . I will try to sit myself, . . . make myself attentive. . . . I’ll force myself, so I am disciplined enough to get myself back on track.” She described the act of focusing as “a dedication to listening.”
Terri felt that she had both an external and internal focus, but her focus began as an external experience. Terri felt that being focused felt like “a heightened sense of alert.”
Terri’s ability to focus had more to do with interest than just a sense of awareness:
“Somehow I have to have more than awareness. I have to have either have an interest or motivation.”
Terri reached out to three people after the precipitating event, all of whom were members of the organization. “I needed validation,” she said—validation that she was
145 correct in her perspective that changes to the heart and vascular unit resulted in the lower scores.
That it, that I, that I was right. Not how I felt. I knew how I felt. I didn’t want them to say it’s okay; you should be mad or you should be angry; you should be sad. I, I just basically wanted someone to agree that what I thought and what the problem areas were, were accurate.
Terri believed that in making sense of things, “you have to somehow explore with somebody.” Her experience of reaching out to her colleagues was not a satisfying experience. She felt that several of her colleagues ridiculed the heart and vascular program out of a sense of jealousy from the program’s earlier successes. She described her conversations with others as follows:
It was like yeah, you know, the heart center’s always bragging that they got this, they got that. They have a whole showcase, you know, and nobody even knows the rest of the specialty areas, bone, ortho joint center, bariatric center, nobody even gets to get in the limelight because the heart and vascular center steals everything.
Terri’s perspective did not change after she spoke to others.
Terri felt her sensemaking process during the precipitating event was diminished by two important factors: fear of being judged by others and lack of affect by others.
I think in people making sense and taking in and doing stuff, when you’re stifled by the fact that others are trying to read you or judge you so that they can either, I don’t know what they do, but I think that setting made a difference versus now, where I’m Terri and you aren’t judging me. You simply are seeking information. I am much freer to explore and make sense of things to a higher degree than what I did on my own. I think that’s what happens with counselors and therapists where someone isn’t going to judge you and explores with you.
Additionally, the lack of affect from others made her feel as though she could not openly express how she was feeling about the information being presented. This in turn did not allow her to utilize the full range of her sensemaking abilities. According to Terri:
146 I would have made sense of that whole situation more if I could have verbalized concerns or the process or how was this data collected and over what period of time. I would have taken in multiple factors that you can’t get, even now so that I’m not misunderstood.
Victoria: Individual Structural Description
The structures that were present during Victoria’s sensemaking experience of the precipitating event were feelings of sympathy (for others), being disconnected, relief, observing, making sense in the present moment, being distracted, being focused, reaching out to others, speed in making decisions, and emotions.
As Victoria experienced the precipitating event, she felt a sense of sympathy for the “other folks sitting in the room.” She had heard the information before but realized that others present had not. According to Victoria:
I think I did feel a little sympathy for some of the other folks sitting in the room who may have seen—been hearing this for the first time, particularly because it was a direct sort of blow to their, to their job and to what they do every day.
Even after having heard the HealthGrades scores before, she felt the message sounded “worse” coming from the hospital executive. “It definitely felt worse, I think, coming from him.” She noticed the person directly in front of her and thought that she
“seemed really anxious.” Victoria sat back in her seat and listened to the message.
Because Victoria had heard the information previously she was able to adopt a neutral observer position. In addition, she felt “disconnect” from the message as she was not a clinician like others in the session. “I don’t do patient care. I’m not even in the same building.” She did not have “influence at all on the outcomes of these patients.” Having heard the information before and her nonclinical role in the organization seemed to minimize the number of emotions that Victoria felt. She did not personalize the message
147 as others had because she did not provide direct patient care. As the message concluded,
Victoria felt a sense of “relief.” “I did feel initial, initial relief to say, okay, all of the cards are on the table now—now what?’
Since the precipitating event in this research did not appear to represent a significant event for Victoria, the researcher asked Victoria to remember a significant event that happened recently and describe how she made sense of it at the time it occurred. She described a meeting with the vice president of her unit, along with others from her unit. She noticed something in the vice president’s body language that caught her attention and produced in her a strong sensemaking response. She felt that something negative was going to happen, which made her feel uncomfortable and launched her deeper into her sensemaking process. She began running the possible scenarios through her mind, based on her previous experiences. Victoria, by nature, always analyzed what might be going on “whenever there’s a sense of unknown.” Doing this made her “feel better” as it gave her a sense of control over the unknown by identifying what might be going on. She pondered the various possibilities, and as she did she considered how each of the possibilities would affect her. Finally, Victoria considered what her plan of action would be for each of the scenarios she came up with. Developing a plan of action once again offered Victoria a sense of control over the unknown. By imagining what was happening and developing a plan for how to respond, she felt that she was in control, which in turn made her feel less anxious.
I think creating an action plan for me lowers my stress level. It makes me feel a little more at ease just to know, even if, even if ultimately everything is gonna be a little hard, at least I know.
148 Victoria became distracted during the precipitating event by coworkers discussing something extraneous to the event.
I think I even made a note in my journal like the cookie thing with Larry. I was like, What are you talking about? . . . I’m trying to think about something and he’s talking about cookies.
Victoria brought her focus back to the message through her sense of responsibility to the organization. “I think in most situations you feel a responsible—a sense of responsibility to do that.” As she experienced divergent thoughts, in the back of her mind was the present moment and the task at hand.
You’re thinking all of these thoughts and, of course, as one or two things are running through your brain, you know, one of the things that is sort of still in the back of your mind is the task at hand. So it’s like as you’re shuffling through all of the things that you’re thinking of, it’s bound to come back around and say okay, oh my gosh, this is why I’m here.
When Victoria regained her focus, she felt good as if she had accomplished something and that her presence in the session was worthwhile. Focusing for Victoria was both an internal and external process. Her thoughts and sense of responsibility, as well as observation of others in the session, helped Victoria to focus on the task at hand.
Victoria spoke with others after the event, but not to gain additional information to support her sensemaking process. She was asked questions by curious coworkers wondering what the session was about. While Victoria acknowledged that she typically reached out to others to help her make sense of events, in this case, her role in the organization (nonclinical) and the fact that she had heard the information before precluded this behavior.
Two notable aspects of Victoria’s sensemaking process were her ability to make decisions about what was going on and her recognition of her emotions. Victoria sized up
149 situations very quickly and came to conclusions quickly about what was going on. She could change her thinking about the conclusions she drew by examining the body language of others and by having discussions with others, but she was quite comfortable in coming to an answer for “what’s going on?” by herself. She felt that thought was what triggered emotions for her. She was very aware of the myriad of emotions that come to the surface as she is making sense of something. In being aware of emotions during the sensemaking process, she could choose to attach or not attach her thinking to a certain emotion. Victoria experienced sensemaking as a process, and contained with the sensemaking process was a subprocess of emotions, where a thought would lead her to a certain emotion and then another thought would bring about another emotion, and so on.
Section 4: Textural-Structural Descriptions
The textural and structural descriptions are integrated as a means to an overall description or essence of the appearing phenomenon (Creswell, 1998; Moustakas, 1994).
Creating the textural-structural description involved “narration of the ‘essence’ of the experience . . . or . . . statements and meaning units” (Creswell, 1998, p. 149). What follows are textual-structural descriptions for each coresearcher.
Alice: Individual Textural-Structural Description
The essence of Alice’s present-moment sensemaking experience was characterized by four core themes: emotions (anger, fear, anxiousness, responsibility, insecurity, frustration, and disappointment), present-moment sensemaking response (a flood of experiences, a sense of need, and developing a plan of action), being distracted, and being focused. Each is explicated below.
150 Emotions were intertwined throughout the present-moment sensemaking experience of Alice. Beginning with a sense of shock, Alice moved through a myriad of emotional responses as she heard and processed the message from the precipitating event.
Emotional responses included anger, fear, anxiousness, responsibility, insecurity, frustration, and disappointment. Some of the emotions were directed at herself (anger, anxiousness, fear, and insecurity) and some at other people (anger, fear, frustration, and disappointment). She would often be overcome by certain emotions, which mentally distracted her from the moment at hand (the message being delivered). One such emotion, that of insecurity about her job, led her to become distracted and her mind wandered to where she might find her resume and whether she needed to update it.
Alice’s present-moment sensemaking experience is best described as “a flood of experiences” coming to her mind at “a high rate of speed,” having an almost “liquid” quality to the frames of experiences. She mentally scanned her experiences and picked out “frames of experiences” that served to help her “deal with what’s at hand.” For Alice, a sensemaking response was triggered by a “sense of need.” Alice was deeply attuned to situations where she felt she was needed in some form. A sense of need created in Alice a strong sensemaking response supported by an extreme focus response that allowed her to analyze what was going on in the moment. As Alice analyzed, she moved in the direction of developing a plan of action to satisfy “what is at hand.” The concluding characteristic of Alice’s present-moment sensemaking process was developing a plan of action. Alice was drawn to developing a plan of action as a means of gaining a sense of security and control as the moment unfolded. This need for security and control was, once again,
151 driven by various emotions that she experienced as she made sense of events happening to and around her.
Being distracted and regaining focus were a central part of Alice’s sensemaking experience. Alice reported being aware of her mind wandering, which appeared to be related to certain emotional responses she experienced during the precipitating event. Just as emotional responses led her mind to wander, they were also responsible for bringing her back to the present moment. Alice described her mind wandering to where she would find her resume and whether it needed updating. As she contemplated the idea of leaving the organization, she felt a sense of responsibility for her fellow coworkers and then a sense of anger with herself for allowing this thought to enter her mind. These emotions— responsibility and anger—appeared to be a catalyst that brought her to self-awareness that her mind had wandered. This self-awareness enabled Alice to mentally force her attention back to the present moment.
Being focused for Alice felt as if she was in a “zone” or “bubble,” filled with energy derived from adrenaline. Periphery elements, events, and emotions were restricted from her “field of vision.” Her “field of vision” was a metaphorical expression for her combined mental, physical, and emotional senses. When she was highly focused, she limited the amount of mental, physical, and emotional stimuli by not focusing on anything other than what she chose to focus on at the moment. In so doing, she found that she could control her focus to various degrees, thereby limiting her ability to become distracted.
152 Jane: Individual Textural-Structural Description
The essence of Jane’s present-moment sensemaking experience was characterized by five core themes: development of a framework, emotions (surprise, confusion, disbelief, and being overwhelmed), present-moment sensemaking response (value of the experience), reaching out to others (middle ground of sensemaking), and being distracted or focused. Each is explicated below.
Jane struggled to understand the information presented in the precipitating event.
Her struggle stemmed from her day-to-day experience of the heart and vascular program and the ratings that were presented. Jane attempted to develop a framework in which to understand the information. The framework was constructed using her experiences and knowledge of the current program, combined with her experiences and knowledge of other programs. Development of a framework did not increase her understanding of the message she was hearing in the precipitating event, and she remained confused through much of the session.
Emotionally, Jane felt a sense of surprise. Her surprise was a result of her first- hand experience of the program. She was a frontline caregiver, and her day-to-day experience of the program was much different from the information revealed in the report. She experienced an episode of cognitive dissonance as a result of holding two contradictory thoughts. Surprise moved to disbelief. The combination of trying to make sense of the information being presented, aligning it with her personal experience of the program, and mentally developing a plan to improve patient outcomes produced a sense of being overwhelmed.
153 Jane described her present-moment sensemaking response as being triggered by two questions: “Should it be important to me?” and “Where does it fit?” The value Jane placed on an event and information appeared to be a tipping point at which she either filed the information away for future use or went on to analyze it with a goal of developing a plan of action for how to address the information or event.
Jane described her sensemaking process as both an individual and collective process. While Jane could and did make sense on her own, she felt, however, that the sensemaking process was incomplete unless she reached out to others. Jane liked to reach out to access other people’s perspectives and experiences, which she saw as accessing other people’s frameworks for making sense. Jane saw the collective aspects of sensemaking as “living in the gray.” She felt that while it was important to form her own thinking around a given experience, that experience was neither “black or white,” but was rather somewhere in the middle; hence the notion of sensemaking as “living in the gray.”
Jane recalled becoming distracted during the precipitating event as a result of becoming physically uncomfortable because of her chair. She brought herself back to present-moment awareness by “refocusing on the objectives” of why she was in the meeting and by becoming aware of the presence and activities of others in the room.
Being focused felt good to Jane. She felt as though she accomplished her task when she remained focused.
Jim: Individual Textural-Structural Description
The essence of Jim’s present-moment sensemaking experience was characterized by three core themes: emotion (shock, disbelief, fear, embarrassment, burden, and
154 responsibility), physical sensations, and being distracted or focused. Each is explicated below.
The overarching emotion experienced by Jim was one of surprise. He was surprised by the low ratings. He believed that the lower ratings did not match what he experienced each day in his work environment. As Jim continued to listen to the message, the emotion of surprise was quickly followed by other emotions. Jim’s emotional response of surprise triggered disbelief, fear, embarrassment, and a sense of burden and responsibility. Jim’s surprise as a result of the healthcare ratings first produced a feeling of disbelief. His day-to-day experience of how care was being delivered did not align with the reported lower outcome scores. Disbelief dissolved into fear—fear that he might lose his job as a result of the healthcare outcomes. As Jim continued to process the information, fear turned into embarrassment. Jim’s sense of embarrassment stemmed from his competitive nature and the fact that other hospitals achieved better outcome scores than his facility. Finally, Jim experienced a sense of burden and responsibility.
These two feelings arose from his leadership role with the organization. Jim saw it as his
“responsibility to make sure the program is running well.” These strong emotional reactions produced physical sensations for Jim during the precipitating event; he became
“flushed” and his “top lip was sweating.”
In addition to physical sensations, Jim recalled becoming distracted during the precipitating event. He described becoming unfocused as his “mind runs . . . a rush of thoughts . . . all mixed up at one time.” Jim indicated that when he was focused, he could become so intent on what was going on that he did not hear or think about anything else.
155 Conversely, being focused for Jim was “as if I stop hearing and sometimes thinking.”
Feeling focused felt better to Jim than being unfocused.
Joanne: Individual Textural-Structural Description
The essence of Joanne’s present-moment sensemaking experience was characterized by eight core themes: feelings (shock, disbelief, scare, desire to remain calm, stress), physical sensation, need to turn to others, sorting of facts, need for additional time to process, present-moment sensemaking response, development of an action plan, and being distracted. Each is explicated below.
Joanne reported being “shocked” by the information she received during the precipitating event. She felt as though she knew what the program’s outcome statistics were, and what she heard in the message did not reflect what she thought she knew. This misalignment of fact and thought created a sense of shock for Joanne.
As Joanne’s sense of shock registered, she experienced a number of feelings, beginning with a sense of disbelief, which emanated from a belief that patient outcome scores should have been higher. When she had some time to process the information and consider the source of the message, she became scared.
Joanne’s emotional shock and the resulting feelings spread throughout her system, causing the physical reaction of being nauseated. Joanne’s nausea indicates a strong neuroendocrine reaction to the information presented during the precipitating event.
Joanne reported using a kind of “in-the-moment” meditation practice to calm down and to become more relaxed. This practice involved taking deep breaths and reminding herself that she did not have sufficient information “to make a decision one way or another.” She felt she needed to listen and gather more data; part of her data gathering
156 involved scanning her environment to see how others were reacting to the information being presented. In these observations, she felt as though everyone was being “stoic” and she was not able to draw any conclusions from the reactions. She then turned to “sorting” in her own mind what she knew about the program gathered from her day-to-day experiences and data for documents she helped to gather. Based on her experience of the program, she still did not feel that the information made sense to her, which produced in her a desire for more time—time to think about the information and to destress. The feeling of being stressed moved her to think about a plan of action.
Joanne’s present-moment sensemaking process was attached to interest and her
“value system.” Interest and her value system were different sides of the same coin for
Joanne. For Joanne to start making sense of something, the event or information had to connect to her values. When this occurred, the event or information became interesting to her, and she started to consider what was taking place and what impact it would have for her. Her value system represented those things that Joanne cared deeply about, so if something did not connect with her value system, she was inclined to disregard it and move on.
Joanne came to the realization that this was not just the problem of the executive who delivered the message, but it was a problem for her and the entire healthcare system.
This realization led her to start thinking about a plan of action and what her “part” in it might be. Joanne’s desire to develop a plan of action seemed partly motivated by a strategy to gain a sense of control and security over a challenging situation, but was also motivated by her strong commitment and loyalty to the organization, which had been forged by nearly 40 years of employment.
157 Finally, Joanne acknowledged that she became distracted during the precipitating event, which led her to become unfocused. Being unfocused did not cause Joanne discomfort. Her comfort level with being unfocused was associated with her confidence in her mental ability to bring her mind back to the present moment. She described a mental “watchdog,” which was equivalent to her ability to become aware when her mind had wandered.
Karen: Individual Textural-Structural Description
The essence of Karen’s present-moment sensemaking experience was characterized by six core themes: a sense of surprise, emotions (fear, disappointment, distrust, being overwhelmed), a desire for more information, present-moment sensemaking response, being focused and distracted, and reaching out to others. Each is explicated below.
Karen experienced a sense of shock and a feeling of disappointment as she heard the HealthGrades scores. Karen, a long-time employee of the healthcare system, had worked hard her entire career to provide the very best care. She was under the impression that everyone in the system approached his or her work as she did. The HealthGrades report presented a much different perspective for Karen. As she pondered this information, she felt the emotion of fear for the healthcare system and her job. Fear moved her to contemplate what she and others needed to do to fix the problems that had led to the poor patient outcomes. As she developed a mental plan of action, Karen felt overwhelmed. She moved from feeling overwhelmed to once again experiencing a sense of shock and disappointment over the information. This final emotional cycle moved her to feeling distrustful of the information. Karen’s unwillingness to accept the information
158 as presented produced in her a desire for more information to help her analyze the message.
Karen described her present-moment sensemaking process as beginning with her becoming “quiet” and “still” and “listening” to what was presented. In the case of the precipitating event, she kept going “over it and over it again” even as her thoughts changed. She tended to avoid eye contact as a way to avoid distractions. Karen used her ability to concentrate as a way to force herself to remain focused in the moment.
Additionally, her desire for more information, which was triggered by her emotional response of disappointment and then distrust, also appeared to keep her poised to receive whatever information emerged from the precipitating event.
Her sense of focus came from within, and she identified her sense of focus as the
“zone,” the place she went to concentrate and remain focused on the moment at hand.
When she was in the “zone,” Karen felt “awake,” “clear,” and as though she had a “total understanding of what is going on.” When Karen was distracted, she had the feeling of being “spacey” and being unfocused, and that feeling was connected to a sense of freedom. These feelings of spaciness and freedom, while not entirely objectionable to
Karen, made her feel as though she had a lack of structure in her thinking and a sense of not being responsible. Karen’s ability to focus appeared to emanate from her strong desire to be a responsible person.
Karen reached out to others after the precipitating event and, in so doing, she felt better about the information and gained a sense of security. Her positive affect and sense of security was stimulated by the act of reaching out to others to “see what they thought
159 of the message.” This fostered a sense of belonging to a group that needed to address the problem as a collective rather than her addressing the issue alone.
Larry: Individual Textural-Structural Description
The essence of Larry’s present-moment sensemaking experience was characterized by six core themes: lack of shock, emotion (relief, a desire to help, urgency, deflation, and depression), being an observer, present-moment sensemaking response, reaching out to others, and being distracted or focused. Each is explicated below.
Larry, who had heard the information prior to the precipitating event, did not experience a sense of shock as others in the study reported. His prior knowledge of the information and his nonclinical role with the healthcare system predisposed Larry to take an observer position as the information was being presented. In his observer position he scanned the room while the information was being presented and thought perhaps the information was uncomfortable for some who had not yet heard the results of the
HealthGrades report. He himself was not uncomfortable; in fact, Larry felt a sense of relief that the information was “finally on the table” and as a result a plan might be developed to move the program “from average to superior again.” As Larry continued in his observer mode, he pondered whether there was a leader “at the helm pulling us out of this dip.” Nearing the completion of the report, Larry began to see discomfort on the faces of his fellow coworkers. This realization produced a desire to “do something to help them,” and it also created a sense of urgency. He mentally ran through his previous experiences to seek a solution to the issues being presented. Larry’s nonclinical background was a limitation to finding a solution and, as a result, he felt “deflated” and
“depressed.”
160 Larry described his present-moment sensemaking process as consisting of consulting his “own personal experiences,” an examination of his thinking and its effect on others, a reflective aspect, if time permits, and an assessment element that helped him determine whether to take action or not. Larry seemed to take a guarded approach to sensemaking, measuring and weighing each piece of information he received to help him determine where to go next in his process and what angle to take when feeding his thoughts back to others. This guarded approach may have presented itself partly in response to his short employment at the healthcare system, his personality (he appeared introverted), and by virtue of his participation in this study.
For Larry, making sense of the precipitating event did involve reaching out to others to make sense of the information, but not during the event or immediately afterwards. Several reasons contributed to his reluctance to approach others: (1) he was
“aware of it [the information] for a couple of months”; (2) there “were very few people in the room that I had a personal relationship with”; (3) the message was “threatening enough” that he was “less inclined to make the first overture”; and (4) his nonclinical background meant that his department was not being evaluated so he could “stand a little bit on the edge.” When he did finally reach out to “one or two” other people whom he had a personal relationship with, he felt they brought up some “nuances” that he had not considered before.
Larry became distracted during the precipitating event by observing the body language of others in the room, which caused him to drift away from the information being presented. He became anxious, and his sense of anxiousness, responsibility, and desire to perform as a member of the organization brought him back to the present
161 moment. Larry viewed being focused as being “engaged” in the present moment and saw it as a pleasurable experience. Being engaged for Larry was like “pulling out the individual strands that might make up a ball of yarn. . . . It is lining up information in a way that fills in gaps, answers questions, informs me so that I can use that.”
Lisa: Individual Textural-Structural Description
The essence of Lisa’s present-moment sensemaking experience was characterized by seven core themes: comprehension, sense of disbelief, emotion (fear, sadness, and anxiety), present-moment sensemaking response, being distracted, being focused, and reaching out to others. Each is explicated below.
Comprehension was at the forefront of Lisa’s mind as she tried to make sense of the information presented during the precipitating event. She tried to comprehend the significance of the outcome scores to the healthcare system and to her and her coworkers.
She felt that she and her fellow caregivers provided excellent care, but the outcome scores gave her pause and created a sense of disbelief. Disbelief faded as she continued to listen to the preponderance of the data, suggesting that the quality of care had declined.
As she started to contemplate what the lower scores meant to the healthcare system, she became fearful for her family and sad for the patients. Underlying this sense of fear and sadness was a sense of anxiety for the system and its image. Her predominant feeling was sadness.
Lisa described her present-moment sensemaking process as listening to what was going on, thinking about what she was listening to, and examining her past experiences to aid in sensemaking.
162 Lisa described herself as someone who was easily distracted. She was aware that her mind wandered during the precipitating event. She felt lost, which produced a sense of anxiety and fear. These feelings were connected to not being aware of what had occurred while her mind wandered and the potential for not responding correctly to what might be asked of her. Because she felt fear and anxiety as a result of becoming distracted, she had a negative reaction to becoming distracted. Conversely, Lisa felt good when she focused. Focusing helped her to “understand better” and then apply what she understood, which made her feel relaxed. Lisa reported having both an internal and external ability to focus but felt her dominant method of focusing was externally driven.
When Lisa became distracted during the precipitating event, she became aware of her mind wandering and then she forced herself back to the present moment by saying to herself, “no, come back.”
Lisa did not reach out to others during or after the session for several reasons: (1) she was doing an educational practicim and was not assigned full time to the department that received the low scores, (2) she did not by nature bring up such topics unless approached by others, and (3) because the message was distressing to her, she felt that it would be for others, and speaking of it could make them uncomfortable.
Sue: Individual Textural-Structural Description
The essence of Sue’s present-moment sensemaking experience was characterized by seven core themes: sense of surprise, emotion (fear, uncertainty, the bottom fell out, blindsided, and eagerness), physical response (sick to her stomach), present-moment sensemaking response, being distracted or focused, reaching out to others, and development of an action plan. Each is explicated below.
163 Sue was surprised as she listened to the report during the precipitating event. Her first thought was, “What have I missed? How is this different than what we’ve been presenting?” She felt unprepared to receive the information. She tried to understand the
“disparity” of what she was hearing versus what she believed. She tried to “rationalize” what she was hearing. Her thoughts turned to her family, and she developed feelings of fear and uncertainty. As the report continued, Sue felt as though the “bottom fell out,” which prompted the physical reaction of being sick to her stomach. Finally, Sue felt blindsided by lack of knowledge going into the session. Lack of information seemed to make her feel insecure professionally and set up a negative feeling for what she was about to experience. The negative feeling going into the session was compounded by the negative information she received during the precipitating event. Toward the end of the message, when the hospital executive mentioned, “We have work to do,” Sue felt a sense of eagerness at this phrase, as it signaled to her a desire by executive leadership for her to make a plan of action for improvement.
Sue’s present-moment sensemaking response began when she personally associated herself with the information being presented during the precipitating event.
Sue listened to the low outcome scores and realized almost instantly that she had a significant role to play in the outcomes of the program. Her identification with the content of the message caused her to listen intently to what was being presented; she thought about what she experienced previously in the program and what she was currently experiencing. As she continued to think, she could feel her “brain scrunching” as she listened. It felt like a “little skull cap” on her head. It was as if her brain was working “independent” of herself, and other body sensations faded away. Her brain
164 began to “hum like a machine” as she brought the “information into herself” for further thought. As the information was internalized, it became something that affected her
(caused fear and uncertainty and made her sick to her stomach) and moved her to want to do something about the information.
Thoughts connected to her family and previous decision not to leave the organization distracted Sue during the precipitating event, causing her to shut out parts of the message being played. Additionally, Sue (and others) were not given visual information during the session. Lacking any reference point for her attention, she became easily distracted and found her mind wandering in various directions during the session.
Her sense of personal and professional responsibility brought her back to the moment at hand. She forced herself to attend to the message by saying to herself,
Outcomes is what you do. Outcomes are what affect the patients. This is your community. It could be your mother. It actually was my mother-in-law. It could be your husband, it could be you, and so you need to listen.
Sue reached out to others by scanning the room during the precipitating event for visual feedback. The scanning was a way for her to assess how her colleagues were feeling and thinking. According to Sue, she “wanted to know what were they thinking that this was valid information, and like me, did it also have some fear for them as well?”
This provided a feeling of security to Sue, most likely engendered by having a sense that she was not alone in what she was feeling and thinking. After the precipitating event, Sue reached out to her coworkers to talk about and analyze the data she had received in the report. The act of talking through the experience and relating her thoughts of the lower scores to her coworkers allowed her to step into her professional role and, in so doing, took away the personal sting of the message. As she viewed the message from her role
165 perspective, it created distance between her personal and professional feelings, allowing her to feel more secure and confident that she could develop a plan of action to address the issues that resulted in the lower scores.
One final aspect of Sue’s present-moment sensemaking experience was that of developing a plan of action. Sue reported to have made executive leadership aware of some concerns that she had with the program months earlier. The information she received during the precipitating event seemed to validate her concerns. When she reached the point of feeling her concerns were valid, she began to look for indications that leadership heard her concerns and was prepared to take action. The indication came in the words used by the hospital executive, “We’ve got work to do.” These words changed her frame of mind and feelings from fear and uncertainty to eagerness. These words signaled to her to start making a plan for action. “I was already ready to make a move.” When Sue reached the point mentally that she was actively working out a plan, it seemed to end her need to make further sense of the precipitating event. It was not, however, until she reached out to her coworkers that she felt secure and confident in her ability to develop a plan of action to address the issues presented in the precipitating event.
Terri: Individual Textural-Structural Description
The essence of Terri’s present-moment sensemaking experience was characterized by eight core themes: being and not being surprised (ambivalence), emotion
(anger, embarrassment, comfort, and reassurance), a desire to blame someone, a need for accuracy, present-moment sensemaking response (interest, motivation, and assessing),
166 being distracted or focused, reaching out to others, and a diminished sensemaking process
(fear of being judged). Each is explicated below.
Terri’s present-moment sensemaking experience began with a sense of ambivalence about the information she received. She was both surprised and not surprised by the information. Terri’s sense of ambivalence stemmed from her long history with the healthcare system and her first-hand knowledge of the care she and others delivered in the program. Recent budget cuts and the ensuing changes to the program were an immediate concern to Terri, as she felt they could compromise the program. Hearing the news of the lower outcome scores, she was forced to examine her belief that the healthcare system provided excellent care and to confront her concerns about budget cuts. As she contemplated these two beliefs, she slowly began to accept the thought that budget cuts compromised the delivery of care in the heart and vascular program. This thought made her feel angry and embarrassed. She also had a sense that others in the room were blaming her for the low scores; this in turn created a desire in
Terri to blame others, too. She moved to a desire for accuracy, which manifested in her writing down the scores verbatim. Terri scanned the room to observe the body language of others and, in the process, made eye contact with some of her coworkers. This moved
Terri to feel a sense of comfort and reassurance. Terri was left with a sense of grief, “a loss of something” that arose from her deep sense of personal commitment to the organization.
Terri’s ability to make sense in the moment was connected to attention, awareness, and interest. Attention and interest were different aspects of sensemaking for
Terri. She might give some of her attention to something, but she didn’t give her “full
167 attention” until she became interested. Terri also suggested that awareness was necessary, but not necessarily sufficient for sensemaking to take place. Terri’s sense of interest was what triggered a strong sensemaking response. Without interest, Terri might be aware of something but not feel the need to fully explore it. Interest provided the motivation for
Terri to switch from an attentive state to one of active sensemaking. She described this as a circular process where she processed “what I just got back from you . . . and it can go on and on. . . . The more we interact, the more confident I am on either how I feel or you change how I feel.” This “processing mode” was equivalent to assessing what was going on in the moment. Terri brought all her senses into play when she was making sense of something. “I would basically end up processing what I saw, felt, touched, and smelled.”
Terri became distracted by thoughts of being blamed for the lower HealthGrades scores and by thoughts of how her coworkers’ decisions to make changes in the program may have contributed to the declining scores. She found it easy to bring herself back to the present moment, as she was committed to finding out what areas were affected in the program, so that she could help to plan a strategy for improving outcomes. Terri’s sense of commitment to the organization and its patients represented a sense of “purpose” that helped to anchor her attention in the moment. “When I have a purpose, I’m less distracted.” She indicated that making eye contact with her coworkers also helped to bring her back to awareness of the moment as well as efforts to “straighten up” her posture and to force herself to pay attention. Terri described the act of focusing as “a dedication to listening.” She felt that she had both an external and internal focus, but that her focus began as an external experience. Terri believed that being focused felt like “a heightened sense of alert.” Her ability to focus had more to do with interest than just a
168 sense of awareness: “Somehow I have to have more than awareness. I have to have either have an interest or motivation.”
Terri reached out to others both during and after the precipitating event. She made
“eye contact” with some of her coworkers; she felt that the communication contained in their mutual eye contact suggested that “heads will roll” over the lower scores. Eye contact provided a sense of “comfort” and “reassurance that they heard what I heard.”
After the event, Terri reached out to three additional people, all of whom were members of the organization. Terri indicated, “I needed validation.” She wanted validation that she was correct in her perspective that changes to the heart and vascular program resulted in the lower scores. She did not receive the validation she was looking for from others.
Terri’s perspective from the precipitating event remained unchanged. She continued to feel concern and grief.
Finally, Terri experienced a diminished sensemaking process as a result of two factors: fear of being judged by others and lack of affect by others. Terri described herself as someone with strong affect. She felt stifled by the lack of affect present during the precipitating event and by her fear of being judged by others. This in turn made her feel self-conscious about showing any affect, which diminished her ability to make sense of the information being presented.
Victoria: Individual Textural-Structural Description
The essence of Victoria’s present-moment sensemaking experience was characterized by five core themes: observing, emotions (sympathy, being disconnected, and relief), present-moment sensemaking response, being distracted or focused, and reaching out to others. Each is explicated below.
169 Victoria listened to the message being read during the precipitating event and found herself observing the reactions of others. Since she had heard the information prior to the event and was not a clinician, she operated from an observer position. As the message was read, she felt a “little sympathy for some of the other folks sitting in the room.” After hearing the information for the second time, she felt it sounded even
“worse” coming from the hospital executive. She felt disconnected from the message as a result of her nonclinical role in the healthcare system. As the message concluded, she thought to herself, “All the cards are on the table—now what?” This thought produced a sense of relief for Victoria, which stemmed from her belief that now that the low outcome scores were “out in the open,” a plan would be developed to improve performance.
For Victoria, making sense in the present moment was connected to something catching her attention, which then triggered a strong sensemaking response. This response involved running through her past experiences, analyzing how what she was making sense of would affect her, and developing a plan. Developing a plan of action offered Victoria a sense of control over the unknown. By imagining what was happening and developing a plan for how to respond, she felt that she was in control, which in turn made her feel less anxious. “I think creating an action plan for me lowers my stress level; it makes me feel a little more at ease just to know. Even if ultimately everything is gonna be a little hard, at least I know.”
Victoria became distracted during the precipitating event by coworkers discussing something extraneous to the event. Victoria brought her focus back to the message through her sense of responsibility to the organization, even though she felt disconnected from the message. As she experienced divergent thoughts, in the back of her mind was
170 the present moment and the task at hand. “You’re thinking all of these thoughts and, of course, as one or two things are running through your brain, you know, one of the things that is sort of still in the back of your mind is the task at hand.” When Victoria regained her focus, she felt good as if she had accomplished something and that her presence in the session was worthwhile. Focusing for Victoria was both an internal and external process.
Her thoughts and sense of responsibility, as well as her observations of others in the session, helped Victoria to focus on the task at hand.
Victoria spoke with others after the event, but not to gain additional information to support her sensemaking process. She was asked questions by curious coworkers wondering what the session was about. While Victoria acknowledged that she typically reached out to others to help her make sense of events, in this case, her role in the organization (nonclinical) and the fact that she had heard the information before precluded this behavior.
Section 5: Composite Description
Moustakas (1994) posed integration of individual textural and structural descriptions into a composite description as the path to understanding the essence of an experience. The composite description is an “intuitively-reflectively” integrative description of the meanings and essences of the appearing phenomenon for the entire group of individuals making sense in the present moment.
For the 10 coresearchers, the experience of making sense in the present moment was a multiphased, circular process that drew them along a continuum towards the attainment of meaning. Individuals in this study moved towards meaning creation through seven distinctive patterns: awareness, focus response, consultation of personal
171 experiences, a desire for more information, reaching out to others, action planning, and embodied responses. Each is explicated below.
Awareness
Participants described a tipping point in their present-moment sensemaking experience that took them from merely being aware of something going on to actively seeking understanding. The tipping point was the moment when individuals in this study became interested in the information being presented to them. Interest was interconnected with a sense of how individuals valued the information. As several participants reported,
“Somehow I must first have an interest or you won’t have my focus. . . . If I’m interested, now you will get my senses,” and “I think it’s [sensemaking] really connected to my values. . . . If it’s something that also connects to my value system, then I am engaged.”
Interest provided the motivation for participants to switch from an aware state during the study to one of active sensemaking.
Interest took several forms for participants. One individual reported, “If someone is in need or a situation is in need or I feel needed or I feel—even if I get the inkling that someone needs me, I think that sets me in that mode [sensemaking].” For other individuals a sensemaking response was triggered when they personally associated themselves with the information being presented. In the words of one individual,
Well, understanding that this outcomes is what I do. The importance of listening to the full message was important to me personally and professionally. Because if this is part of my job, I am going to have to figure out a way to now deal with this, change it for the future, and understand how we got there.
Others expressed interest in terms of level of importance and where something fit. One participant summed it up:
172 If it’s not important, then you file it away; . . . I don’t need to take action on it. . . . I’ll keep it as a frame of reference and move on to my next thing. If I deem it important, then this is important to what I am doing or what else do I need to look at . . . so that this piece of information helps me go forward from where I’m at.
And, finally, some expressed interest as engagement.
What you’re trying to do when you’re engaged is that you’re pulling out the individual strands that might make up a ball of yarn. And I can do something with those individual strands of yarn. . . . Engagement is, for me, is lining up information in a way that fills gaps, answers questions, and informs me so that I can use that.
Interest, whether expressed as need, personal association, level of importance, or engagement, was the point at which individuals moved from a state of awareness to a state of active sensemaking. When individuals moved from awareness to sensemaking, a strong focus response surfaced that allowed participants to analyze what was going on in the moment.
Focus Response
Being distracted and regaining focus were a central part of participants’ present- moment sensemaking experience. Participants reported being aware that their mind wandered from the information being presented. Being focused for participants was “as if
I stop hearing and sometimes thinking. I become so intent on what I’m doing or listening to that I just don’t hear or think about anything else.” Another participant described it as
“your brain scrunches . . . where you think, in the frontal part of your brain.” Further, being focused was as if the participant brought the information into herself: “When I bring it [the information] into myself, it’s kinda like the message is no longer just out there; it’s now a part of me. It’s something that I will take on that will affect me.” Focus was also described as a “heightened sense of alert” and an “out-of-body experience.” In
173 contrast, becoming distracted was described as a “flood of thoughts.” “It feels unwritten,” and “I just totally shut down . . . and go away.” Both being focused and being distracted were described in a way that suggested participants felt as if they experienced an altered body state, different than the mere state of attention. Being focused was reported by all participants as “feeling good” and as if they “were on task” and “making a contribution.”
Being distracted, on the other hand, produced a sense of “anxiety” related to being
“unproductive,” an experience of being “blank” and the mind going “in different directions.” Being focused was associated with participants’ interest level, whereas becoming distracted was related to emotional responses (individual and other), individual thoughts, and observations of body language experienced during the precipitating event.
Just as emotional responses, thoughts and observations of others led some participants’ minds to wander; they were also responsible for bringing them back to the present moment. According to study participants, a sense of “responsibility” (both personal and professional), a thought that entered their mind, and an awareness of the presence and activities of others in the room brought them back to the present moment. One participant described being able to refocus as “I thought about my resume and then I felt responsible for all these people. And that’s when I said ‘stop it’ and came back to focus.” Another person described regaining focus by reconnecting to a sense of “purpose.” Other participants described being aware of the “presence of others” or “some element of the discussion” helping to bring them back to the topic at hand. Every participant in the study reported an episode of mind wandering and a process for regaining focus.
174 Personal Experiences
Reflection on personal experiences was intertwined throughout the present- moment sensemaking experience of study participants. Reflection on experiences took the form of mentally “running through the frames” of one’s past experiences and observing other study participants to give meaning to the information being presented.
One participant described consulting experiences as, “I think sensemaking in the moment for me is a flood of experiences coming to your immediate mind at a high rate of speed.
. . . It’s almost like liquid going through those frames of experiences, . . . trying to pick out the ones that will most benefit you at the moment.” Participants also reported speaking to other coworkers outside the study and family members to access their experiences as a means to make sense of the information presented during the precipitating event. While the majority of the participants indicated that speaking to others about the event did not change their perspectives, one participant reported, “I talked to one or two people about the experience. . . . I think they probably brought some nuances up that I maybe hadn’t thought of.” Another participant described the collective aspects of sensemaking as “living in the gray.”
In making sense, it’s not black and white for me, it’s like living in the gray. It’s not I’m right and you’re wrong. It’s like I can make sense, but I’m not. I’m not black and white enough that if I make sense it’s black and it’s my way, and your sense can’t make any sense to me.
Making sense in the present was grounded in past experiences and reaching out to others as a means to access their previous experience.
175 Desire for More Information
Participants experienced the need for more information during and after the precipitating event. This desire for more information was connected to participants’ feelings of shock and disbelief as the information was first presented, but as the information continued, participants perceived the information as plausible, coherent, and reasonable. Conflicted, wanting the information to be false but sensing that it was not, participants vacillated between disbelief (based on their first-hand experience of the program) and accepting the information as correct (because of the context of how the information was presented). As participants tried to align the information being presented with their personal experience of the program, a sense of ambivalence emerged. In an attempt to resolve the feeling of ambivalence, a middle ground was reached where participants desired additional information so that they could reach a more definite conclusion. Many in the study began this search for more information during the precipitating event by looking into the faces of those assembled, attempting to read gestures and body language. Participants also reported thinking about what other sources they would use to analyze the data, which caused some to become distracted.
Reaching Out to Others
Study participants reached out deliberately with the intent of finding out what the other was thinking. Reaching out to others took the form of observing other participants’ gestures and body language and in considering whom they would reach out to after they left the session. The individuals who were not frontline caregivers used observation as a means to reach out to others and to interpret the thoughts of others. This was expressed as follows: “In my role I didn’t feel the professional pressure perhaps that the clinical people
176 felt. . . . I could stand a little bit on the edge, . . . more of an observer” and “I was determining that the other people in the room might feel more discomfort than I felt.”
Individuals who were closer to the patient observed others during the session and reached out to others later. As one participant expressed, “I knew there was some key players in the room. . . . I wanted to see their reactions.” And, “I reached out to others inside the system for validation and I wanted somebody to tell me what this data really means.”
Reaching out to others during and after the study offered participants an opportunity to compare their thinking to that of others and to access other people’s experiences. “There are other frameworks to look at the same thing. Two people standing at the same moment in time can get a very different impression.” While all participants reported reaching out to others to help make sense of the precipitating event, none reported having their understanding of the information or their emotional responses altered as a result.
Action Planning
Each participant described developing a plan of action as they were making sense of the information being presented. Developing a plan of action was a means to gain a sense of security and control over the negative message as it was unfolding. “I think for me after that point I think is when I started to feel all the emotions attached to the moment. I immediately wanted to have a plan. The plan is . . . my sense of security.”
Another participant expressed the need for a plan as “the brain was churning a bit and you got more involved in the situation. And I think I did that because prior to that I felt insecure that maybe what we had been doing wasn’t valid. . . . And so now there’s gonna be action.” For some, action planning was also driven by a sense of responsibility. “I guess that’s when my sense of urgency, I guess, and responsibility and the need to fix it
177 kicks in, and that’s when I’m planning or doing.” For most, the need for security and control was driven by various emotions—fear, disappointment, frustration, being overwhelmed, anger, and more—that were experienced as participants made sense of the information being presented.
Emotional and Physical Responses
Participants in this study experienced physical and emotional responses to the precipitating event. Some reported feeling physically nauseated as they listened to the information being presented. One person experienced “feeling flushed” and his “upper lip sweating.” All participants reported emotional responses. Consistently, the initial emotional reaction among participants was one of shock, followed by disbelief. After these initial emotional reactions, a stream of varied emotional responses occurred— anger, fear, embarrassment, frustration, disappointment, being overwhelmed, a sense of relief, and many more. Emotional responses and their intensity varied by the individual and the role he or she held within the organization. Participants who were frontline caregivers experienced a significant number of deeply felt emotions compared to those who were least involved with patients. Those on the periphery of patient care (who lacked a clinical background) adopted an observer mode, which allowed them the freedom to not personalize the information and, thus, minimized the emotional reactions that were experienced. Often certain emotions emerged, dissolved into other emotions, and then reemerged later. Disappointment, fear, and uncertainty were three such emotions that recurred frequently for participants, most particularly for the frontline caregivers.
Emotional reactions sometimes caused participants to become distracted, and then they had to refocus their attention back to the present moment. Emotions were intertwined
178 throughout the present-moment sensemaking experience of study participants, forming a substrate for sensemaking activity.
Summary
Chapter 4 presented the findings from the interviews of employees of a healthcare organization. The chapter identified the themes resulting from the 10 interviews and detailed the individual textural description, individual structural description, and textural- structural description of each coresearcher. Finally, this chapter presented the composite description of the meaning and essences of the experience under study, representing the group as a whole. Chapter 5 provides a multidisciplined discussion of the research findings in the context of classical and postmodern views of sensemaking.
179 CHAPTER 5:
FINDINGS RELATED TO SENSEMAKING
The purpose of this qualitative phenomenological research study, using
Moustakas’ (1994) modified van Kaam method, was to explore the present-moment aspects of sensemaking by examining how individual awareness contributes to one’s ability to make sense of his or her environment. For the purpose of this study, the phenomenon of present-moment sensemaking was defined as the continuous, moment-to- moment process that conscious individuals experience as they live through events occurring around and to them. Awareness in this study is understood as a transient experience (Freeman, 2000), which is characterized as a process that involves suspension, letting go, and redirecting one’s attention (Depraz et al., 2003) and being present with one’s mind and body to the experiences of everyday life (Varela et al., 1993).
This phenomenological case study was a means to examine sensemaking as an embodied process. Much of the current literature focuses on sensemaking as a psychosocial phenomenon. In that perspective, sensemaking is viewed as a retrospective cognitive process to explain surprise (Weick, 1995); it is a continuous recurring cycle consisting of events occurring over time that begins as individuals form unconscious and conscious anticipations and assumptions to predict future events (Weick et al., 2005), taking place in a socially created world that both supports and constrains action (Weick,
1995). The psychosocial perspective overlooks how the body is used to make sense of events (Allard-Poesi, 2005; Maitlis & Sonenshein, 2010), concealing the actual lived experience of the sensemaking process. By examining sensemaking as a subjective, present-moment phenomenon, this study captured the constitutive, subjective processes
180 that have been largely ignored (Maitlis & Sonenshein, 2010) and gave an account of the interdependent, reciprocal, and mutually constitutive processes at work in the psychosocial and biologically embodied process of sensemaking. Chapter 5, using the framework of the embodied mind (Varela et al., 1993), presents a conceptualization of how individuals in this study made sense of their lived experience in the present moment using the frameworks of classical and postmodern sensemaking.
Characteristics of Classical Sensemaking
The present-moment sensemaking experience of individuals in this study underscored the distinguishing characteristics of sensemaking as outlined by Weick
(1995)—grounded in identity construction, retrospective, enactive of sensible environments, social, ongoing, focused on and by extracted cues, and driven by plausibility rather than accuracy.
All research participants made sense of the precipitating event through the prism of their self (identity)—the individual self and the collective self. In many cases, the information presented made study participants concerned for their jobs and the safety of their families and raised concerns about the image of the organization.
Retrospection was intertwined throughout the present-moment sensemaking experience. Retrospection took the form of mentally “running through the frames” of experience to give meaning to the information being presented and of consulting other study participants, coworkers, and family members to access their past experiences.
Making sense in the present was grounded in past experiences.
Present-moment sensemaking was enactive of sensible environments. Participants constructed meaning by way of assessing the information based on the way in which it
181 was being presented, prior experience, and acquired knowledge. In other words, individuals made sense by giving weight to the information by virtue of how it was presented, by taking in the data (cues) and attempting to make the information fit with their concept (mental model) of the situation, and through their role perspective
(experience with the program and formal knowledge acquired through formal education and training).
Making sense in the present moment involved the creation of shared meaning and shared experience through interaction with others (social). In most instances, participants either observed each other during the precipitating event or had a follow-up conversation with others to explore the information further.
Making sense in the present moment was an ongoing process for the study participants, which involved refining their understanding (by consulting their past experiences and the past experiences of others), developing action plans (restoring equilibrium), continuing to analyze the information after the event, and dealing with lingering emotional responses.
Focused on and by extracted cues was a significant aspect of this study.
Participants reported noticing and extracting certain cues (facial expressions, attitudes, words and phrases) during the precipitating event and then contextually interpreting those cues according to certain held beliefs, mental models, procedures, stories, and experiences.
Finally, the participants in this study initially seemed very concerned with accuracy rather than plausibility. A large number of participants (80%) reported feeling surprised by the data they received during the precipitating event and expressed a desire
182 for more information to help them better understand the message. Interestingly, when participants were asked if they believed the information to be true, they said yes. This indicates that the information was presented in such a way as to be perceived by participants as plausible, coherent, and reasonable—sufficient to facilitate sensemaking.
This sensemaking anomaly appears to be related to a combination of ambiguity relative to the content of the message being presented and uncertainty related to lack of clarity around what steps would be taken to change the present outcomes and by whom. The information presented was reported as being insufficient for a complete understanding of how the ratings were calculated. Further, the organization providing the ratings report,
HealthGrades, and the processes it uses to calculate the ratings were viewed by some participants as not being trustworthy because of their status as a for-pay healthcare ratings organization. Uncertainty was related to what actions would be taken and by whom to improve the program’s patient outcomes. The information was presented to participants without an understanding of how it should be used and by which members of the organization. There was also an underlying concern expressed by most participants about the consequences to them and the program as a result of the lower ratings. Many participants reported being concerned for their jobs and for the reputation of the heart and vascular program. Ambiguity and uncertainty functioned to increase the desire for more accurate information. Most of the participants were unwilling to accept the information at face value.
Finally, two additional and more future-oriented characteristics surfaced during the study as noted by Weick, Sutcliffe, and Obstfeld (2005)—prospection and an action orientation. Prospection took the form of participants developing an individual action
183 plan and wondering what actions the organization might take to address healthcare outcomes in the program. An action orientation was exhibited when individuals in the study sought to acquire more information about the HealthGrades rating process, either from fellow coworkers or through independent research, and when they mentally developed a plan of action to address healthcare outcomes.
Characteristics of Postmodern Sensemaking
Yet, at the same time, seven other characteristics emerged from this study that are significant to the present-moment sensemaking process and are indicative of embodied subjectivity: awareness, focus response, personal experiences, desire for more information, reaching out to others, action planning, and emotional and physical responses. These are considered postmodern in nature.
Awareness
All participants recounted being aware of their surroundings during the precipitating event. They described a moment in their present-moment sensemaking experience, a tipping point, that moved them from merely being aware of something going on to actively seeking understanding. The tipping point emerged for 8 of the 10 participants when the hospital executive began to read the message and they heard the first negative program rating (i.e., “CABG mortality, for example, being one star”). Most of the participants described the need to write down what was being said and the need to acquire more information. Two participants, who had nonclinical roles with the program, did not feel the need to write down or seek more information. The tipping point for these two individuals in their sensemaking experience seemed to occur for one when she heard
184 the voice of the hospital executive (i.e., “it seemed worse coming from him”) and for the other when he saw the reactions of his fellow coworkers to the message being played
(i.e., “I was determining that the other people in the room might feel more discomfort than I felt”). These two individuals acknowledged that they had more of an observer role since they were nonclinical and their departments were not being evaluated as a result of the healthcare ratings. They were making sense of the information being presented, but their tipping point from awareness to active sensemaking was not role generated but rather empathy based.
Data collected from the one-on-one interviews pointed to three areas that moved individuals from awareness to sensemaking: personal interest in the information, importance of the information to their role, and connection to their value system. As one participant noted, “You could have some of my attention, but I could be multitasking. So, if you have my interest, then you have my full attention.” Awareness is necessary for sensemaking, but it is not sufficient. As Freeman (2000) posited, “Awareness is implicit in thinking and representing” (p. 26), but it is not until humans have intent that they are moved into the realm of active sensemaking. Intent is the “directing of an action toward some future goal that is defined and chosen by the actor” (Freeman, 2000, p. 8).
According to Thompson (2007), intentionality operates “anonymously, involuntarily, spontaneously and receptively” (p. 30). In other words, intentionality does not always function at a conscious level. Freeman (2000) proposed that “meanings arise as a brain created intentional behaviors and then changes itself in accordance with the sensory consequences of those behaviors” (p. 8). Thus, present-moment sensemaking is the confluence of awareness and intentionality.
185 So, for the majority of the individuals in this study, the tipping point was the juncture at which they were aware of the significance of the message to them personally and professionally and the emerging desire to take action to correct performance issues in the program (Mouilso, Glenberg, Havas, & Lindeman, 2007). The two individuals who were nonclinical and, thus, participated more from an observer position were drawn into sensemaking not by goal-directed behavior, but rather by witnessing the affect of others and assimilating their thoughts, language, feelings, emotions, and actions, which produced an empathetic response, leading to a desire to help (goal-directed behavior) their fellow coworkers.
Empathy, according to Thompson (2007), “is a unique form of intentionality in which we are directed toward the other’s experience” (p. 386). Stein (1989) posited empathy as the “feeling of being led by an experience that is not one’s own but that is given in one’s experience of another’s expressive bodily presence” (p. 10). Presence is understood as “the feeling of being and acting in a world outside us” (Riva, 2008, p. 103) and is a neuropsychological phenomenon that results from the interaction of our biological and cultural history and is designed to create a sense of agency and control
(Riva, 2008). In the case of these two participants, an affective empathy response was exhibited. Eisenberg and Miller (1987) defined affective empathy as an observer’s emotional response to another person’s emotional state. The desire to help was the tipping point for these two individuals. Awareness, according to Freeman (1997), is the subjective experience of the momentary focus of the activity that constitutes a meaning.
“Awareness is an experience, which in neurodynamic terms is a transient state”
186 (Freeman, 2000, p. 116). This “transient state” of awareness was evident by participants’ loss of focus during the precipitating event.
Focus Response
Closely related to awareness was the ability to redirect and focus mental attention
(Fiol & O’Connor, 2004). All participants reported being distracted at various points during the precipitating event and then regaining focus. Being focused was described as
“your brain scrunches,” feeling “as though I’m in a zone,” as a “heightened sense of alert,” and as an “out-of-body experience.” Conversely, becoming distracted or having one’s mind wander was described as a “a flood of thoughts,” “it feels unwritten,” and “I just totally shut down . . . and go away.”
Freeman (2000) posited that “intentionality . . . allows us to take in just as much as we can handle and no more” (p. 28). After that point, we become overwhelmed.
According to Varela et al. (1993), “It is a matter of simple experience that our mind and body can be dissociated, that the mind can wander, that we can be unaware of where we are and what our body or mind are doing” (p. 28). These continuities (i.e., focus) and discontinuities (i.e., mind wandering) speak to the relationship between embodied action and the temporal structure of experience. The embodied system is a complex dynamic structure, in which neurons have activity patterns (local) and cooperate to produce coherent collective behavior (global) (Varela et al., 1993; Thompson, 2007; Varela &
Depraz, 2003). “It is a two-way street: the local components give rise to this emergent mind, but vice versa, the emergent mind constrains and affects directly these local components” (Varela & Depraz, 2003, p. 214). The nervous system has a domain of viability (i.e., allows certain functioning), but within this domain it explores a multiplicity
187 of possible states in a recurrent, yet always changing, manner (Palus, 1996).
Consequently, one’s conscious experience manifests subjectively as a continuously changing or flowing process of awareness (Varela et al., 1993; Thompson, 2007;
Cosmelli, Lachaux, & Thompson, 2007). At any moment, according to Cosmelli et al.
(2007), “consciousness appears diverse and complex, rich with multiple, synchronous, and local contents (images, expectations, sounds, smells, kinesthetic feelings, etc.), yet it seems to hold together as a coherent and globally organized experience” (p. 4). The embodied system is affected by dynamic internal neural systems and external sensory inputs (Varela et al., 1993; Thompson, 2007; Cosmelli et al., 2007) “that shape the behavior of peripheral sensory neurons” (Cosmelli et al., 2007, p. 7). Thus, patterns of consciousness arise, maintain themselves for a time, and then subside as a result of these internal (i.e., the transient nature of neural interactions) and external influences. Cosmelli et al. (2007) viewed the “stable/fleeting duality” of conscious experience, or what others might call being focused and distracted, as a structural feature of embodiment. Another structural feature of embodiment is reflection of past experience.
Past Experiences
Many of the participants in this study reported that as they were making sense of the precipitating event they consulted their past experiences as a way to find meaning and to develop a plan of action. A particularly salient description of consulting one’s past experience was “a flood of experiences coming to your immediate mind at a high rate of speed. . . . It’s almost like liquid going through those frames of experiences, . . . trying to pick out the ones that most benefit you at the moment.” From an embodied perspective, reflection is the result of the body and mind being brought together. Reflection, according
188 to Varela et al. (1993), “is not just on experience, but reflection is a form of experience itself” (p. 27)—in short, experiencing. According to Thompson (2005), “bodily experience offers not only the experience of physical events that relate one’s body to things, but also the experience of sensorial events that relate one’s subjectively lived body to itself ” (p. 412). In other words, reflection is enactive reflexivity. Freeman (1987) has correlated the neurobiological properties of the sensory and limbic systems to the subjective experience of the dynamic of consciousness—the fusion of modalities, the rapid sequence of frames, the limited span of a few heartbeats, and the causal sense of an impending action and its sensory consequences.
Freeman (1997) posited that the limbic mechanism for consciousness makes available to an individual the entire body of past experience, which serves to guide each new step, breath, and word. According to Freeman (1997), perception and recollection are a unitary dynamical process by which meaning is created. Similarly, the philosopher
Hartshorne (1962), whose work Weick (1995) used as a view towards understanding the reflective nature of sensemaking, stated, “All perception . . . is a form of memory”
(p. 442). The intuitive philosophical perspective (Hartshorne) and neurobiological research (Freeman) convergence suggests that “any given now-phase of consciousness retains the whole just-past phase of consciousness; . . . at any given moment there is a retentional continuum stretching back over past experience” (Thompson, 2007, p. 321).
From an embodied perspective, reflection takes the form of double consciousness
(Thompson, 2007). According to Thompson (2007), “The conscious re-presentation of a past occurrence, remembering is also the conscious re-presentation of a previous consciousness” (p. 290) or what Varela (1999b) called “double intentionality.”
189 Consciousness includes thoughts, images, our perceptions of the physical world, as well as awareness of our body and bodily sensations (Varela, 1999b; Thompson, 2007; Varela
& Depraz, 2003). According to Varela (1999b), consciousness is atemporal and time is merely a mental model of the scientific world. As such, the concepts of “past,” “present,” and “future” are human inventions. What we perceive as time is actually “a stream of change in physical space” (Sorli & Sorli, 2005). We experience atemporal space as present moment (Sorli & Sorli, 2005) and, as such, all our experiences (whether we label them past, present, or future) are available to us as part of our lived experiencing of the world.
Participants also reported consulting the past experiences of others as they tried to make sense of the precipitating event. This consulting took the form of observing the body language and gestures of others present during the event and by speaking to others after the event. This behavior speaks to the collective nature and embodied perspective of sensemaking, as one participant explained:
In making sense, it’s not black or white for me, it’s like living in the gray. It’s not I’m right and you’re wrong. It’s like I can make sense, but I’m not. I’m not black and white enough that if I make sense it’s black and it’s my way, and your way can’t make any sense to me.
While the psychosocial perspective of sensemaking looks at the collective aspect of sensemaking through the lens of symbolic interactionism and the work of Mead that viewed mind and self arising and developing within the social process, the embodied view takes a slightly different perspective. Social cognition from an embodied or enactive perspective is based on autonomy and sensemaking (De Jaegher & Di Paolo, 2007, 2008) and focuses on the process of interacting as a special form of coupling (Maturana &
Varela, 1980).
190 According to De Jaegher and Di Paolo (2007, 2008), not all forms of coupling between individuals are social, but only those that engender an autonomous dynamic, without destroying the autonomy of the interactors. This means that dynamic coemergence is vital for organizational relationships built on structural coupling
(Maturana & Varela, 1980). De Jaegher and Di Paolo (2008) described this process occurring through the development of presence, whereby individuals “differentiate between internal and external intentions, between their actions and those of others”
(p. 107). It is also through the development of presence that the individual becomes a self, which leads to the recognition of the “other” as “another intentional self.”
Consequently, a social presence develops, consisting of three mutually inclusive layers
(i.e., proto social presence, interactive social presence, and shared social presence), allowing for a nonmediated (i.e., prereflexive) perception of an enacting other within an external world (De Jaegher & Di Paolo, 2008; Stern, 2009). Participants used their own and others’ past experiences as a means to reconstitute meaning around the precipitating event. Individual and collective reflection is a central aspect of sensemaking, whether past, present, or future oriented.
Desire for More Information
Participants experienced a desire for more information during and after the precipitating event. The desire for more information was connected to participants’ feelings of shock and disbelief upon hearing the message regarding the program’s patient outcomes. Study participants, particularly those who were frontline caregivers in the program, found it difficult to align their personal experience of the program with the information being presented. Because the information presented was plausible, coherent,
191 and reasonable, yet ran counter to their own belief about the program, participants experienced a type of cognitive dissonance.
Cognitive dissonance is a theory of human motivation that posits that it is psychologically uncomfortable to hold contradictory cognitions. In other words, dissonance occurs when individuals perceive a logical inconsistency in ideas, opinions, beliefs, knowledge of the environment, and knowledge of one’s own actions and feelings
(Festinger, Riecken, & Schachter, 2008). Festinger (1962) saw cognitive dissonance as an antecedent condition that leads to activity oriented toward dissonance reduction.
Festinger et al. (2008) asserted that there are three ways to reduce cognitive dissonance:
(1) trying to change one or more of the beliefs, opinions, or behaviors involved in the dissonance; (2) trying to acquire new information or beliefs that will increase consonance and, thus, cause the dissonance to be reduced; or (3) trying to forget or reduce the importance of those cognitions that are in a dissonant relationship. Festinger et al. (2008) did not consider the three methods of reducing cognitive dissonance as mutually exclusive.
The information presented to study participants, being psychologically and physically uncomfortable, created a desire in participants for more information as a means to reduce cognitive dissonance and achieve consonance. From an embodied perspective, the cognitive dissonance is an embodied representation of emotion. The emotion (shock and disbelief) created an action tendency (Mouilso et al., 2007) that produced the desire to seek out additional information in the hope that the additional information would intuitively reduce the cognitive dissonance that participants experienced.
192 Reaching Out to Others
The participants in this study reached out to each other to make sense of the precipitating message, either by observing other participants’ gestures and body language or considering who they would reach out to after the event. This phenomenon is a form of participatory sensemaking that could be characterized as intersubjectivity (Fuchs & De
Jaegher, 2009). Intersubjectivity was both an internal and an external process and manifested in the moment-to-moment interactions of the participants as they tried to interpret the precipitating event.
During the interaction process (enactive reflexivity), several outward gestures appeared such as facial and vocal expressions, coordination of gestures, and affect attunement. Inwardly, participants experienced body resonance (Fuchs & De Jaegher,
2009). In other words, certain aspects of the event held significance for participants and produced inward responses, such as a variety of emotions (fear, disbelief, insecurity, anger, ambivalence, embarrassment, etc.), a desire for additional information and the development of a plan of action, and physical reactions (e.g., nausea, sweating, feeling flushed, a sense of shock). Intersubjectivity appeared to be a circular process (Varela,
1999b), whereby individual participants influenced the group and the group, in turn, influenced individual participants. This influencing or affectivity was a type of mutual incorporation in which study participants extended themselves (structural coupling) to form a common intercorporality through which common meaning was created (Fuchs &
De Jaegher, 2009).
193 Action Planning
All of the study participants described developing a temporal plan of action as they were making sense of the information being presented during the precipitating event.
The desire for a plan of action was associated with various emotions—insecurity, lack of control, fear, disappointment, frustration, being overwhelmed, and anger. One participant described the experience of making a plan of action: “I started to feel all the emotions attached to the moment. I immediately wanted to have a plan. The plan is for me, it’s my sense of security.”
From a behaviorist perspective, emotions are tendencies (the motivational urge to act) to engage in behavior influenced by the needs of the individual (Arnold, 1960;
Frijda, 1986), just as Freeman (2000) made clear that motivation is the behaviorist term for emotion. Arnold (1960) posited, “organisms constantly evaluate the relevance of environmental changes for their well-being, checking whether significant stimuli are present or absent, beneficial or harmful, and easy or difficult to approach or avoid” (p.
572). These “appraisals,” according to Arnold (1960), result in action tendencies, which are “experienced as emotions.” Similarly, Lazarus (1991) stated that the central function of emotion is to enable people to adapt to a complex and occasionally threatening environment. By motivating actions that are at least broadly functional, emotions help people manage fundamental tasks (Lazarus, 2001), such as achieving goals, building relationships, protecting themselves, enforcing social rules, learning new things, and dealing with loss (Izard & Ackerman, 2000). Emotion, from a neurobiological perspective, “is the welling up of an impulse within that tends toward outward expression and action” (Thompson, 2007, pp. 363-364). Action and intentionality bear a close
194 resemblance to emotion, in that emotion is an impulse moving outward and intentionality is a dynamic striving for intentional fulfillment (Thompson, 2007). Freeman (2000) indicated emotion is essential to all intentional behaviors.
From a biological perspective, emotion comprises mostly nonconscious brain and body states and is considered a “prototype whole-organism event, for it mobilizes and coordinates virtually every aspect of the organism” (Thompson, 2007, p. 363). In other words, emotions function to facilitate action (Davidson, 1994) and do so by virtue of the
“autonomic nervous system, which activates the appropriate physiological processes to allow the organism to carry out the chosen behavior” (Mouilso et al., 2007, p. 1325). In the case of these study participants, the information received during the precipitating event signaled that some things were not as they should be in the program, setting up a negative state among the group. This negative state motivated participants to develop a mental action plan to help fix the situation and thereby reduce anxiety levels.
Physical and Emotional Responses
Some participants reported experiencing physical responses to the information presented in the precipitating event. Some reported feeling physically nauseated. One person reported “feeling flushed” with his “upper lip sweating.” All participants reported emotional responses stemming from the information presented. The widespread reaction was one of shock, followed by disbelief. After this initial period of shock and disbelief, participants experienced a stream of varied emotions—anger, fear, embarrassment, frustration, disappointment, being overwhelmed, a sense of relief, and many more. The intensity of the emotional responses also varied according to the role of the individual in the program. The most deeply felt emotions were reported by those individuals who
195 provided bedside care. Individuals who were more remote from patients and/or the program reported fewer and less intense emotions and did not indicate any physical responses.
The enactive perspective views emotion and physical responses as faculties of the
“whole embodied and situated organism” (Colombetti, 2008) by virtue of its autopoietic and adaptive systems (Varela et al., 1993; Thompson, 2007; Colombetti, 2008).
Accordingly, emotions and body arousal are enactive reflectivity; in other words, they are
“some of the many ways in which sense-making manifests its self in experience”
(Colombetti, 2008). Storbeck and Clore (2007) concluded that emotion does not function independently of perceptual and cognitive processes, that, in fact, they are inherently integrated, and that affective values guide cognitive processing. As such, individuals in this study experienced various emotions and body stirrings as a result of their subjective perceptual experience of the precipitating event. The emotions and body sensations could be characterized as nonverbal reflexive experiences (Stern, 2009) that emerged progressively during the present moment of the precipitating event. Nonverbal reflexive experiences can be characterized as sensorimotor experiences (Varela et al., 1993) that act as a mode of perceiving and understanding the natural world (Stern, 2009). The emotions and physical responses experienced during the study were “autonomic impressions” that manifested in an embodied and situated organism by virtue of bringing forth its world of significance. The emotional and physical responses of participants were shaped by embodied regulatory processes that were elicited by certain properties of the precipitating event (unexpected event with negative connotations, in this case, but not always) and the propensities of the participants (various emotional and physical
196 responses). This study clearly revealed the embodied mind operating during present- moment sensemaking and, as such, being the essence of human experience or the process of experiencing.
Summary
Chapter 5 has presented a cross-discipline conceptualization of the sensemaking findings from 10 interviews of employees from a healthcare organization in the light of current and emerging literature. Using the framework of the enactive approach, this study examined the constitutive, subjective process of sensemaking that has been underdeveloped and, in come cases, overlooked. Chapter 6 presents conclusions and future implications for theory, research, and practice.
197 CHAPTER 6:
CONCLUSIONS AND FUTURE IMPLICATIONS
This qualitative phenomenological research study explored the present-moment aspects of sensemaking by examining how individual awareness contributes to one’s ability to make sense of his or her environment. This chapter presents the researcher’s conclusions and the implications for theory, research, and practice.
The conclusions that follow were developed by reflecting on the study’s findings, the problem addressed in the study, and the research question. This study was undertaken as a means to address the lack of understanding of sensemaking as an embodied process in theory, research, and practice. To address this problem, I explored the meaning and essence between awareness and sensemaking as a present-moment phenomenon. The research question—What is the role of individual present-moment awareness in sensemaking?—also served as a guide.
This study is significant because it provided a complex description of sensemaking as an embodied process, a process that moves underneath and is oftentimes obscured by the psychosocial process of sensemaking. This study is also significant because it provides insight into sensemaking in situ. Study participants were observed in the workplace, which allowed the researcher to explore an unrefined and immediate sensemaking experience.
Conclusions
The conclusions fall within three primary areas: (1) present-moment sensemaking is the confluence of awareness and intentionality; (2) intersubjectivity is a form of
198 intercorporality through which common meaning is created; and (3) embodied responses, which emerge as autonomic impressions (physical and emotional responses), are reflective of the way in which sensemaking manifests in subjective experience and can be understood as embodied wisdom.
Awareness
“Whereas we live through a number of different experiences, our self-awareness remains as an unchanging dimension . . . with its own quality unchanged by the events that stream through it” (Zahavi, 2003, p. 165). Awareness, prereflexive and reflexive, is the mode of access to our subjective experiences (Thompson, 2007). It is part and parcel of being a sentient being. It allows us to be sensitive to aspects of our experience that would otherwise remain inaccessible (Thompson, 2007). Being aware from an embodied perspective involves three intertwined modes of bodily activity: self-regulation, sensorimotor coupling, and intersubjective interaction (Varela et al., 1993; Thompson &
Varela, 2001; Thompson, 2005, 2007). Self-regulation is foundational to being alive. It is evident in such human states as being awake or asleep, alert or fatigued, hungry or thirsty. Sensorimotor coupling is the way in which individuals couple with their environment and is manifest through perception, emotion, and action (Thompson, 2005).
“Intersubjective interaction is the cognition and affectively charged experience of self and others” (Thompson, 2005, p. 408). “The human mind is embodied in our entire organism” (Thompson, 2005, p. 408) and not just in our brain; thus, the mind is
“reciprocally shaped and structured” by these three modes of bodily process—self- regulation, sensorimotor coupling, and intersubjective interaction (Varela et al., 1993;
Thompson & Varela, 2001; Thompson, 2005, 2007). Participants in this study, then, were
199 aware not just from a mental perspective (reflective), but from a bodily perspective
(prereflective). As such, participants’ bodies were vehicles for being aware of the precipitating event. Awareness alone, however, was not sufficient for sensemaking to occur.
Participants reported needing to be “interested” in the information or have it be connected to their “values” before they actively engaged in sensemaking. The tipping point for just being aware to active sensemaking was evident in the enactive concepts of significance and valence. According to Weber and Varela (2002) and Thompson (2007), whatever individuals encounter in their environment, they must evaluate from the
“vantage point established by its self-affirming identity” (Thompson, 2007, p. 154).
Further, this evaluation takes the “form of the dual valence of attraction or repulsion”
(Thompson, 2007, p. 154). Accordingly, sensemaking “lays a new grid over the world: a ubiquitous scale of value” (Weber & Varela, 2002, p. 118). Thus, at the point at which participants of this study made the determination that the information being presented was important (significant) to them personally and/or professionally (identity), they were attached (valence) to the information, and this became the tipping point between awareness and sensemaking. Thompson and Stapleton (2008) posited that sensemaking is the intentional engagement of a system (an individual) with its environment. Thus, present-moment sensemaking is the nexus at which awareness and personal interest converge. In other words, sensemaking is the confluence of awareness and intentionality.
Intersubjectivity
The participants in this study experienced a form of participatory sensemaking
(Fuchs & De Jaegher, 2009) that could be characterized as intersubjectivity.
200 Intersubjectivity is understood as a form of “dynamic coupling and coordination of embodied agents” (Fuchs & De Jaegher, 2009, p. 470). Intersubjectivity was both an internal and an external process and manifested in the moment-to-moment interactions of the participants as they tried to interpret the precipitating event. During the interaction process, several outward gestures appeared, such as facial and vocal expressions, coordination of gestures, and affect attunement. In other words, participants experienced holistic development of the situation, which was coconstituted by their bodily movements
(Fuchs & De Jaegher, 2009). Inwardly, participants experienced body resonance (Fuchs
& De Jaegher, 2009). In other words, certain aspects of the event held significance for participants and produced inward responses; these responses included a variety of emotions (fear, disbelief, insecurity, anger, ambivalence, embarrassment, etc.), a desire for additional information, development of a mental plan of action, and physical reactions
(e.g., nausea, sweating, feeling flushed, a sense of shock). Intersubjectivity appeared to be a circular process, whereby individual participants influenced the group and the group, in turn, influenced individual participants. Further, intersubjectivity supported key dimensions of the sensemaking process in four ways:
1. It provided structure. The social interaction that took place during the
precipitating event functioned as a structuring process that influenced the
cognitive aspect of sensemaking. Intersubjectivity is an embodied social process
that influences brain functions (Fuchs & De Jaegher, 2009). Participants,
consciously and unconsciously, coordinated their movements, expressions, and
remarks (or lack of remarks) with changes in the environment during the event.
This coordination allowed participants to experience each other’s sensemaking,
201 thus creating a participatory sensemaking process (Fuchs & De Jaegher, 2009). In
other words, a social understanding of the precipitating event emerged from the
dynamical process of interaction and coordination of embodied participants to
each other and their environment.
2. It provided a context of embodied and meaningful interaction. The participants in
this study worked together, many over a significant span of time, resulting in
meaningful patterns of interaction. Thus, sensemaking in this study extended
beyond the precipitating event and beyond individual cognition. Meaning
emerged and became aligned through an understanding of each other and their
environment forged within the context of their situation over an extended period
of time. Participants accurately gauged what the other was thinking and felt by
virtue of their shared history together. Each participant engaged in the other’s
sensemaking activities, which means that sensemaking is reciprocal and mutually
influencing. Individual autonomy did not break down during the event.
Participants acquired additional understanding and intentions, but they also
consulted their own experiences and understanding of the event. It can be said that
the interaction of individuals created meaning in an emergent, self-organizing
fashion through the combined histories, backgrounds, expectations, affect, and
thoughts of the individuals, and the process can be viewed as one in which social
encounters self-organize.
3. It led to empathic perception. Participants’ body movements and facial
expressions influenced each other’s movements and sensations. In other words,
the precipitating event as a face-to-face sensemaking experience elicited a process
202 of “empathic perception” which became the basis of their social understanding
(Stein, 1989; Thompson, 2007; Fuchs & De Jaegher, 2009).
4. It regulated behavior. The mutual incorporation of movements, expressions, and
sensations by participants, which in some cases overrode individual sensemaking,
allowed a common sensemaking to emerge. According to Fuchs and De Jaegher
(2009), when individuals interact, the coordination of their body movements,
utterances, gestures, gazes, etc., gains momentum and can override the individual
intentions, and common sensemaking emerges.
Embodied Responses
Participants in the study experienced a variety of emotional and physical responses. These responses, from an enactive perspective, inform subjectivity. The body is simultaneously the basis of who and what we are as individuals; it is not simply something we know but also the basis of our knowing. Thus, its processes (emotions and physical responses) contribute to the meaning we make (Varela et al., 1993; Thompson,
2007). The body informs subjectivity through an array of feelings and body sensations, as was clearly demonstrated by this study. From this perspective, one can say that decision- making is embodied (Cromby, 2005). The actual decision-making process relies upon and incorporates bodily feedback and feelings (Cromby, 2005). Individuals in this study reported experiencing feelings and body sensations during the process of sensemaking, which added to their conviction that some things were not as they should be with the program. Emotions and body sensations also moved most of the participants along the path of developing a plan of action to resolve the low outcome score of the program.
Embodied reaction did not solely move participants to make certain decisions during the
203 study (i.e., to believe the ratings were accurate or to develop a plan of action); prior socialization no doubt played a role. “Our embodiment is societally produced (i.e., upbringing, religion, education, organizational role, general discourse over time, etc.), reflecting both the culture we inhabit and our location within it” (Cromby, 2005, p. 11).
It is important to note, however, that embodied responses (i.e., emotion and body sensations), cognition, and discourse are joined and mutually influential and operate together to coconstitute subjectivity (Cromby, 2005; Storbeck & Clore, 2007; Duncan &
Barrett, 2007). Affect (emotion) provides the necessary components that give strength to beliefs and gives individuals a sense that what they know is correct or not (Duncan &
Barrett, 2007). Affect in this study acted as a sort of internal compass (albeit a process, rather than a mechanical device) that aligned individuals’ subjective experience with external facts (the information in the precipitating event). While most participants experienced a sense of shock and disbelief upon hearing the message, and then sadness, fear, and other emotions, they moved to acceptance, which was evident by their desire to develop a plan to resolve the issues that resulted in the low outcome scores for the program. If participants had not ultimately believed that some things were amiss in the program, it is doubtful that they would have moved to plan development.
Colombetti (2010) posited the notion that meaning is generated within the system
(humans) for the system itself and is simultaneously consumed by the system as a result of being coupled to its environment. Additionally, the type of coupling to the environment codetermines meaning; different couplings produce different meanings, and, thus, meaning is always relational. This was evident with two of the participants in this study who were not clinicians. The meaning they made of the information presented in
204 the precipitating event was different from that of the frontline caregivers. These two individuals reported fewer and less intense emotions and were never moved to develop a plan of action to help improve the program’s outcome scores. They reported feeling empathy for the others in the study, but clearly their roles within the healthcare system
(nonclinical) distanced them from the patients and the program and created a different subjective experience of the precipitating event. Their coupling with the program was different from that of their coworkers and, thus, the meaning they made of the lower outcome scores was much different as well. This further suggests that embodied responses are self-organizing and mutually influence brain and body processes.
Embodied responses are a result of “distributed networks of self-organizing and mutually influencing brain and bodily processes” (Colombetti, 2010, p. 156), in which
Freeman (2000) characterizes as a self-organizing process whereby perception, action and the amygdala modulate one another in the service of the organism’s viability. In other words, it is the whole situated human being that constitutes the “capacity to make sense of the environment and to act in it” (Colombetti, 2010). Thus, embodied responses in this study were clearly the result of participants’ constitutive ability to make sense of their environment.
It can be said, then, from the literature and as a result of the findings of this study that embodied responses—emotions and physical sensations—support sensemaking in three ways:
1. As autonomic impressions. Emotions and/or body sensations act as a type of body
intelligence that informs individuals that whatever is happening to or around them
is important enough to having meaning assigned to it.
205 2. As a support for decision making. Decision making is bound up with feelings and
socialization (Cromby, 2005). An embodied sensemaking perspective unites the
individual and social constructivist view of sensemaking.
3. As a marker to examine thinking. Every perceptual experience is in part also an
experience of one’s body and, as such, reveals our situation in the world
(Colombetti, 2007). In other words, embodied responses help to disclose a world
of meaning and importance (valence) by focusing our attention. Because
embodied responses function as an alarm bell, adding a stamp of valence to
commonly held or accepted truths, which may or may not be true, they can act as
a marker to examine one’s thinking. In this way, embodied responses act as
embodied wisdom.
Implications
The awareness and sensemaking constructs used in this research supported this study in the manner that reflects the embodied perspective. The findings and results have implications for theory, research, and practice.
Theory
In recent years, sensemaking theorists have called for a more expanded view of sensemaking by “pinpointing central features of sensemaking” (Weick et al., 2005) that take into account “the role of the body” (Allard-Poesi, 2005; Maitlis & Sonenshein,
2010). Specifically, research around sensemaking has tended to focus on the “cognitive processes over social and affective processes in sensemaking” (Maitlis & Sonenshein,
2010, p. 574), using a psychosocial lens (Cromby, 2005) and “ignoring how the body
206 makes sense of the world” (Maitlis & Sonenshein, 2010, p. 574). Additionally, current theories have identified multiple characteristics of sensemaking that implicate the present-moment aspects of the processes, without ever fully explaining them, thus leaving a gap that warrants attention and development. This study explored present- moment aspects of sensemaking through an embodied perspective, demonstrating that the body and its embodied processes play a key role in sensemaking, in conjunction with cognitive and social processes. By implication, future sensemaking investigations should take into account the reciprocal and mutually influencing aspects of body, mind, and environment. This study encourages theorists to view the body, mind, and environment, not as detached elements, but rather as active and subjective processes that are structured by our lived bodily dynamics.
This study has implications for the understanding of intersubjectivity and embodied responses:
1. Intersubjectivity. In this study, intersubjectivity was a feature of the sensemaking
process and was aligned with what De Jaegher and Di Paolo (2007) called
“participatory sensemaking,” which is sensemaking by virtue of interpersonal
interactions that emerge in the “coupling” of two or more autonomous systems.
While current theories speak to the collective nature of sensemaking, they do not
go far enough in explaining how the interactions of individuals influence the
sensemaking process.
2. Embodied responses. This study indicated that embodied responses—emotions
and physical sensations—are basic building blocks of the human sensemaking
processes. They keep us grounded in the present moment (Varela et al., 1993) and
207 prepare us to take action (Freeman, 2000). Embodied responses are part and
parcel of subjective experience and, as such, are an important aspect in explaining
how the sensemaking process functions in organizations. Although to date, little is
known about embodied responses, affective neuroscience and neurobiology can
help to guide our thinking and build a more profound understanding of our body’s
role in sensemaking.
Sensemaking is not merely an external process, but rather the interaction of internal and external processes. This research suggests that feelings and cognitive content are attributes of any state of knowing. We have traditionally valued rational thought in organizations over feelings (Dougherty & Drumheller, 2006). Yet feelings function as knowledge. As evident by this research, feelings served to focus attention and guide future action. We often say that a situation “feels good” or it “doesn’t feel right.”
Sensemaking, thus, is also a bodily-emotional form of knowing (Stewart et al., 2010), not just psychosocial and, as such, more credence should be given to how we feel in a situation, rather than just what we think. The bodily-emotional knowing combined with our experiences in the world results in embodied wisdom. The concept of embodied wisdom is illustrated in Figure 6-1.
208
Figure 6-1. Embodied wisdom.
Embodied wisdom is conceptualized as a form of cognition that comes from having a physical body with sensorimotor capabilities that are themselves embedded in an encompassing psychological, social, and cultural context. In other words, this model confirms that there are different ways of knowing, and embodied wisdom represents the transformation of knowledge from merely abstract knowing to embodied conception and perception.
Research
This study demonstrates the value of changing the way we conceptualize sensemaking processes. Sensemaking viewed purely from a social constructivist lens reductively distorts human sensemaking into individual characteristics, such as identity construction, retrospection, enactive of sensible environments, social, ongoing, focused on and by extracted cues, and driven by plausibility rather than accuracy—which together do not fully account for sensemaking. Rather than treating sensemaking from a single viewpoint, we need to incorporate social theory, neuroscience, and embodied subjectivity to more fully conceptualize the sensemaking process. As we account for social participation, body dynamics, and the psychological aspects of sensemaking, we can
209 yield significant new insights for sensemaking research. Some of the implications for research areas are in awareness, intersubjectivity, and embodied responses.
Awareness. Awareness, according to Freeman (2000), “is an experience, which in neurodynamic terms is a transient state” (p. 116); thus, our awareness of things around us is fleeting at best. The transient nature of awareness was demonstrated in this study, whereby all of the participants reported losing their focus at one time or another during the precipitating event, either by internal thoughts, emotions, or body sensations or by outward distractions (e.g., someone wanting cookies, an uncomfortable chair, others’ body language). Based on the transient nature of awareness combined with the state of
“habitus” that most of us operate with and the rational assumptions that we operate under
(Croswell & Holliday, 2004), it becomes apparent that we oftentimes operate less mindfully (Levinthal & Rerup, 2006) and long before rationality is ever conceived
(Dougherty & Drumheller, 2006). Organizational theorists are beginning to make the connection between mindful ways of thinking (Eastern and Western notions of mindfulness) and organizational thinking (Weick & Putnam, 2006). This study supports
Weick and Putnam’s (2006) call for the identification of acts with meditative properties in organizations that move underneath these conceptual processes (i.e., resonant empathy, embodied responses, biological autonomy and agency, etc).
Intersubjectivity. In recognizing that emotions and physical sensations are both subjective as well as intersubjective experiences, it would be extremely valuable to understand how the interplay of embodied responses between organizational members affects the sensemaking process. Specifically, in organizations, what kind of data do members’ intersubjective embodied responses (emotions and physical sensations) provide
210 to leadership, and how should they be interpreted? Hatfield, Rapson, and Le (2009) posited that emotional expression can become contagious among organizational members and significantly affect group sensemaking processes. The question is how emotion affects group sensemaking and in what ways. And, finally, are there advantages and disadvantages to the intersubjective influencing of another’s sensemaking?
Embodied responses. “Affect makes important contributions to both sensory and cognitive processing” (Duncan & Barrett, 2007, p. 1184). According to Duncan and
Barrett (2007), “There is no such thing as a ‘non-affective thought.’ Affect plays a role in perception and cognition, even when people cannot feel its influence” (pp. 1184-1185).
Barsalou, Simmons, Barbey, and Wilson (2003) posited that how you see an object and how you feel about it may, in fact, be the same precise experience. It would be valuable to know, in fact, if there is a phenomenological distinction between thinking and feeling or whether they are two sides of the same coin.
Practice
This study underscores a conception of sensemaking as a subjective, embodied, and purposeful process that takes place in the activities and conversations between members of an organization. Certain patterns emerged from this study that have implications for participants in organizational life: sensemaking as self-organizing, decision-making, and embodied wisdom.
Self-organizing. It can be said from this study that sensemaking is self- organizing. Human beings are autonomous systems; they generate and sustain their own activities and, as such, enact or bring forth their own cognitive domain (Maturana &
Varela, 1987; Varela et al., 1993; Thompson, 2007; Thompson & Stapleton, 2008).
211 “Sensemaking is the interactional and relational side of autonomy” (Thompson &
Stapleton, 2008, p. 25). By changing the dominant vocabulary used to conceptualize sensemaking, we can reframe the way we think about organizations—from seeing organizations as mechanistic to seeing them as organic and/or complex adaptive systems.
The organic organization (Burns & Stalker, 1992) stresses the interdependence of its component parts, as well as its differentiation. Other properties include the ability to adapt, learn, and evolve; emergent behaviors or emergent properties; and steady change or growth, as opposed to instant change. Similarly, complex adaptive systems theory
(Eisenhardt & Bhatia, 2005) offers an evolutionary or naturalistic approach to organizing.
This theory views the agent as coevolving; the system lightly constrains agent behavior, but the agent modifies the system by his or her interactions with it. In the view of Burns and Stalker (1992) and Eisenhardt and Bhatia (2005), such organizations respond better to dynamic situations and unforeseen circumstances, relying more on adaptable applications of knowledge as opposed to more predictable knowledge in the form of routines, training, policies, etc. Likewise, loosely coupled systems (Weick, 1976; Orton
& Weick, 1990) maintain the identity, uniqueness, and separateness of constituent elements, and such systems can potentially retain a greater number of possible recombinations, mutations, and novel solutions. Loosely coupled systems adapt more effectively to changing conditions because they have many independent sensing elements that “know” the environment and, thus, can sense when and where to change with greater skill (Eisenhardt & Bhatia, 2005). Communication structures in organic organizations are information-based, as opposed to being command-and-control structures. In such a case, patterns of interconnected relationships that are reciprocal and mutually influencing and
212 conceived within an environment of valence could also be understood as an autopoietic network, one that adapts to change through autopoietic processes of self-generation.
Autopoietic systems create their own boundaries as distinct entities, while at the same time remaining open to their environment. Autopoietic systems are self-organizing.
In other words, the system determines its overall behavior and the interconnecting of relationships among its component elements, as opposed to the external environment deterministically imposing such couplings (Maturana & Varela, 1980, 1987; Luhmann,
1990; Capra, 1996). According to Weber and Varela (2002), it is important to understand that in autopoietic biology:
Because there is an individuality that finds itself produced by itself it is ipso facto a locus of sensation and agency, a living impulse always in relation with its world. There cannot be an individuality which is isolated and folded into itself. There can only be an individuality that copes, relates and couples with surroundings, and inescapably provides its own world sense. (p. 117)
Based on these characteristics of an autopoietic system and its implications for organizing, one can see the challenges of continuing to conceptualize sensemaking as a psychosocial processes. This view is conceptually inadequate for current conceptualizations of organizations as autopoietic systems and, as such, lacks the language to move us from seeing organizations as mechanistic to understanding them as organic processes and complex adaptive systems.
Additionally, Weick et al. (2005) posited, “The seemingly transient nature of sensemaking belies its central role in the determination of human behavior” (p. 409). One speculates to what extent the current conceptualization of sensemaking has created this experience. By reframing how we view sensemaking and the language we use to describe it, we will change the ways in which we view interactions and other organizational
213 behaviors that may otherwise be dismissed as arbitrary, nonsensical, or inconsistent. If we enlarge the concept of sensemaking to include the psychosocial and embodied subject, the benefits of conceptualizing sensemaking in this way will bring about different patterns of thinking about sensemaking in organizations so that the view is more coherent, credible, and explicit—and, in so doing, we will transform the way we see organizing behavior.
Decision making. An organization processes information to make sense of its environment, to create new knowledge, and to make decisions (Choo, 1998).
Sensemaking builds shared meanings that define organizational purpose and frame the perceptions of problems and/or opportunities that the organization needs to work on
(Choo, 2002). It is the problems and opportunities that become occasions for creating knowledge and making decisions (Choo, 2002). Yet, in complex and emergent environments, an overreliance on prelearned responses (mental models, training, strategic planning, etc.) can impair or constrain sensemaking and thereby reduce reliability and mindfulness (Weick & Putnam, 2006; Weick & Sutcliffe, 2001, 2005).
Elsbach et al. (2005) posited that highly situated cognition or contextualizing is a solution to individual and organizational reliability problems (Weick & Roberts, 1993;
Weick & Sutcliffe, 2001, 2005; Weick, 2005a, 2005b, 2006). Situated cognition is defined as “thinking that is embedded in the context in which it occurs . . . and tends to be transitory, arising as the interactions of existing cognitive structures (i.e., schemas) and momentary context (Elsbach et al., 2005). What Elsbach et al.’s (2005) study did not account for were the shared interactions among organizational members as an embodied
214 process, which is situated cognition (Varela et al., 1993; Thompson, 2005, 2007;
Thompson et al., 2005; Colombetti & Torrance, 2009).
This study underscores the significance of momentary interactions between organizational members and how those interactions refine and expand our sensemaking processes through subjective experience. Individuals make sense of the world by virtue of their autonomous structures, as opposed to just a cognitive-evaluative psychological capacity (Colombetti & Torrance, 2009). Affect and body sensations play out in the interactions between individuals and perturb and transform meaning (Colombetti &
Torrance, 2009), which affects sensemaking and, thus, the decision-making processes inherent in organizational life. Through affect attunement, which is the “sharing by two minds of the same mental landscape evoked by a referent” (Stern, 2009), individuals enact the desire to maintain an explicit feeling of connectedness (Colombetti & Torrance,
2009). Through a sense of alterity of self and other (Gallagher, 2005), we grasp the other as an autonomous alter with his point of view and share a common appraisal (Colombetti
& Torrance, 2009). Schutz (1967) would label the sense of alterity as the “thou as the
‘other I,’ the one whose experiences are constituted in the same fashion as mine”
(p. 114). Thus, situated cognition can and should be viewed as taking place within the context of interactions between individuals and as an autonomous biological process of living human beings. The implications for situated cognition as an embodied process from a practice perspective are twofold: how meanings emerge and the ethical consideration of affective and interactive modes of self and other.
First, from an embodied perspective, meanings emerge in organizations through the interaction between individuals. During interaction, “participants do not just bring
215 their ready-made significances to bear on the interaction; significances are implicit in the situation of the encounter” (Colombetti & Torrance, 2009, p. 520). Along with these implicit significances are also “myriad shaped, complicit, disputed, resolved, dissolved, rebutted, etc., significances which emerge in a constantly shifting, more or less shadowy way, in any interactional situations” (Colombetti & Torrance, 2009, p. 520). Thus, according to Colombetti and Torrance (2009), the interactions between individuals have their own autonomy and dynamic process that modulates and is in turn modulated by “the participants’ own individually autonomous authorial perspectives on the situation (p.
520).” Thus, meaning is shaped and sometimes reshaped as a shared product of the interaction between self and other.
Second, there is an emotional and an ethical character to be considered in the negotiation of meaning (Colombetti & Torrance, 2009). According to Colombetti and
Torrance (2009), different styles of interaction, with their varying affective overtones, will make an ethical difference. Various affective styles modulate the ethical coloring of any given situation and, thus, the meaning we make of that situation. In other words, how we affectively frame our discussions in organizations has a direct bearing on the ethical character of a situation and influences the “inter-relations” between participants.
Embodied wisdom. The concept of wisdom is ancient. Yet, there is no expert consensus on the definition of wisdom, let alone the concept of embodied wisdom. From a physiological perspective, Sternberg (1990) focused on wisdom as application of tacit knowledge as mediated by values toward achievement of a common good through a balance among multiple interpersonal, intrapersonal, and extrapersonal interests as a means to achieve a balance among adaptation to existing environments, shaping of
216 existing environments, and selection of new environments. Baltes and Smith (1990) and
Baltes and Staudinger (2000) viewed wisdom as expert knowledge in the fundamental pragmatics of exceptional insight, judgment, and advice about complex and uncertain matters and expertise in the conduct and meaning of life.
In a recent study conducted by Meeks and Jeste (2009) in which wisdom was viewed as a stable trait in the general population, they identified central unifying elements that define wisdom. Meeks and Jeste (2009) agreed that wisdom could be characterized as (1) uniquely human; (2) a form of advanced cognitive and emotional development that is experience driven; (3) a rare personal quality; (4) something that is learned; (5) something that increases with age; and (6) something that can be measured.
Weick (2001) posited wisdom as an “attitude rather than a body of thought” and cited the nature of wisdom by using Meacham (1990), who characterized wisdom as “knowing that one does not know, in the appreciation that knowledge is fallible, in the balance between knowing and doubting” (Weick, 2001, p. 358). But nowhere do these psychological definitions and characteristics of wisdom explain the embodied nature of wisdom.
Embodied wisdom is part and parcel of embodied cognition, which posits that in human cognition, such aspects as ideas, thoughts, concepts, and categories are largely determined by the body. These aspects include the perceptual system, the intuitions that underlie the ability to move, activities and interactions with our environment, and the native understanding of the world that is built into the body and mind (Varela et al.,
1993). “The cognitive self is its own implementation: its history and its action are of one piece” (Varela, 1999a, p. 54). Accordingly, wisdom was conceptualized by Varela
217 (1999a) as ethical know-how. Ethical know-how is rooted in the immediacy of human perception and action as an “immediate coping” with what is before us in the moment
(Varela, 1999a, p.5).
Similar in nature to ethical know-how is the concept of “presence.” Senge et al.
(2004) posited presence as “deep listening, of being open beyond one’s preconceptions and historical ways of making sense” (p. 11). “Presencing is about ‘pre-sensing’ and bringing into presence—and into the present—your highest future potential” (p. 226).
Presencing is a deep sense of awareness, and through this deep sense of awareness one is able “to see the larger wholes that generate ‘what is’ and our own connection to this wholeness” (p. 10). In other words, presencing is an “inner knowing,” which can be seen as embodied wisdom. Senge et al. (2004) described presencing as “a different state—the body feelings, where your ears are ringing, and you have a heightened sense of awareness, and everything around you seems to slow down” (p. 102). Further, “things become more integrated as a path—with intention, body and mind coming together rather than being all over of the place” (p. 99).
Ethical know-how (Varela, 1999a) and presence are aligned with embodied wisdom, which emerged in this study by means of the interconnection of participants’ intentions, physical body, and mind as they experienced the precipitating event. The individuals in this study were not asked to devise a plan to correct program deficiencies.
Yet, almost every participant, the exception being two outliers (nonclinical individuals), developed a plan of action to resolve the issues in the program. This plan came from a spontaneous sense of knowing (an inner knowing) of what needed to be done, which is different from the analytic knowing of organizational decision making. Varela (1999a)
218 would call this spontaneity “immediate coping.” Embodied wisdom, then, is the nexus of one’s intentions, body, and mind, rooted in subjective history and action. Embodied wisdom kept participants in this study grounded in the present moment and, at the same time, connected them to both the past (reflecting on their past experiences) and the future
(development of action plans). Embodied wisdom was experienced by participants in this study as affect, physical sensations, and the desire to take action.
Historically, “emotions in organizations have been undervalued in favor of rationality” (Dougherty & Drumheller, 2006, p. 215). Interestingly, however, “many rational organizational strategies are pursued on highly emotional grounds and much of what we describe as rational is in fact emotional” (Dougherty & Drumheller, 2006, p. 216). According to Dougherty and Drumheller (2006), emotionality in members of organizations is thought to cloud judgment and produce organizations that are weak and irrational. Emotions, however, are now viewed in the neurobiological perspective as
“dynamic processes in the brain and body that prepare the body for forthcoming action”
(Freeman, 2000, p. 91). As such, emotions can be understood as the “energy of transformation” (Croswell & Gajjar, 2007). If we overlook the existence and importance of emotions in organizations, then we deny the subjective experiences and inherent vitality of individuals. If, on the other hand, we recognize that emotions are deeply inherent in the sensemaking process and we harness the energy and wisdom offered by emotions, then we hold the potential to create more human organizations.
It can be said, then, that present-moment sensemaking emerges from the interrelated processes of self-organizing (i.e., our autopoietic nature), embodied wisdom
(i.e., cognition that comes from having a physical body with sensorimotor capabilities),
219 and our desire for decision making in organizations. These processes are the result of the inseparable outcome of the interaction of intentional behaviors, cognitive conception, and affective perception. Taking into account these aspects, present-moment sensemaking is illustrated in Figure 6-2.
Figure 6-2. Present-moment sensemaking.
This conceptualization is closely aligned with Bandura’s (1977, 1986) social learning theory, which explains human behavior in terms of continuous reciprocal interaction between cognitive, behavioral, and environmental influences. While similar, present-moment sensemaking takes into account in an explicit way the role of the body in cognition and meaning generation. Bandura’s view of cognition is based on psychological and social processes that do not include the bodily cognitive-emotional forms of knowing. In the embodied view of cognition, emotions arise from a living system’s motivation to sustain itself (i.e., autopoiesis) and to satisfy its preferences. Thus
220 conceived, emotions specify action-guiding values, drivers, and preferences (Stewart et al., 2010) and are constitutive of the process of interpreting a situation (Freeman, 2000).
Present-moment sensemaking in this study is conceptualized as a subjective, embodied, and purposeful process that takes place in the activities, relationships, and conversation between members of organizations as they enact a world in which they choose to live.
Summary
This study was undertaken to explore the present-moment aspects of sensemaking by examining how individual awareness contributes to one’s ability to make sense of his or her environment. This chapter, using the lens of embodied sensemaking, presented the researcher’s conclusions. Specifically, (1) awareness is necessary for sensemaking, but it is not sufficient; (2) intersubjectivity supports key dimensions of the sensemaking process; and (3) embodied responses, which show up as autonomic impressions, are reflective of the way in which sensemaking manifests in subjective experience.
Additionally, this chapter presented implications for theory, research, and practice. This study encourages theorists to view the body, mind, and environment not as detached elements, but rather as conjoined, active, and subjective processes that are structured by lived bodily dynamics. From a research perspective, this study demonstrates the value of changing the way we conceptualize the sensemaking process to include neuroscience and embodied subjectivity along with social theory; in so doing, we can bring about new insights for sensemaking research in the areas of awareness, intersubjectivity, and embodied responses. Finally, from a practice perspective, this study underscores sensemaking as a subjective, embodied, and biologically purposeful process
221 that takes place in the activities, relationships, and conversations between members of organizations and shines light on the self-organizing and embodied aspects of organizational behavior.
Epilogue
A rich body of literature for understanding the value and potency of sensemaking is emerging, even as the embodied wisdom of sensemaking in this present-moment research is empirically evident and related to both self-organizing and decision-making.
This research confirms other findings that cognition and emotion (Storbeck & Clore,
2007; Duncan & Barrett, 2007; Colombetti & Torrance, 2009) are inseparable and that both emotion and cognition are fundamental processes of wisdom (Birren & Fischer,
1990), participatory sensemaking (De Jaegher & Di Paolo, 2007), and mindfulness
(Davidson, 2010). Merely understanding cognition alone falls far short of cultivating the mind and its human potential. While this research explored sensemaking as an enactive
(Varela et al., 1993) or embodied phenomenon (Maitlis & Sonenshein, 2010), much more about the complexity of sensemaking can be understood from the view of affective science and neuroscience (Davidson et al., 2003).
Recent empirical explorations of the affective aspect of mindfulness (Davidson,
2010) continue to emerge from the affective neuroscience field (Panksepp, 1998, 2004,
2005; Gallagher, 2005), while affective science (Davidson et al., 2003) is confirming that perception/conception, feeling/thought, emotion/cognition, and body/mind are inseparable and coemerge dynamically with complementarity, neither as conventionally polarized opposites nor as mythical dualities. Moreover, the classical approach to sensemaking that is bounded by psychology and sociology alone leaves practitioners only
222 partially adept at understanding the profound value of sensemaking as an essential foundation for human and organizational learning (Schwandt & Marquardt, 2000). The affective and ethical dimensions of participatory sensemaking appear to be vital to the valuation of a given situation, both ethically and affectively (Colombetti & Torrance,
2009).
Additionally, this research exposed the elements of reflexivity, valence, and valuation of affect in its six forms (Davidson et al., 2003)—emotion, feeling, mood, attitude, affective style, and temperament—as naturally adaptive human processes and, as such, vital to sustaining, maintaining, and preserving human life in organizations. Our sensemaking affects the other, just as the other affects us, either positively, negatively, or with neutrality. Particularly with regard to the valence of affect (Varela & Depraz, 2003) and affect’s dynamic preparatory and enabling function for action (Freeman, 2000), emotion and affection can indeed be viewed as the energy of transformation (Croswell &
Gajjar, 2007, p. 25). People can be emotionally productively engaged or emotionally destructively engaged, or somewhere in between. It follows then that the affective aspect of sensemaking is both an asset and a liability, depending upon the practice of wisdom and mindfulness in sensemaking.
Finally, two models emerged as a result of this research: one that represents the embodied wisdom that resides between the social and the self and one that represents the process of unifying mind that is the integrating nature of autonomic self-organizing, embodied wisdom, and decision-making. Both models have vital implications for the practices of leading, learning, and mindful (Weick & Putnam, 2006) sensemaking in
223 organizational life. It can be said that sensemaking is a practical process for unifying mind.
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247 APPENDIX A:
RECRUITMENT EMAIL
Dear Mike Smith:
I am asking you to participate in a study that explores the present-moment aspects of sensemaking by examining how individual awareness contributes to one’s ability to make sense of his or her environment. The information from this study will be reported without reference to you. Your response will be known only to the researchers and will not be revealed to anyone outside the research team. Once the study is completed (but prior to publishing), I will give you a debriefing. The complete results of the study will be available in about 12 months. If you wish to obtain a copy of the results, you may contact me.
I hope you will participate in and complete this study, but if for any reason you decide to withdraw, you are free to do so. Whether you chose to participate or not, your employment will not be affected in any way.
If you have questions about this study, please contact me at (540) 664-2944 or [email protected]. You may also contact [name], Corporate Director of Organizational Development, [organization] at [phone number, e-mail].
Thank you for your consideration.
Sincerely,
Faith B. Power
248 APPENDIX B:
RESEARCH INFORMATION AND CONSENT FORM
In the Moment: A Phenomenological Case Study of the Dynamic Nature of Awareness and Sensemaking
Invitation to Participate in Research You are being asked to voluntarily participate in a research project. The purpose of this sheet is to give you the information you need to make an informed decision about whether or not to participate. It is important that you understand what the research involves. Please take a few moments to read this letter carefully. You should feel free to ask the researcher any questions you may have about the study at any time.
Purpose of the Study This study is designed to explore the present-moment aspects of sensemaking by examining how individual awareness contributes to one’s ability to make sense of his or her environment. In particular, we want to examine some of the distinctive ways in which individuals cognitively process information in their organizational environments in “real- time.”
Number of Subjects and Expected Duration of Study This study will involve 8 to 10 people and will include participants from across [organization]. The study is expected to take a total of 5 hours to complete.
Participation Criteria This study is an option for individuals who (1) have the ability, willingness, and comfort to participate, to maintain a journal, and to take part in debriefing sessions and can devote sufficient amounts of time to see the study through; (2) have an interest in the phenomenon being studied; and (3) are employed by [organization].
Procedures If you take part in the study, you will participate over several sessions. The study will be completed in three phases—(1) initial study, (2) follow-up interviews and (3) participant debriefings. Each session will be composed of the following:
(1) The initial study phase will consist of 8 to 10 participants who will experience a precipitating event. The precipitating event involves a member of [organization’s] management team giving participants some pertinent and important information about an [organizational] healthcare program. The participants will then be asked to take about 20 minutes to process the information given about the healthcare program. The initial study phase will be audio and video recorded, and study participants will be asked to keep a journal of their thoughts and reactions as the precipitating event unfolds. Participants will be provided with journaling instructions and a journal prior to the initial study phase.
249 This phase of the study is expected to take 2 hours. The follow-up interviews will be scheduled at the conclusion of the initial study phase session.
(2) The follow-up interview sessions involve one-on-one interviews with each of the study participants. The researcher will ask each participant a series of questions related to their experience of the information they were given during the initial study phase. Prior to asking questions, the researcher will play a videotape of the initial study phase as a means to place the interview questions into context. This session will be audio recorded and is expected to take 2 hours.
(3) The participant debriefing sessions are an opportunity for participants to review the data collected as a means to test for factual and interpretative data accuracy. This phase will consist of a one-on-one session with each participant, in which a summary of their particular interview is presented for review and comment. This session is expected to take an hour. No recordings of this session will be made.
Risks and Discomforts You may have some emotional discomfort in talking about your experience during this study. You are free to not answer any question(s) during the interview, and to give only as much information as you are comfortable giving during the study interview. Additionally, you are free to withdraw from the study at any time.
There is a minimal risk of confidentiality. While this study does not involve the use of sensitive personal information, precaution will be taken to minimize possible breaches of confidentiality. The precautions are explained under the Confidentiality section of this sheet.
Benefits Taking part in this research will not directly benefit you. However, we believe that the information gained from this study may help others in the future by further advancing knowledge in the area of sensemaking.
Right to Withdraw From the Study Participation in this study is voluntary. You may refuse to participate, refuse to answer any questions, or withdraw from the study at any time with no effect on your employment with [organization]. You do not waive any legal rights by signing the consent form.
If you are participating in another study, please inform our researchers to ensure that there is no problem with participating in both studies.
Confidentiality Any information that is collected about you during the study will be kept confidential. If the results of the study are published, your name will not be used and no information that identifies you will be released. The records of this study will be kept private. In any publications or presentations, we will not include any information that will make it
250 possible to identify you as a subject. Research records will be stored securely, and only researchers will have access to the records. Each participant will be given a number code that links their identity to that of the data collected. The code key will be stored in a separate, secure location. All records of the study will be destroyed 1 year after the study is completed.
Harm Given the nature of the study, it is unlikely that you will be harmed. If, however, you believe that you have been harmed in this study, you may report this to the Principal Investigator of this study, Clyde Croswell, who can be reached at (703) 726-3786 or via email at [email protected]. Additionally, you may report it to the Office of Human Research, George Washington University, at (202) 994-5009.
Reimbursement for Participation There will be no reimbursement for participation in this study.
Contact Persons for Study For more information on this study, please contact the following individuals:
• Faith B. Power, researcher, (540) 664-2944 or [email protected] • [Name, Organization, phone, e-mail] • Clyde V. Croswell, principal investigator, (703) 726-3768 or [email protected] • Office of Human Research, George Washington University, (202) 994-5009
Taking part in this research is up to you. You can refuse to take part. You can join now and quit later. Either way, it will not affect how you are treated.
By signing the consent form below, you acknowledge that you have read and understood the information sheet attached and thereby agree to participate in this study. You will be provided a copy of this informed consent form.
Faith B. Power Researcher The George Washington University ------
I consent to participation in the study entitled “In the Moment: A Phenomenological Case Study of the Dynamic Nature of Awareness and Sensemaking,” as described in the information letter.
______Print Name
______Signature Date
251 APPENDIX C:
PARTICIPANT RECRUITMENT AND SCREENING GUIDE
Script for first interaction (over the phone, about 5-6 minutes)
Good morning/afternoon, [name of the prospective participant]. I am Faith Power, a doctoral student.
I am following up on an information sheet that you were recently sent regarding participation in a research study that I am working on as part of my doctoral studies. I am enrolled in the Executive Leadership Program at George Washington University.
Specifically, my research is an exploratory case study on how we make sense of events as they unfold in organizational settings. Your organization, [name], provided your name to me as a potential research participant. I’d like to explore with you your interest in participating in this study.
I want to make it clear that participation in this study is voluntary, and whether you choose to participate or not, your employment will not be affected in any way.
[If there is interest on the part of the prospective participant]. . . Initially, I would like to meet with you for approximately 20 minutes, at a time and location that is convenient to you, to review in more detail the purpose of the study and the time commitment required to participate.
[If prospect agrees, schedule meeting time and location and thank him/her for their interest in the study.]
252 APPENDIX D:
JOURNALING INSTRUCTIONS
What is the purpose of the journal? This study is designed to use journaling as a mean to help participants capture their thinking and to promote reflection around an unfolding organizational event.
What is the expected format of the journals? Handwritten free-form style. Do not get caught up worrying about spelling, proper use of grammar, or sentence construction. The important thing to remember is that the journal is being used to capture the essence of your sensemaking experience as an event unfolds. You are not expected to write in complete sentences. Think of this as a stream of consciousness exercise.
In what will the participants write? A journal will be provided to you prior to the research.
How much writing is required? As much as the participant is comfortable writing.
How much time will I have to complete the journal? You will be required to have the journals completed by the end of the initial study phase, which will be around 2 hours.
How will the researcher use the journals? The journals will be used by the researcher to facilitate a face-to-face interview with individual participants. The journal will serve as a means to probe for deeper insights and knowledge around individual awareness and present-moment sensemaking.
Who will read the journals? No one, other than the researcher, will be allowed to read your journal.
When will I start to journal? The study participants will experience a certain spontaneous event during the course of the initial study phase. The event will be significant enough to act as a cue for journaling; however, a verbal cue will also be given.
What do I put in the journal? The following information will serve to structure your journaling process:
1. What were you thinking as the event unfolded? 2. What did you observe about yourself and others in the study as the event was unfolding? 3. How did this unfolding event make you feel? What emotions were you experiencing?
253 4. What was it like to become aware of this event? 5. What was the process of becoming aware like for you? 6. How did you start to make sense of this event? 7. What thoughts were running through your mind as you were trying to make sense of the event (whether pertinent to the subject at hand or not)? 8. At the beginning moment of the unfolding event, what were you thinking? What if any emotions did the event trigger? 9. In terms of feeling, was there a succession in terms of inner feelings? Were there different states, or was it something continuous? 10. Were there any colors, images, or sounds that manifested inwardly as you made sense of the event?
Note: The above journaling instructions are merely suggestions. Becoming aware of one’s subjective experience and describing it can be a difficult process, and often our vocabulary fails to adequately convey what we experience. Feel free to use your own words or phrases to describe your experience, even if you have to invent new words to do so.
254 APPENDIX E:
INTERVIEW PROTOCOL
Purpose: To allow the participant to become aware (Depraz et al., 2003) of a present- moment sensemaking experience in order to allow a more detailed and refined first- person description (Petitmengin, 2006) of such conscious experience (Thompson, Lutz, & Cosmelli, 2005).
Key questions:
I want to begin our session today by asking you to go back to [indicate the day, time, and location] when you first became aware of the heart and vascular program rating. I’d like you to imagine that we had a video recorder. We’re going to replay the event in your mind’s eye and then we’ll see what you thought of the event. It’s very easy. We’re going to rewind, and to do that I’m going to ask you to immerse yourself in this experience, the experience of learning that the heart and vascular program rating had declined.
At the moment you heard [executive’s name], what did you think? What happened?
I’m going to repeat what you say to me, which will help me to make sure I understand what you said. Don’t hesitate to tell me I am wrong; that can and will happen. Please stop me if what I repeat does not exactly correspond to what you did or to what you experienced.
As [executive’s] message was unfolding, in those moments, how were you making sense of it? (What was your sense of the event?)
[Probe to delineate the experience by repeating what the participant said about the experience of making sense of the event.]
• Can you say more about that? • You indicate in your journal that you felt the emotion of [insert emotion: happiness, sadness, fear, indifference, etc.]. • When you said to me that [insert specific participant description], how did that happen? • How did it lie in your body; in other words, how did you feel about it?
[After indication of an embodied utterance position—such as the use of “I,” use of present tense, the specific context indicators (place and time), and/or concrete and detailed vocabulary—the researcher will turn to more descriptive questions.]
Okay, I want to take you back once again to the executive’s message about the heart and vascular program rating that you experienced in the group setting. What comes to mind as you think about becoming aware of the unfolding message that you experienced in the group setting?
255
• Can you go into more detail about . . . [whatever emerges from the previous question] and how that took place inwardly? • You mentioned earlier feeling the emotions of [specify emotions]. Can you give me more detail about this emotion? [If more than one emotion, probe each emotional response.] • Did you experience any physical sensations as you were making sense of the message? • Where there any images associated with those thoughts or sensations? • If you can imagine becoming aware as a process, how would that process take place? How would it begin? • Did you find yourself becoming distracted (losing focus), either by passing thoughts, emotions, or external disturbances? Did your mind jump somewhere else? • When you receive that kind of surprising information, how do you maintain your focus?
You seem to be struggling to find the words to describe the sensations you felt during this event. Take your time. Let’s go back once again to the other day when you first experienced the unfolding event. You said that you kind of felt like [specify the sensation], but not exactly so. Can you create or combine words to form a more accurate picture of the sensation? Take your time. Replay the event in your mind’s eye until you have a firm grasp of it.
How do you make sense in the present moment?
• Can you describe how to do that? • What does it feel like? • Is there a physical (or body sense) reaction or sensation? • Is there a mental reaction or sensation? • Is there an emotional reaction or sensation?
Now that you are past the event, when you think about it now, what comes to your mind?
• As you have described this process of becoming aware, let me ask you how it affected your ability to make sense of the unfolding event.
Since receiving the information last Thursday, have you spoken to anyone about the information? (I’m not looking for people’s names.)
• Why did you speak with that person or persons? • Can you describe that conversation? • How did you feel during that conversation(s)? • What does this information mean to you? • After you spoke to that person, how did you feel?
256 • In what way, if any, did it change your sense of what was going on?
When you are trying to make sense of something, do you have an internal focus or an external focus?
• Can you describe to me how having an internal or external focus feels to you? • How do you know when you are focused? • What is it like to be focused?
What was your experience of how the message was delivered?
• Was it a positive or negative experience? Mixed? Or was it something entirely different?
How has this knowledge affected you?
• Physically? • Mentally? • Emotionally? • Other?
Is there anything else that comes to mind surrounding this event that we have not spoken about? Anything at all—even if you think it sounds odd or out of place. I would like to hear your thoughts and feelings surrounding the event.
257