Executive Master in Business Administration
Henley Business School, University of Reading
Management Challenge
Towards an understanding of how to enhance sensemaking in organizational strategic change
By Sandra Greve
Student ID Number: 82107332, DK04
Supervisor: Professor George Tovstiga
Report submitted in partial fulfilment of the requirements for the degree of
Executive Master of Business Administration 2011
Varde, Denmark, September 29th 2011
© Copyright 2011 Sandra Greve.
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“There is a crack (*), a crack in everything. That's how the light gets in.”
Leonard Cohen
(*)
“A crack is where something new can emerge, where something can be said, done,
seen, heard, sensed, reflected upon; something that has not previously been tested.
It can be carried by people, managers or employees who have a special ability or
openness, but it can also happen in a conversation or a sudden opportunity that
presents itself. The objective then becomes to perceive them and having the courage
and ability to comprehend and grasp them. It may be in the cross fields, the foci, or in
the paradoxical that might at one level seem like opposites; but it can, if understood
from a higher level, make sense. The crack is precisely the space between, so if we
focus too much on the concrete, we may miss it.”
Lone Belling, Consultant and owner of Life and Leadership
and participant in this Management Challenge Delphi Study
© Copyright 2011 Sandra Greve.
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Executive summary
This Management Challenge (MC) arises from the one-man consultancy SenseMaker
ApS owned by the author of the MC. Daily, the author see SenseMaker customers
struggle to succeed with strategic change in a turbulent context. This fact combined
with the author´s strong interest in sensemaking led to the purpose of this MC to
generate new insights around the notion of sensemaking that might then find use in
organisations engaging in strategic change by investigating:
1. What is the role of sensemaking in organizational strategic change?
2. What is the current state of sensemaking in organizational strategic change?
3. Which factors might enhance the effectiveness of sensemaking in
organizational strategic change?
4. What are the limitations to sensemaking in organisational strategic change?
The investigation is based on a Delphi study with five panels: employees, CEO´s,
consultants, academics and medical doctors. The panels were gathered in physically
unstructured dialogue sessions to explore the research questions from the
perspectives of the traditional practice field engaging in organizational strategic
change – and by high reliability organizations (HROs) which by Weick and Sutcliffe
(2007) are defined as organizations who have developed more mindful practices that
make them perform better than most traditional practices in a turbulent context.
Findings show that to avoid inertia and sensemaking blockages, continuous changes
are preferred because of a general increase in complexity in business environments.
The role of sensemaking in organizational strategic change is considered necessary to
generate change – especially within a strategic context, because it often demands that
the ideas of top management have to make sense to the rest of the organization.
The current state of sensemaking in organizational strategic change within the
traditional practice field shows that the concept of strategy is drifting towards a more
tactical and operational nature – and that although there is a high awareness of what
to do, action is blocked by the traditional organizational system and structures.
© Copyright 2011 Sandra Greve.
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The main factors to enhance sensemaking in organizational strategic change are
creating a movement with a higher purpose, within an environment of confidence,
sincerity, open dialogue and acceptance of paradoxes and ambiguity. The higher
uncertainty and the shorter planning horizon, the more important HRO practices
becomes, e.g. improvisation and calm overview within clear structure, roles,
prioritization and help mobilized within the system.
The limitations to sensemaking in organisational strategic change are strong
sensemaking blockages within the traditional practice field, showing a circular intent
but with linear output and a strong need for labelling and placing responsibility.
Recommendations for the professional sensemaker, i.e. the CEO, manager and
consultant engaging in organizational strategic change, is listed by following the three
sequence model of Weick and Quinn (1999) for continuous change.
Implications with respect to new insights into sensemaking in the context of
organizational strategic change are derived from two different levels – the individual,
e.g. the professional sensemaker and the collective, i.e. the organization.
© Copyright 2011 Sandra Greve.
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Acknowledgements
I want to thank everyone who agreed to participate in this research. And that is quite a
number of people. This journey began on December 9th 2010 with an introductory talk
with two PhD students, Tove Brink and Lisbeth Brøde Jepsen. Thanks for taking the
time to meet me and for asking me questions that made me think and re-think.
A special thank goes to the five groups of professionals participating in the Delphi-
panel, providing knowledge and enthusiasm along the way. The panel consisted of 43
people whom I will never forget for their enthusiasm and professionalism:
10 employees
6 CEOs/managers
7 consultants
9 academics
11 medical doctors
Thanks to these 43 people, the process has been very inspiring. Their names are in
appendices C, E, G, I and K. Since March of 2011, I have received e-mails with
reflections, like Monday-thoughts, Tuesday-thoughts etc., “Best Bets”-mails,
references to further readings and phone-calls from panel members.
Off course, I want to thank my supervisor Professor George Tovstiga. Already at the
first semester, I knew that Tovstiga was the right person to help me. The writing
process proved me right.
I also wish to thank my family and friends. I know I have not been around much,
neither physically or mentally. I have been living in my own little bell jar trying to make
sense. Finally, off course, a big hug and thanks to my partner in life and business, C.,
for always challenging and supporting me at the same time. This has been a big hurdle
in the middle of heavy workload and turbulence. We did this, too. Thanks.
© Copyright 2011 Sandra Greve.
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Table of content
Executive summary ........................................................................................................................ 3 Acknowledgements ........................................................................................................................ 5 List of Figures and Tables ............................................................................................................... 7 1 3BIntroduction ........................................................................................................................... 8 1.1 12BBackground and context ................................................................................................ 8
1.2 Statement of the issue to be investigated ................................................................... 10
1.3 Importance and relevance of the issue to be investigated.......................................... 14
1.4 Structure and key content ........................................................................................... 16
2 4BReview of current thinking ................................................................................................... 17 2.1 17BSensemakings main mechanisms ................................................................................. 18
2.2 18BSensemaking in an organizational change context ...................................................... 24
2.3 19BHigh reliability organizations ....................................................................................... 28
2.4 Sensemaking in an organizational strategic context ................................................... 31
3 Objectives of the research ................................................................................................... 34 3.1 21BResearch questions ...................................................................................................... 34
3.2 22BResearch objectives ..................................................................................................... 35
3.3 23BKey definitions.............................................................................................................. 36
4 Research design ................................................................................................................... 37 4.1 24BDelphi method ............................................................................................................. 38
4.2 Validity, reliability and generalizability ........................................................................ 46
5 Research findings and analysis ............................................................................................ 48 5.1 26BPanel 1-4: Sensemaking in organizational strategic change ........................................ 48
5.1.1 The role of sensemaking in organizational strategic change ................................. 49
5.1.2 The current state of sensemaking in organizational strategic change .................. 51
5.1.3 Factors to enhance sensemaking in organizational strategic change .................... 54
5.2 Panel 5: Sensemaking in high reliability organizations ................................................ 59
5.3 Panel 3-4: Meta-reflections ......................................................................................... 65
6 Conclusions and recommendations ..................................................................................... 67 6.1 Conclusions .................................................................................................................. 67
6.2 Recommendations ....................................................................................................... 74
6.3 Implications .................................................................................................................. 77
7 9BReflections ........................................................................................................................... 79 7.1 Evaluation of findings ................................................................................................... 79
7.2 33BExperience of the research process ............................................................................. 80
7.3 The limitations to this Management Challenge ........................................................... 82
7.4 Achievement of personal objectives ............................................................................ 83
References ................................................................................................................................... 85 Appendices ................................................................................................................................... 89
Word count: Total word count of this Management Challenge is 17.796, excluding executive summary, table of content, figures and tables, references and appendices.
© Copyright 2011 Sandra Greve.
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List of figures and tables
Figures
Figure 1: Four levels of uncertainty. Source: Courtney (2008) ....................................................................................... 9
Figure 2: Areas of interest forming the research focus. Adapted from Henley Study Guide (2008) ............................ 10
Figure 3: SenseMaking and StrangeMaking. Source: Humantific webpage www.humantific.com .............................. 12
Figure 4: SenseMaking and ChangeMaking. Source: Humantific webpage www.humantific.com .............................. 13
Figure 5: Structure and key content of this Management Challenge. .......................................................................... 16
Figure 6: Sensemaking’s seven properties. Adapted from Weick (1995, 2005) and Mills (2010) ................................. 19
Figure 7: Sensemaking blockages. Adapted from Weick (1988, 1995) and Maitlis and Sonenshein (2010) ................. 21
Figure 8: Sequences for continuous change. Adapted from Weick & Quinn (1999) .................................................... 26
Figure 9: Seven practical questions to the organizations. Adapted from Weick (2001) ............................................... 27
Figure 10: Principles of high reliability organizations. Adapted from Weick and Sutcliffe (2007) ................................ 29
Figure 11: Sensemaking and the formation of insight. Adapted from Tovstiga (2010) ................................................ 32
Figure 12: Sensemaking mechanisms in an organizational context. Adapted from Tovstiga et al. (2005) ................... 33
Figure 13: Knowledge domains important to this investigation ................................................................................... 39
Figure 14: Primary data collection process ................................................................................................................... 41
Figure 15: Delphi iterations in the research process .................................................................................................... 42
Figure 16: Overview on Delphi panels paired with the research questions ................................................................. 43
Figure 17: Thematic coding. Source: Dey (1993) .......................................................................................................... 44
Figure 18: Fine coding grouped into conceptual categories. Source: Dey (1993) ......................................................... 45
Figure 19: Broad thematic coding refined to identify different dimension. Source: Dey (1993) .................................. 45
Figure 20: The role of sensemaking in organizational strategic change ....................................................................... 50
Figure 21: The strategic hierarchy levels under change ............................................................................................... 51
Figure 22: Inverted traditional organizational hierarchy .............................................................................................. 52
Figure 23: Data display for recommended state by the traditional practice field ........................................................ 54
Figure 24: Data display for current state of the HROs .................................................................................................. 59
Figure 25: Main sensemaking limitations within the traditional practice field............................................................. 65
Figure 26: The role of sensemaking in an organizational strategic change. Adapted from Tovstiga et al. (2005) ........ 68
Figure 27: The current state of sensemaking in organizational strategic change. Adapted from Tovstiga (2010) ....... 69
Figure 28: The focus of the traditional practice field and HROs. Adapted from Weick and Quinn (1999) ................... 70
Figure 29: HRO contributions to the traditional practice field ..................................................................................... 71
Figure 30: Seven practical questions to the organization combined with factors to enhance sensemaking ............... 74
Figure 31: Sequences for continuous change. Adapted from Weick and Quinn (1999) ............................................... 75
Tables
Table 1: Delphi panels knowledge domains paired with research objectives ..............................................................40
© Copyright 2011 Sandra Greve.
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1 3BIntroduction
This Management Challenge (MC) arises from the one-man consultancy business
SenseMaker ApS owned by Sandra Greve (SG). SG is the author of this MC and
SenseMaker is the sponsor of both the Executive MBA program and this MC.
1.1 12BBackground and context
SG has been an independent process consultant since 2006 within the fields of
leadership, communications, cooperation and facilitation of strategic change
processes. SG works full time at SenseMaker and in addition runs a health school with
her spouse who is a medical doctor, helping companies implement a healthier lifestyle
in their work culture. SenseMaker customers are primarily medium-sized and big
companies within both the private and public sector in Denmark.
Daily, SG sees SenseMaker customers struggle to develop and implement new
strategies. Often something new and unexpected happens during the implementation
period or the planned process does not work in practice.
SG personal objective, related to this MC, is to increase competencies in order to work
more strategically with sensemaking, strategy and change and move from a broad to a
deep knowledge. In the long run, the objective is to create differentiation within the
consultancy business within the field of sensemaking.
It is generally known and accepted within the consultancy business that 70-90 % of all
change initiatives fail to achieve their objectives – this general knowledge is supported
by several researchers (Strebel, 1996:140; Senge et al., 1999, Quirke, 2000:124) – and
that some organizations and industries seem to be significantly better at coping with
turbulence than others. Professional employees are now fundamental in order for the
companies to increase value, primarily by creating and exchanging knowledge as
hierarchies are replaced with horizontal communication, making managers facilitators
and not experts (Balugun, 2004).
© Copyright 2011 Sandra Greve.
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The later years of facing several crises and changes in tempo, form and scale never
seen before seems to have affected corporate life. Even a small country as Denmark
has faced terror threats, avoided terrorists’ attacks and experienced the Roskilde
Festival disaster.
In addition, the economic crisis has affected corporate life. The recession reached an
alarming level in 2008. The fear of a double-dip as well as a fear of a non-uniform
recovery leads to cost cutting and rethinking strategy.
The environment is changing quickly. Depending on the industry it might be level 3,
with a range of possible future outcomes, or level 4, where anything is possible
(Courtney, 2008).
Figure 1: Four levels of uncertainty. Source: Courtney (2008)
The tempo of crises and changes among other macro-economic factors within a global
economy and innovation context are powerful drivers for strategic business change.
Most business transformation models tend to focus on macro-level transformation
elements like systems, structures and processes, which are especially beneficial at
Level 1 and 2, rather than micro-level levers, which become increasingly important at
Level 3 and 4.
© Copyright 2011 Sandra Greve.
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1.2 Statement of the issue to be investigated
In order to identify, define and scope the management problem that requires
investigation within the business industry, the intersection between the areas of
interest and concerns are listed in the figure below. The sweet spot represents the
focus of this MC.
Figure 2: Areas of interest forming the research focus. Adapted from Henley Study Guide (2008)
Especially the practical interest in how to succeed with organizational strategic change
in a turbulent context combined with the strong theoretical interest in sensemaking
colours the scope of this MC.
When strategic change is complicated or fails, there can be a number of reasons and
many contributors. Sensemaking can be one of many, especially if sensemaking is not
well understood and/or if there is a lack of proper use of sensemaking.
The topic of sensemaking in the greater strategy and change context is especially
interesting in view of shortened planning horizons and increasing complexity of
© Copyright 2011 Sandra Greve.
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business environments, as sensemaking happens faster and more frequently when the
level of uncertainty increases.
Sensemaking is a cognitive mechanism within the human mind that comes into effect
when something unexpected happens. The human mind needs to find meaning in
order to want to carry on with the interrupted activity.
Sensemaking is described as:
“ the process of social construction that occurs when discrepant cues interrupt
individuals´ ongoing activity, and involves the retrospective development of plausible
meanings that rationalize what people are doing” (Weick, 1995).
The work of Karl E. Weick represents only one of several avenues that lead to what is
21st century sensemaking, an avenue with a particular texture, tone and focus. The
latest avenues of sensemaking are e.g. critical sensemaking (Mills, 2010:257-260) and
visual sensemaking and social sensemaking by New York consultancy HumantificF
1F.
The focus of this MC will be on the work of Weick because of the following points:
Weick is focused on the altitude of organizations with great knowledge as a
widely recognized American organizational psychologist and academic.
Weick´s insight is expected to help organisations and managers to deal with
uncertainty in how to approach and deal with strategic change.
Weick´s sensemaking model provides the most comprehensive description of
the sensemaking process on both the individual and the organizational levels.
Weicks latest work in 2007 with co-author Kathleen Sutcliffe on high reliability
organizations (HROs) build on the sensemaking approach and contribute with
an understanding of why some organizations perform better than others under
turbulent conditions.
1 http://www.humantific.com/
© Copyright 2011 Sandra Greve.
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Weick is primarily focused on his own scholarly academic audience, which might make
the work of Weick difficult to understand and work with for practitioners. Although
Weick in his later writings sought to make sensemaking more action oriented, he still
described it as: “turning circumstances into a situation that is comprehended explicitly
in words” (Weick, 2005).
New York consultancy Humantific visualize SenseMaking as making the strange familiar
and as being the opposite of StrangeMaking, making the familiar strange.
Figure 3: SenseMaking and StrangeMaking. Source: Humantific webpage www.humantific.com
However, sensemaking is more than making the strange familiar and it is not about
simplification but about clarification. Among scholars, sensemaking is positioned
between two philosophical assumptions, namely the positivistic and the social
constructionist view (Tovstiga, 2010:48). The two circles represent these two
philosophical assumptions, as the white circle seeks to normalize [positivism], while
the black circle seeks to anomalize [social constructivism].
Humantific state that “SenseMaking has become the 21st century fuel for
ChangeMaking!” and visualize the process through which SenseMaking leads to new
insights, which again leads to ChangeMaking and new value.
© Copyright 2011 Sandra Greve.
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The purpose of this MC can be explained by this piece of visual sensemaking:
Figure 4: SenseMaking and ChangeMaking. Source: Humantific webpage www.humantific.com
The purpose is to generate new insights around the notion of sensemaking that might
then find use in organisations engaging in strategic change and lead to better
ChangeMaking, new value and success with organizational strategic change.
The investigation intends to answer four research questions (RQ):
RQ1: What is the role of sensemaking in organizational strategic change?
RQ2: What is the current state of sensemaking in organizational strategic change?
RQ3: What factors might enhance the effectiveness of sensemaking in organizational
strategic change?
RQ4: What are the limitations to sensemaking in the organisational strategic change?
© Copyright 2011 Sandra Greve.
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1.3 Importance and relevance of the issue to be investigated
This MC intends to explain why sensemaking is important, to clarify the current status
of sensemaking and to make suitable recommendations for enhancing its application,
within its limitations, in order to gain better strategic results in organizations.
Creating better results is especially important to change agents actively engaging in
strategic change. The target audience of this MC is therefore the CEO and manager
engaging in strategic change, but also the consultant working within the field of
strategy and change. Depending on the nature of the business and the qualifications
and experience of the CEO or manager engaging in strategic change, this MC is
expected to increase the ability to be capable of driving the change themselves, rather
than relying on external consultants to implement the strategic change. The consultant
is expected to increase the insight of the importance of micro-level levers in strategic
change and to be able to more deliberately choose between a macro or micro
approach, depending on the nature of the strategic change and the specific company
and business context.
The relevance of insights into sensemaking in strategic change is underpinned by the
preliminary top 10 global business opportunities until 2013, published by Ernest &
Young (2010):
1. Emerging market demand growth
2. Innovating in products, services and operations
3. Improving execution of strategy across business functions
4. Investing in IT
5. Investing in clean tech
6. Investing in process and training to achieve greater productivity
7. Merger and acquisition
8. New marketing channels
9. Private public partnership
10. Excellence in investor relations
© Copyright 2011 Sandra Greve.
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To “improve execution of strategy across business functions” has been named the
trend until 2013 and its significance is labelled “much more” compared to 2010. It is
therefore represented by a red triangle.
The first two opportunities – “emerging market demand growth” and “innovating in
products, services and operations” – indicate that the engine in global growth and
business growth in many sectors are emergent markets. Those who can innovate both
within products, services and operations and “improve execution of strategy across
business functions” will be the winners. In addition, “investing in process and training
to achieve greater productivity” is another important opportunity related to the
purpose of this MC. As customer reaching and operational agility become new
important competitive parameters, sensemaking insights are especially important in
order to drive and redirect organizational strategic change in new and better ways.
Sensemaking theory and micro-level levers can seem as very complex and theoretical
mind-sets, and to many practitioners this is a quite new knowledge domain. The
findings of this MC should lead to new insights for the CEO, manager and consultant on
how to avoid contributing to the statistics of the 70-90 % of all change initiations which
fail to meet their objectives.
© Copyright 2011 Sandra Greve.
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1.4 Structure and key content
The structure and key content of the MC is shown in the figure below:
Figure 5: Structure and key content of this Management Challenge.
Chapter 2: Review of current thinking within sensemaking and HROs. The findings in
this chapter will influence Chapter 3: Objectives of the research and
Chapter 4: Research design and Chapter 5: Findings and analysis.
Chapter 3: Objectives of the investigation identifies the research objectives that the
research intends to answer and lists key definitions.
Chapter 4: Research design explains the research strategy, research design, research
method and technique. In addition, it assesses research validity, reliability
and generalizability.
Chapter 5: Research findings and analysis presents the results of the investigation
and shows key steps in the analysis, making both the logical arguments
and the evidential base clear.
Chapter 6: Conclusions and recommendations provide conclusions to the research
questions followed by recommendations and their possible implications.
Chapter 7: Reflections represents the author’s reflections and evaluation of the
process outcome, including the personal learning this MC has generated.
© Copyright 2011 Sandra Greve.
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2 4BReview of current thinking
Karl E. Weick is especially known for his contributions within the terms enactment,
organizing, loose couplings, sensemaking, and mindfulness. He is considered to be a
pioneer within sensemaking in an organizational context.
Despite the cognitive focus on sensemaking mechanisms, Weick has a dominant
system thinking approach and a social constructionist view. Weick’s contributions build
on each other and have been tied together from various strands of social and
psychological theories, including Harold Garfinkel’s work on juries, Chris Argyris and
Donald Schons’s double loop learning as well as elements of Peter Berger and Thomas
Luckmann’s social constructionism (Mills, 2010:852).
Early attempts at using sensemaking include analysis of organizational disasters and
the processes that set them in motion (Mills, 2010:852) – e.g. the Bhopal accident in
1984 (Weick, 1988), the Tenerife air crash in 1977 (Weick, 1990) and the Mann Gulch
fire in 1949 (Weick, 1993). Especially the Tenerife and Mann Gulch analyses
contributed to the development of the sensemaking model (Mills, 2010:852) in 1995,
explained in Section 2.1.
Weick’s sensemaking model was transferred to organizational change contexts and
gradually became more action-oriented for practitioners. Especially the analysis of the
Cerro Grande fire in 2000 led to the articulation of the five principles for HROs. The
analysis of Bristol Royal Infirmary in the period from 1988 to 1994 (Weick and Sutcliffe,
2007) led to the description of the culture of the HROs and how to handle change
strategy and manage organizations more mindfully.
© Copyright 2011 Sandra Greve.
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2.1 17BSensemakings main mechanisms
Sensemaking is a two-way process in which people generate what they interpret:
“Sensemaking is about authoring as well as reading” (Weick, 1995:7). SenseMaking is
the process of organizing, which is:
1. grounded in identity construction.
Peoples’ identity and the factors that have shaped their lives influence how they
interpret an event: “The individual creates his own identity by constantly projecting the
identity of the surroundings and then observe the reactions it generates” (ibid:23).
2. retrospective.
In order to give meaning to the present, people compare it to similar or familiar events
from their past and rely on the past event to make sense: “How can I know what I think
until I see what I say?” (ibid:12).
3. enactive of sensible environments.
People are co-creators of their reality, which determines their actions: ”(…) people
created their own environments and these environments then constrained their
actions” (ibid:31).
4. social.
People are always positioned in relation to someone, either physically or mentally, as
we project our thoughts and think about how others would react. ”One has to fit one´s
own line of activity in some manner to the actions of others” (ibid:40).
5. on-going.
Sensemaking is an on-going process spread across time: “Our talking is spread across
time, competes for attention with other ongoing projects, and is reflected on after it is
finished, which means that our interests may already have changed” (ibid:62).
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6. focused on and by extracted cues.
People extract cues and interpret them. ”Extracted cues are simple, familiar structures
that are seeds from which people develop a larger sense of what may be occurring”
(ibid: 50).
7. driven by plausibility rather than accuracy.
Once people have found a plausible meaning, they will stop searching for alternatives:
“I need to know enough about what I think to get on with my projects, but no more,
which means sufficiency and plausibility take precedence over accuracy” (ibid:62).
The seven properties are interrelated and some can be more dominant than others,
depending on the event. Each of these properties, taken on its own, has the ability to
partially explain action, but their strength lies in their holistic ability to dissect
sensemaking events.
Mills (2010:854) suggests that identity construction is pivotal to sensemaking process
and that identity construction influences how the six other properties are understood.
Weick acknowledges this importance and suggests that plausibility (Weick, 2005:415)
is another fundamental property in the sensemaking process, illustrated below:
Figure 6: Sensemaking’s seven properties. Adapted from Weick (1995, 2005) and Mills (2010)
© Copyright 2011 Sandra Greve.
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Labelling is fundamental to sensemaking. In order to make sense, people organize
what they enact and put labels on the experience to identify it and to determine how
to handle the experience. Three other related and fundamental concepts for
sensemaking are commitment, capacity and expectations (Weick, 1988).
Commitment
Weick (1988) draws on Shrivastava’s (1987) analysis of the Bhopal accident when he
notes that: “when people make a public commitment that an operating gauge is
inoperative, the last thing they will consider during a crisis is that the gauge is
operating. Had they not made the commitment, the blind spot would not be so
persistent” (Weick, 1988:310).
Capacity
Weick explores the importance of capacity for crisis perception: “people see those
events they feel they have the capacity to do something about” (ibid:311). Capacity
often decreases during a crisis. “…a reduction in the level of competence directed at the
problem as well as an overall reduction in the use of action to develop meaning”
(ibid:12).
Expectations
Expectations are closely linked to cognitive maps: “a plant perceived as unimportant
proceeds to act out, through turnover, sloppy procedures, inattention to details, and
lower standards, the prophecy implied in top management´s expectations” (Weick,
1988:313). That is, expectations can lead to the enactment of a self-fulfilling prophecy,
both in a positive and negative way, as expectations lead to extracting further cues to
reinforce and strengthen the expectation. Related to the self-fulfilling prophecy is the
mechanism found when authoritarian control from the top persists as lower-level
managers try harder to determine a right decision. In doing so, the mandate is
reaffirmed more forcefully, which worsens performance even more and creates a
vicious cycle (Weick and Quinn, 1999:370).
© Copyright 2011 Sandra Greve.
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Commitment, capacity and expectations, like sensemaking properties, are interrelated.
Insights into these mechanisms are valuable in strategic change in order to be able to
stimulate and increase commitment and capacity, and redirect or match expectations
to trigger action. Sensemaking blockages are also very relevant in order to know what
to avoid in strategic change. Some are closely linked to commitment, capacity or
expectations, and they can influence and even trigger one another. When sensemaking
is weak, the grey circles of blockages have fertile ground to grow:
Figure 7: Sensemaking blockages. Adapted from Weick (1988, 1995) and Maitlis and Sonenshein (2010)
Weick (1988) notes how commitment to an action and the tenacious justifications that
follow can create blind spots, in particular when these commitments are active,
voluntary and public. Maitlis and Sonenshein (2010:555) mention the blind spot
paradox: recent studies of crises suggest that public commitment in the form of
optimistic evaluation of a situation is especially likely to generate sensemaking blind
spots. However, research in psychology e.g. by Taylor and Brown, (1988) and Taylor
(1989) cited by cited by Maitlis and Sonenshein (2010) shows that positive illusions of
control over the environment and what the future holds can be highly adaptive.
© Copyright 2011 Sandra Greve.
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Pre-summit assertions
Maitlis and Sonenshein (2010) draw on Kayes (2004:1277) and note how pre-summit
assertions made by mountain climbers, such as “as long as the weather holds, we will
have success” and “We have got the Big E *Everest+ all figured out” prevent them from
sensing what is really a poorly defined problem with no clear goal or solution. This
ultimately led to the deaths of eight climbers (Maitlis and Sonenshein, 2010:555).
Pre-summit assertions and blind spots are closely connected. The difference is that
there can be several pre-summit assertions within the same blind spot.
Attentional coherence
Maitlis and Sonenshein (2010:556) draw on the Roskilde Festival disaster study by
Vendelo and Rerup (2009), a 20-minute disaster at a Danish music festival in 2000 that
saw nine young people suffocating to death at a Pearl Jam concert. Security guards
failed to make sense of the swiftly rising threat, partly because they did not have
“attentional coherence” because the event was labelled as a “low risk context where
swiftly incubating threats can occur” (Vendelo and Rerup, 2009).
The fallacy of centrality
Weick uses the Battered Child Syndrome when explaining the phenomenon in which
people think to themselves: “Because I don’t know about this event, it must not be
going on” (Weick, 1995:1). He explains how it could take 23 years from the
phenomenon was first discovered until it came into focus; it did not come into focus
until a label finally was put on the phenomenon and it was made public in the right and
important forum. The fallacy happens when someone in a central position assumes
that if something serious was happening, he or she would know about it. Since they
know nothing of it, it cannot be happening (Weick and Sutcliffe, 2007:158).
© Copyright 2011 Sandra Greve.
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Interpretive indeterminacy
Maitlis and Sonenshein (2010) use the Columbia Shuttle disaster in 2003 studied by
Dunbar and Garud (2009) to show how careless use of categories can lead to serious
disaster (Weick and Sutcliffe, 2007:33). The research of Maitlis and Sonenshein (2010)
focuses on how knowledge is distributed. The authors note that in crises similar to the
Columbia Shuttle disaster, people make sense by using a variety of knowledge sources
that are distributed within different action nets. The result is “interpretive
indeterminacy”, as individuals draw on different knowledge bases to develop different
understandings about what is happening and what should be done to prevent crises
(ibid:557).
Pluralistic ignorance
Weick draws on Miller and McFarland (1987) when explaining why people at times
think: “I am puzzled by what is going on, but I assume that no one else is” (Weick,
1990:588). Pluralistic ignorance is the belief that others, often higher positioned
individuals, have made plausible sense of a situation. This mechanism prevents
individuals from taking action or even merely signalling their confusion to others,
which could prevent a crisis (Maitlis and Sonenshein, 2010:556).
Insights into sensemaking blockages are important because an increase in capacity
leads to a decrease in the next level of ring seen in Figure 7, page 21, which enhances
the effectiveness of sensemaking. When expectations change towards accepting
ambiguity and paradoxes, it will lead to more nuanced schemes: “Actions clarifies what
the problem may be, specific action renders many cues and options irrelevant, and
action consolidates an otherwise unorganized set of environmental elements” (Weick,
1988:315). That is, while a crisis consists of much complexity, individuals can take
action to reduce this complexity. As a result, enacted sensemaking can provide the
basis of crisis prevention and management ideology by arguing for human involvement
in systems that are rooted in shared beliefs about self-control and voluntary
cooperation (Maitlis and Sonenshein, 2010:554). This allows people to “think about
crisis in ways that highlight their own actions and decisions as determinants of the
conditions they want to prevent” (Weick, 1988:316).
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2.2 18BSensemaking in an organizational change context
Weick (1995:70) sees organisations as open systems with a transparency in relation to
their surroundings and with loose couplings between the elements contained in the
system, i.e. organization.
Sensemaking mechanisms can be transferred from the context of crisis to the context
of change as there are several important parallels. Both contexts are often situations
characterized by ambiguity, confusion and feelings of disorientation (Maitlis and
Sonenshein, 2010:552). Although a crisis often occurs quickly while change unfolds
slower, a crisis can be enacted very slowly and change can occur quickly in highly
pressurized conditions (ibid:552).
To understand sensemaking is to understand how people cope with interruptions: “An
organization that expects change may find itself puzzled when something does not.”
(Weick, 1995:5) and “Sense may be in the eye of the beholder, but beholders vote and
the majority rules” (ibid:6). By studying the cockpit recordings of the Tenerife air crash,
Weick shows how small, separate failures can contribute to major disasters. He
suggests that when interruptions of important routines lead to system breakdowns,
people revert to familiar scripts and habitual responses (Mills, 2010::852). Weick notes
that: “If sensemaking in crisis is difficult, we can see that collective sensemaking in
crisis is near impossible” (Weick et al. 1999:88).
Weick and Quinn (1999) distinguish between episodic and continuous change. Episodic
change is infrequent, discontinuous and intentional, an occasional interruption and a
divergence from equilibrium. The perspective is macro, distant, global and the result of
a growing misalignment and inertial deep structure and perceived environmental
demands (ibid: 365). Episodic change tends to be dramatic and: “...organizational
change would not be necessary if people had done their jobs right in the first place”
(Dunphy 1996, cited by Weick and Quinn 1999:362). It is usually triggered by a failure
to create continuously adaptive organisations (ibid).
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Continuous change is constant, evolving and cumulative. The change is a pattern of
endless modifications in work processes and social practice and the perspective is
micro, close and local (Weick and Quinn, 1999). The idea that small, continuous
adjustments created simultaneously across units can cumulate and create substantial
change presumes tightly coupled interdependencies. When interdependencies loosen,
the same continuous adjustments are in play, however now confined to smaller units.
They remain important as pockets of innovation that may prove appropriate in future
environments (ibid:375).
Weick and Quinn (1999) denounce the episodic approach to change. They conclude
that although an organization at a distance appears to be stable, there is constant
change at the micro-level. These changes can potentially alter the structure and
strategy of the organization (ibid:362): “The challenge is to gain acceptance of
continuous change throughout the organization so that these isolated innovations will
travel and be seen as relevant to a wider range of purposes at hand” (ibid:381). Weick
and Quinn (1999) argue that the ideal organizations for both episodic and continuous
change are capable of continuous change. This requires organizations that are
emergent and self-organizing, as well as it requires that the role of the change agent to
be that of a “Sense maker who redirects change” rather than a “Prime mover who
creates change” (ibid:366).
A recent analysis of organizational change suggests a growing concern with the tempo
of change (Weick and Quinn, 1999:361), creating inertia for those organizations not
capable of changing as rapidly as the environment. Although inertia creates the
tension that precedes episodic change, the actual triggers of change can come from at
least five sources according to Huber et al. (1993): environment, performance,
characteristics of top management, structure and strategy. In the face of inertia it
makes sense to view a change intervention according to Lewin (1951) as a three step
process of “unfreeze, transition, refreeze”.
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Weick and Quinn (1999) turn Lewin’s (1951) change model “unfreeze, change,
refreeze” upside-down by arguing that when change is continuous, the challenge is not
unfreezing the organization but redirecting what is already under way. In the face of
continuous change, a more plausible change sequence is “freeze, rebalance, unfreeze”
(Weick and Quinn, 1999:379). In Goia and Chittipeddi (1991), the terminology is
envisioning, signalling, re-visioning, and energizing.
Figure 8: Sequences for continuous change. Adapted from Weick & Quinn (1999)
To freeze continuous change is to make a sequence visible and show patterns by
capturing sequences by means of cognitive maps. To rebalance is to reinterpret,
relabel and resequence the patterns to unfold with fewer blockages. In addition, issues
must be reframed as opportunities, thereby reinterpreting history using logic of
attraction, as people change to a new position because they are attracted to it, drawn
to it, inspired by it (Weick and Quinn, 1999:380). Logic of attraction is to lead change
by showing an ideal to mimic (Kotter, 1996); that is, leaders must first make deep
changes within themselves, including self-empowerment (Spreitzer and Quinn, 1996),
before they can let new behaviours infect the organization (Weick and Quinn,
1999:380). To unfreeze is to resume improvisation, translation and learning in new
ways that are more mindful of sequences, more resilient to anomalies and more
flexible in execution (ibid:380).
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Weick and Quinn (1999) acknowledge that it is very difficult to unfreeze patterns and
that attempts at unfreezing start earlier than was previously thought. Beer et al.
(1990:50) suggest that change is not a linear movement through the four stages found
by Prochaska et al. (1992) in a study of smoke cessation and weight loss, but rather a
spiral pattern of contemplation, action and relapse. Prochaska et al. (1992) found that
people could relapse into previous habits three to four times before they maintain the
new sequence (Weick and Quinn, 1999:373). This means that interventions may have
value even when no action is observed, and that relapse should be less common in
continuous change than in episodic change (ibid:373).
Weick (2001) developed seven practical questions for comprehending the
organizations abilities within sensemaking:
Figure 9: Seven practical questions to the organizations. Adapted from Weick (2001)
These seven questions are important because if fulfilled, they form the basis for an
environment capable of enhancing sensemaking and reduce blockages.
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2.3 19BHigh reliability organizations
Weick and Quinn (1999:371) draw on Brown and Eisenhardt’s (1997) study in the
computer industry, which concludes that successful organizations do not rely on
neither a mechanistic nor an organic process and structure. Instead, they have well-
defined managerial responsibilities, clear project priorities while also allowing the
design processes to be highly flexible, improvisational and continuously changing.
According to Weick & Quinn (1999:375), “the image of organizations built around
improvisation is one in which variable inputs to self-organizing groups of actors induce
continuing modification of work practices and ways of relating”. The more
improvisational an act, the narrower the time gap between composing and
performing, designing and producing, or planning and implementation (Moorman &
Miner, 1998a). Moorman & Miner (1998b) empirically found that improvisation often
replaced the use of standard procedures in new product development and, in the
presence of developed organizational memory, had positive effects on design
effectiveness and cost savings.
The tempo of change calls for new organizational routines. Weick and Sutcliffe (2007)
explain why some organizations are better than others at maintaining function and
structure in the face of unanticipated change. These organizations are named high
reliability organizations (HROs). Weick and Sutcliffe (2007) point out HROs such as
emergency rooms in hospitals, flight operations of aircraft carriers and fire fighting
units as models to follow. These organizations have developed ways of acting and
styles of learning that enable them to manage the unexpected better than other
organizations.
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HROs are defined by the following principles:
Figure 10: Principles of high reliability organizations. Adapted from Weick and Sutcliffe (2007)
1. Tracks small failures
HROs are preoccupied with failure and make a continuing effort to articulate mistakes
they do not want to make and assess the likelihood that strategies increase the risk of
triggering these mistakes (ibid:9).
2. Resists oversimplification
HROs welcome diverse experience and scepticism toward received wisdom. HROs
simplify in order to stay focused on a handful of key issues and key indicators, but
know that these are not the only truths. They recognize an event seen and understood
before as a source of concern rather than a source of comfort (ibid:10).
3. Is sensitive to operations
HROs are less strategic and more situational than most other organizations, which
make HROs capable of making continuous adjustments and preventing errors from
accumulating and enlarging. HROs have rules and procedures but only until something
else seem wiser (ibid:12).
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4. Maintains capabilities for resilience
No system is perfect and HROs know that, which presupposes deep knowledge of the
system, one’s co-workers and oneself. When the system stretches from its equilibrium,
it quickly finds its core and avoids bursting (ibid:14).
5. Takes advantage of shifting locations of expertise
HROs cultivate diversity, which helps to notice more details in complex environments.
It also enables them to act on the complexities they spot. HROs push the decision-
making to the front line, which makes authority migrate to the people with the most
expertise, regardless of rank (ibid:15).
It is characteristic for HROs that their members are instilled with a “preoccupation with
failure” and that they encourage the use of “vigilant wariness” at all times. People who
refuse to speak up undermine the system. Those practices produce reliable, mindful
and flexible processes because they convert concerns about failure, simplicity,
operations, resilience and expertise into routines that reduce blockages.
HROs struggle to maintain continuing alertness to the unexpected in the face of
pressure to take cognitive shortcuts which stem from prior successes, simplifications,
strategies, plans and the use of hierarchy to pass responsibility upwards (ibid:19). A
small wins strategy will produce change without confronting the system directly or
aggressively (ibid:139). Instead, the steps are opportunistic steps that move in the
same direction. They are not necessarily logical, sequential steps that lead to a clear
goal, because that is not the reality faced by the HROs. Small wins are controllable in
the sense that they depend mostly on the individuals own actions (ibid:140).
HROs become more vulnerable to error when their attention is distracted, unstable
and dominated by abstractions (Weick and Sutcliffe, 2007:32).
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2.4 Sensemaking in an organizational strategic context
Organizational change has received significant study over the years. The distinctive
character of strategic change, however, remains significantly under-studied (Dutton
and Duncan,1987) until Tovstiga (2005, 2010) contributed with a practitioner-focused
approach to the role of sensemaking in organizational strategic change while providing
two frameworks for its use (Figure 11 and Figure 12).
Sensemaking takes on a particular critical role in strategy as “Most ideas can be proven
to fit most problems, assuming good will, creativity, and a tendency to consensus. Thus,
the act of translation creates the match” (Weick and Quinn, 1999:376). Sensemaking is
the process that creates the match and insights are the outcome of this process
(Tovstiga, 2010:47). The role of strategy is to trigger a certain behaviour “…in the sense
that each competitor makes strategic choices on the basis of its beliefs…” (ibid:81).
From the spatial perspective, Tovstiga (2010) examines a framework for sensemaking
that relates analysis, intuition and interpretation to the derivation of insight. Tovstiga
(2010:51) argues that managers can and should play a central role in manipulating
outcomes through informed action. In order to do so, professional sensemakers must
be able to understand the inner workings of the organization. Sensemaking is a key
element in that process.
Tovstiga (2010) suggests that to handle the sensemaking space as a manager, one
must achieve certain insights in order to paint a certain bigger picture and trigger a
certain behaviour. The process that gives insights and triggers action is the
sensemaking space, characterized by a complex combination of analysis, intuition,
interpretation, meaning, filters and socio-political and cultural context.
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Figure 11: Sensemaking and the formation of insight. Adapted from Tovstiga (2010)
The framework above is important in order to understand the sensemaking space and
the mechanisms that influence changes in insights and paint a new bigger picture,
which leads to new action. Changes in filters and the socio-political or cultural context
will provide a powerful frame for the extraction of new cues and lead to new insights
that support the strategy.
From the process perspective, Tovstiga et al (2005) and Tovstiga (2010) examines how
sensemaking occurs in complex organization contexts and how it relates to learning,
interpretation and the ascription of meaning in complex contexts. These findings are
presented in the Tovstiga et al (2005) framework on the next page.
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Figure 12: Sensemaking mechanisms in an organizational context. Adapted from Tovstiga et al. (2005)
Intuiting is the capability of an expert to recognize a pattern in a problem that a novice
may not. Interpreting is sharing and explaining insights on the basis of knowledge and
expertise. Integrating is developing shared understanding and making coordinated
action through mutual adjustment, and institutionalizing is accepting knowledge and
insights to be embedded in the organization. The institutionalized is different bodies of
explicit knowledge, which should support the strategy as it contributes significantly to
the identity of the organization (Tovstiga, 2010:65).
The original framework of Tovstiga et al. (2005) is added enactment mechanisms and
the orange symbol to symbolize the seven sensemaking properties colouring each
process. Commitment becomes stronger when made voluntary, public and irreversible.
The collective capacity forms what gets institutionalized, which provides a frame for
expectations and future intuiting. The above framework is important because it can be
used to understand how to enhance sensemaking in an organizational context to
support the organizations strategy and to be aware of what gets institutionalized. 5B
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3 Objectives of the research
The purpose of this MC is to generate new insights around the notion of sensemaking
that might then find use in organizations engaging in strategic change.
The approach to the investigation is basic research (Hair et al., 2007) as the
investigated issue is considered to be relevant to the wider business context.
The focus of the research is on knowledge intensive industries with an overweight of
highly skilled professionals who are able to self-manage and with main location or
headquarter in Denmark.
The context is a fast changing environment as described in Chapter 1: The Introduction
with a level 3 or 4 of uncertainty (Courtney, 2008).
3.1 21BResearch questions
The research process will address four research questions:
RQ1: What is the role of sensemaking in organizational strategic change?
RQ2: What is the current state of sensemaking in organizational strategic change?
RQ3: What factors might enhance the effectiveness of sensemaking in
organizational strategic change?
RQ4: What are the limitations to sensemaking in the organisational strategic
change?
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3.2 22BResearch objectives
According to Blaikie (2000:72–83), the basic research intends to produce knowledge by
exploring, describing and/or explaining. The research questions (RQ) from section 3.1
are broken down into Research Objectives (RO):
RQ1: What is the role of sensemaking in organizational strategic change?
RO1: To describe the role of sensemaking in organizational strategic change seen from
the perspective of the traditional practice field*.
RQ2: What is the current state of sensemaking in organizational strategic change?
RO2: To explore the current state of sensemaking in organizational strategic change
seen from the perspective of the traditional practice field.
RQ3: What factors might enhance sensemaking in organizational strategic change?
RO3: To explore factors from the traditional practice field that might enhance
sensemaking in organizational strategic change.
RO4: To explore factors from high reliability organizations** that might enhance
sensemaking in organizational strategic change.
RQ4: What are the limitations to sensemaking in organizational strategic change?
RO5: To describe sensemaking limitations in organizational strategic change seen from
the meta-perspective of consultants and academics
(*) the traditional practice field and (**) high reliability organizations are defined in
next section: 3.3: Key definitions.
An argumentation for the choice of this focus and these particular groupings is
provided in Chapter 4: Research Design.
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3.3 23BKey definitions
The traditional practice field
The traditional practice field is defined as main stakeholders typically engaging in
organizational strategic change, both with and without managerial responsibility,
within the organization, as well as external consultants hired to support the process.
High reliability organizations (HROs)
HROs are practices that produce reliable, mindful flexible functioning because they
convert concerns about failure, simplicity, operations, resilience and expertise into
routines that reduce misspecification, misestimating, and misunderstanding (Weick
and Sutcliffe, 2007:19). This MC will focus on HROs within the medical context.
Organizational strategic change
Strategic change involves an attempt to change current modes of cognition and action
to enable the organization to take advantage of important opportunities or to cope
with consequential environmental threats (Gioia and Chittipeddi,1991:443). This MC
will focus on strategic change within an organizational business context.
Mindfulness
Mindfulness concerns the quality of attention. While less mindful practice seeks to
normalize, mindful practice seeks to anomalize, i.e. to captures unique features that
slow down the speed with which details are normalized (Weick and Sutcliffe, 2007:34).
Professional sensemaker/sensemaking
The attempt to influence the way another party understands or makes sense
downwards in the organizational hierarchy triangle is by some scholars’ labelled
sensegiving (Gioia and Chittipeddi, 1991:443). Sensegiving is caused by a sensegiver. In
this MC, intentional organizational change will be labelled professional sensemaking
initiated by a professional sensemaker. There will be no distinction between vertical
and horizontal sensemaking within the organization in order to indicate a mechanism
rather than a causal relationship between a sensemaker and a sensegiver.
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4 Research design
This chapter explains the research strategy, data collection, sample details, analysis
technique and assesses the validity, reliability and generalizability of the investigation.
This investigation has been made according to the ethical code for the Henley Business
School, as it is described in the Management Challenge Study Guide (2008). None of
the participants fulfil the demands for a preceding approval. All participants have been
made aware of the ethical code related to this MC.
The philosophical assumption of this MC will be dominated by a social constructionist
view. The nature of the research is basic research and cross-sectional. The analysis is
by nature inductive. However, there are deductive elements in relation to the
predefined choice of sensemaking theory and there are strong abduction elements in
relation to the intuitive feeling described in the introduction – that there is an
anomaly, that something does not fit (Mills, 2010:1).
The research design is flexible and will emerge over time in a qualitative and
exploratory study concerned with in-depth understanding. Data collection and analysis
will be iterative with the author as an interpreter. The interviews are unstructured
research in order to ensure nondirective and informal focus at the interview sessions.
The level of analysis is organizational, focusing on patterns and tendencies within the
traditional practice field and HROs, respectively. The higher level context is the
industry and business context. The lower level components represent departments,
teams and individuals. However, individual elements will be used with focus on the
psychological and interpersonal micro-levels. Insights derived from the micro-level will
be used to produce knowledge on patterns and tendencies in organizations.
The data analysis technique used is the Delphi method explained in the next section.
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4.1 24BDelphi method
The Delphi method is ideal for structuring a group communication process by allowing
a group of individuals, as a whole, to deal with a complex problem (Okoli & Pawlowski,
2004). The Delphi method is normally carried out by a virtual panel of experts or
practitioners, aiming to achieve an answer to a difficult question. The panel members
are normally anonymous to each other throughout the process, but not to the
researcher.
The Delphi method does not depend on statistical power, but rather on group
dynamics in order to attain a consensus among experts. The recommends sizes of
panels are 10-18 persons per panel (ibid:16-19).
In this case, the Delphi method is modified to fit the purpose and philosophical
assumptions of the investigation, namely that creating high involvement, dialogue and
inspiration among panel members will allow for small innovations to happen. This has
the best chance of happening in collective physical dialogue meetings between the
researcher and the panel, where dialogue can flow freely and understanding can be
ensured through discussion.
Identifying experts
Most current thinking about sensemaking in strategic change focuses either on CEOs
(Gioia and Chittipeddi, 1991) or middle managers (Balugun and Johnson, 2005:1).
However, the tempo of change calls for the manager in the role of a facilitator to
increase employee responsibility and decision-making. Therefore, this investigation
intends not only to focus on the CEO and manager, but to provide an all-round
investigation of patterns and tendencies in and between: CEOs, managers, employees
and consultants. These groupings all have important roles in order to enhance
sensemaking to make better strategic decisions.
© Copyright 2011 Sandra Greve.
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The consultants are divided into two groups: a practical and not highly academic
group, i.e. a macro-level focus, and an academic group within the organizational
psychological field, i.e. a micro-level focus.
A panel of HROs within the medical context is chosen in order to contribute with new
insights to the traditional subject field in relation to contribute with more mindful
practices in the view of shortening planning horizons and increasing turbulence.
Figure 13: Knowledge domains important to this investigation
There are three main reasons as to why something used in a medical context is
expected to have any relevance to a business management context:
First of all, it is expected to generate new insights around the notion of sensemaking
that might then find use in the traditional practice field.
Secondly, the work of Weick and Sutcliffe (2007) suggests HROs, such as emergency
rooms, as organizational models to follow. Although it is within another context, these
environments are considered organizations as well and human mechanisms are
therefore expected to be transferrable to other turbulent contexts.
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Thirdly, HROs are expected to contribute to the investigation with knowledge about
decision-making in view of the shortening planning horizons that becomes increasingly
important in continuous change, as Weick and Quinn (1999) advocate.
Sample details and description of the five Delphi Panels is provided in the chart below:
Focus group number/name
Description of participants Why they are important Focus on answering research objectives
1. Employees (Employees)
Former students of the researcher employed in different positions with no management responsibility
Understanding from the employee perspective from different industries
RO1 RO2 RO3
2. CEOs/ managers (CEOs)
Customers and potential customers at CEO level and managers with more than 50 employees
Understanding from the change agent perspective from different industries
RO1 RO2 RO3
3. Consultants with macro level focus (Consultants)
Professional business consultants with in LEAN, strategy and change.
Understanding from the professional perspective with knowledge from different industries and contexts
RO1 RO2 RO3 RO5
4. Consultants with micro level focus (Academics)
Teachers and consultants with a unique knowledge within micro processes such as cognitive psychology, philosophy and social constructionist approach
Understanding from the professional sensemaker perspective with focus on human mechanisms, tendencies and patterns.
RO1 RO2 RO3 RO5
5. Medical Doctors (MDs)
Medical Doctors specialized in general medicine, cardiology, gynaecology and military medicine, respectively
Knowledge of how to deal with ambiguity, change and high-stakes decision-making in HROs.
RO4
Table 1: Delphi panels knowledge domains paired with research objectives
Nominating, ranking and inviting experts
In order to select an appropriate group of experts, about 1000 persons were identified
through the researcher´s network. All are considered experts within their individual
knowledge domains. From those 1000 people, 200 persons were ranked and divided
into five knowledge domains relevant to the research questions and research
objectives.
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The selected group of 200 persons was invited in person or by mail to a lecture,
dialogue-meeting, dinner and network. In addition, they were encouraged to point out
other competent persons.
The invitation invited them to share their knowledge and talk about their passion
within their individual, professional fields. An example of the invitation has been
translated from Danish to English and is enclosed in Appendix A.
In total, 43 persons participated in group dialogue meetings at the SenseMaker
training facilities in Varde, West Jutland. For data and signatures see Appendices C, E,
G, I, K. Empirical data was collected in the period from April 2011 to July 2011.
Figure 14: Primary data collection process
In order to apply the Delphi method consistently, the dialogue meetings followed the
sequence “brainstorming, narrowing down and ranking” (Okoli & Pawlowski, 2004:24).
The overall process followed Delphi protocol when moving from iteration to iteration,
illustrated in Figure 15 on the next page:
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Figure 15: Delphi iterations in the research process
Five dialogue meetings, Panel 1-5
All panels were given a one-hour lecture by the researcher regarding the purpose of
the MC and the ethical code of conduct. The lecture was based on Chapter 1:
Introduction and Chapter 2: Current thinking.
Panel 1-4, representing the traditional practice field, were asked: Within this context
and in order to ensure success with organizational strategic change
- “How would you recommend doing in practice, seen from your perspective?”
Panel 5, which represents HROs within the medical context, were asked:
“How do you do in practice when you make successful high-stakes decisions?”
The dialogue ran unstructured and ended with each panel member writing down main
elements of the discussions (Appendix B). Every dialogue meeting was conducted in
Danish to ensure the highest possible understanding and expression of nuances. The
dialogue meetings were videotaped with the permission of the participants.
Subsequent Delphi iterations unfolded by mail and were followed up by face-to-face
meetings with chosen panel members for in-depth discussions of tendencies.
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Two in-depth dialogue meetings, meta-reflections with Panel 3 and 4
In order to explore sensemaking limitations, the Delphi panels 3 and 4 are asked to
meta-reflect on findings from panel 1-5. Panel 3 and 4 are two types of consultants,
strong in macro-processes and micro-processes, respectively. This means that they
themselves also become the subject field of the study when identifying patterns and
tendencies. The participants were given a description and overview of dominating
themes from the five Delphi dialogue sessions which were briefly explained (Appendix
M). This approach is chosen in order to avoid getting nothing more than the opposite
response as to RQ3: How to enhance sensemaking in organizational strategic change.
The dialogue was unstructured but ended with a conclusion of main mechanisms.
An overview of the data collection set-up is illustrated in the figure below:
Figure 16: Overview on Delphi panels paired with the research questions
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Structuring findings
The abstracts were written by looking through the videotapes and comparing them to
the researcher’s and the panels notes (Appendix B). Each abstract is structured in
dominating themes by using open coding (Mills, 2010:155). Findings were verified or
elaborated by mail.
In order to show key steps in the analysis, the inductive coding process used to label
chunks of words (Dey, 2002) – thematic coding, fine coding and broad thematic coding
– was used.
Thematic coding was used as a selective filter and resulted in 32 themes from the
traditional practice field and 8 themes from the medical context, giving a total of 40
themes (Appendix P). The process is illustrated below.
Figure 17: Thematic coding. Source: Dey (1993)
Fine coding was used to group the 40 codes [themes] derived from the thematic
coding process into factors, concrete examples and dimensions of factors. Eight
categories emerged through the organizing of themes in an order aiming to enhance
sensemaking in organizational strategic change and important factors (Appendix P).
The process is illustrated on the next page.
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Figure 18: Fine coding grouped into conceptual categories. Source: Dey (1993)
The fine coding were refined to identify different dimensions in the in-depth dialogue
meetings with consultants and academics. The process is illustrated below.
Figure 19: Broad thematic coding refined to identify different dimension. Source: Dey (1993)
The broad thematic coding process resulted in an overview of the recommended state
by the traditional practice field and a current state within HROs. These findings are
presented in the analysis in figure 23 and 24 as graphical data displays inspired by
Huberman and Miles (1994:429). They are organized by three dimensions: the
structural, the relational and the cognitive dimension, related to social interaction
among organizational members, as suggested by Nahapiet and Ghoshal (1998).
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4.2 Validity, reliability and generalizability
A great deal of the validation within the Delphi method lies within the panel selection.
All invited parties are considered experts within the knowledge domain in which they
are placed. With 10, 6, 7, 9 and 11 people in each of the panels, the total number of
participants is a little below what is recommended for a virtual Delphi panel. As the
intention was close contact and free dialogue by physical sessions, the number is
considered acceptable for this type of research.
Validity has also been sought by following the recommendations of Miles and
Huberman (1994).
Checking for representativeness
To ensure representativeness, experts were invited cross-sectional from different
industries distributed throughout West, Middle and East Denmark. In addition, invited
experts pointed out other experts not previously known by the researcher.
Only respondents who were genuinely interested in discussing new ways of working
with strategy and change participated in the Delphi panel – these are considered more
open and curious than the average stakeholders.
Especially the CEO panel was difficult to gather. With only six people in the panel, the
single opinions weigh heavier than in the panel with eleven people. Managers
participated in the CEO panel as well. It is a weakness that there is no separate panel
for managers.
Checking for researcher’s effect
The lecture by the researcher narrowed down the panel member perspective, but also
strengthened the focus of this research. The context in the five dialogue meetings was
set as described in Chapter 1: Introduction and Chapter 2: Current thinking.
In the two in-depth dialogue sessions, the context was set by summarizing findings
from the five dialogue sessions.
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According to Okoli & Pawlowski (2004:27), the benefit of theory building derives from
asking experts to justify their answers. This can be a valuable support in understanding
the causal relationships between factors.
An unstructured interview form was chosen in order to ensure open dialogue and limit
the effect of the researcher. In order to check for researcher effect, abstracts were
written on the basis of the dominating themes in the videos and notes written by both
panel members and the researcher during the sessions. The abstracts were verified by
panel members shortly after each dialogue session (Appendices B-F).
Objectively weighting the data
Objectivity has been sought in weighting the data by critically reviewing and cross-
referring the answers from panel members. At the end of each dialogue session, the
experts summed up individually and wrote down main findings to ensure that not only
the researcher’s opinion would be weighted. “Anecdotal evidence” in dialogue
sessions was followed up with more in-depth questions either by phone or mail. In
addition, a selection of panel members participated in in-depth dialogue sessions. They
discussed the findings from the five domains and validated abstracts of the in-depth
dialogue sessions (Appendices N and O), which increased the probability that multiple
perspectives and sources of evidence were used.
Generalizability
The concept derived from this MC is expected to have relevance in several settings,
such as small, medium or large-sized organizations and change processes, both with or
without a strategic intent. Once the process is in motion, the same mechanisms are
expected to come into play. However, not all mechanisms must necessarily be found in
all settings, and each mechanism can be presented with different strengths and
interactions, according to the context.
Sensemaking theory is internally focused within the organizational context. By dealing
with main sensemaking mechanisms and insights, the insights of this MC are expected
to be used externally in relation to customers and other stakeholders, when adapted
to the given situation.
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5 Research findings and analysis
This chapter presents the results of the investigation and shows key steps in the
analysis, making both the logical argument and the evidential base clear.
The chapter will follow the structure and sequence of the dialogue sessions:
Section 5.1: “Sensemaking in organizational strategic change” is based on results
from the traditional practice field; employees, CEOs, consultants and
academics
Section 5.2: “Sensemaking in high reliability organizations” is based on results from
the HROs within the medical context, namely medical doctors (MDs)
Section 5.3: “Meta-reflections” is based on meta-reflections on findings from section
5.1 and 5.2 with chosen consultants and academics.
5.1 26BPanel 1-4: Sensemaking in organizational strategic change
The findings of this section are based on results from the four Delphi panel sessions
with 1: employees, 2: CEOs, 3: consultants and 4: academics. The findings are expected
to meet the research objectives:
RO1: To describe the role of sensemaking in organizational strategic change.
RO2: To explore the current state of sensemaking in the organizational strategic
change, seen from the perspective of the traditional practice field.
RO3: To explore factors that might enhance sensemaking in the organisational
strategic change process, seen from the perspective of the traditional practice field.
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5.1.1 The role of sensemaking in organizational strategic change
The findings showed that the traditional practice field found the role of sensemaking
to be very important and even essential to ensure success with organizational strategic
change:
Consultant: “It has to make sense. Therefore, the manager must have insight in his role
as manager and the psychological interventions he/she regularly enters in order to
ensure good and trusting relationships.”
The findings showed that it is essential for the success of organizational strategic
change that the change makes sense to all involved in order to create commitment:
Consultant: “Any vision must be presented as essential to each individual – any “what´s
in it for me?” must be clear to each individual”
CEO: “If people understand and are committed, they will find the way and it is not
necessary to explain over and over again. (…) Talk to everyone in different ways to
create understanding among many.”
This underpins how organizational members act according to their own mental models
and that continuous change at the micro-level can alter the structure and strategy of
the organization. Relapse is less likely to occur because these on-going changes
become a part of the identity. If the strategy does not make sense to organizational
members, they act accordingly to what seems plausible and fits their identity.
This means that sensemaking is especially important within a strategic context,
because it often demands of the ideas of top management to make sense to the rest of
the organization.
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Findings show that in order to create organizational strategic change there must be
confidence and respect in order to stimulate and/or activate action:
Employee: “If there is no trust, all development and flow shuts down (…)”
Employee: “When there is respect and confidence, it [teamwork] works and you find
yourself taking on responsibilities you would not take on if the cooperation does not
function. You do it because it is the best solution for the team. Not only for yourself.”
To sum up findings suggest the role of sensemaking in organizational strategic change
to be:
Figure 20: The role of sensemaking in organizational strategic change
In addition, findings show that it is difficult to have confidence in people you do not
know well or people who are not professionally competent, which underpins the HRO
principle: Maintaining capabilities for resilience requires deep knowledge of the
system, one’s co-workers and most of all oneself.
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5.1.2 The current state of sensemaking in organizational strategic change
The findings show that the financial crisis in particular has affected how the traditional
practice field thinks about strategy:
CEO: “It *the crisis+ did something to us. It does no longer make sense to talk about 10-
year plans or even 5-year plans (…)”
Consultant: “Those who have to make radical changes now have not been doing
anything for 10 years.”
This matches the view of Weick and Quinn (1999:362): “organizational change would
not be necessary if people had done their jobs right in the first place” and their
advocacy for continuous change rather than episodic change.
The findings show that today’s strategy can be minor tasks or functions and more
tactical and operational than previous. What was previously called planning is often
now called strategy.
A consultant drew the following two figures in order to explain the shift in the concept
of strategy. Figure 21 shows the shift towards a more tactical and operational nature
of strategy:
Figure 21: The strategic hierarchy levels under change
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Figure 22 is a traditional organizational hierarchy inverted. The consultant argued:
“Where are the customers? They are often in direct interaction with the bottom of the
hierarchy. Therefore, we must invert the diagram in order to remind ourselves that
strategy must make sense to employees in order to trigger a certain behaviour.”
Figure 22: Inverted traditional organizational hierarchy
Findings show that strategy is at a turning point and that it is hard to change traditions:
Consultant: “Work on letting chaos loose, but under controlled conditions. There is
comfort in the linear paradigm, and it is a difficult project to switch to the circular. It's
hard to drop what you have always done. Directors have their board to be accountable
for (….). There is a system that puts some limits on us.”
This underpins that certain expectations within the system limit the top management
from performing.
The findings show that there is an anomaly in relation to strategy today, but it is
difficult for panel members to articulate exactly what is missing.
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The panel members were very preoccupied with the word strategy and what it brought
into the room when articulated. They did not feel that the word strategy fit to a
complex context:
Academic: “There is something in the word strategy that blocks and conflicts. It doesn´t
fit. I react to it and I don’t like it. Can´t we find a better word for it?”
The findings show awareness among the traditional practice field of paradoxes. They
show that it is not possible to make consensus between a high number of people
without having a random result, although this is what is practiced:
A Consultant in relation to vision work at a former workplace:
“We just had to have something that looked nice. We were tied and we had to come up
with a solution.”
The findings show strong evidence that there is a certain organizational system that
enforces limits upon organizational members, which pull them in the direction of
consensus thinking. In addition, findings show that panel members know that it is
necessary to find better, more suitable and more nuanced ways to act. The panel
members agreed that our actions are lacking behind the knowledge they actually have.
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5.1.3 Factors to enhance sensemaking in organizational strategic change
The findings of factors to enhance sensemaking in organizational strategic change are
shown in a graphical data display.
Figure 23: Data display for recommended state by the traditional practice field
Organizational strategic change in new ways
The panels gave the advice to create a movement that makes organizational members
self-organize and move through blockages by themselves in order to reach the higher
purpose. A way to activate passion and a higher purpose in organizational members
who are not committed is explained by a consultant who was hired to work with
certifying 100 women from a laundry, many of whom were approaching retirement
age, within environment issues. The consultant describes the first presentation in the
laundry cafeteria:
“Half of them sat with their back to me and they did not turn around to follow. I looked
out over the crowd and was wondering what could make them interested in protecting
the environment while they go to work. I looked out over their grey topknots. Then I
pulled the grandchildren card”
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The consultant then told the women a story about how important it was to protect the
environment and to conserve water in order to ensure clean water for their
grandchildren. The women committed instantly. As the day came for the final
examination, an external auditor interviewed a number of the women to ensure that
they had been involved and engaged in the environmental goals. A detailed description
of everything they did was given and they said with great conviction in their voices:
"We must do this in order to ensure clean drinking water for our grandchildren."
The consultant spoke to their feelings by serving certain cues that were extracted by
the women. They had new insights and could now see a new bigger picture which
instantly led to action. One cue changed everything through logic of attraction.
Findings also showed that commitment is especially difficult when the change is
beyond what people had thought was a part of their job description or something that
is not their own idea, which is often the case in organizational strategic change. Panels
agreed that commitment was essential, both when the change is something people
would like to achieve, but also when the change is necessary to avoid.
A consultant working with work environment told a story about an employee who died
in an accident on the job. The CEO had to tell the employee’s two teenage sons that
their father had died.
The CEO said: “This must never happen again. I will never give such a message again.”
This statement underlines the HROs’ preoccupation with failure.
Structural dimensions
The panels advised taking a dynamic approach to strategy by shifting between micro
and macro, top-down and bottom-up and mastering harmonic processes operating in
and out of each other.
Academic: “One thing does not exclude the other. You have to master, accept and
understand both *micro and macro+”
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Panels also pointed out that it is important to be clear about the purpose of change.
Consultant: “When the target is known, you choose the approach and the toolbox that
fits. Leaders must be able to operate with other mental models than own favourites.”
CEO: “If you have to start a turnaround, it is an entirely different toolkit [than in
continuous change+.”
This underpins that although inertia created a given tension, triggers of change can
come from several sources other than the environment, e.g. performance,
characteristics of top management, structure and strategy.
The panels agreed that it is a good idea to have rules and guidelines, but that these
must never stand in the way of common sense, intuition and situational awareness,
which often require a knowledge surplus and the ability and courage to improvise.
Academic: “We need courage at the executive hallways.”
This corresponds with Weick and Quinn’s argument that successive organizations do
not rely on either mechanic or organic processes and structures, but have well defined
managerial responsibilities and clear priorities while at the same time allowing
processes to be highly flexible, improvisational and continuously changing.
The panels advised using strategic focus areas in the coming months and adjusting
continually, but with small on-going adjustments. The panels argued for the use of a
systematic approach - until something else seems wiser, as well as a movement around
in the organization to listen, talk and reflect upon the strategy, because:
Employee: “If you make a very specific plan, all development can close down.”
This is consistent with the HRO principle of being sensitive to operations as less
strategic and more situational, and this becomes the new strategy.
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Relational dimensions
The panels suggested creating a space of confidence where people dare to be sincere
by developing a special ethical context for interaction between people. Findings show
the importance of putting thoughts and feelings into words in order to make sense of
organizational strategic change:
Consultant: “Put words on the unsaid. When it is said out loud it is no longer dangerous
and it is easier to get help. But it should be both ways and count for both CEOs,
managers and employees.”
This enhances sensemaking by providing room for analysis and intuition in the
sensemaking space in addition to having the interpretation and meaning and courage
follow HRO principles. The room will enable people to speak up and welcome diverse
experience and opinions.
Cognitive dimensions
The panels advised professional sensemakers to be very aware of speaking the
discourse of the system to be seen as legitimate participants and to plant a seed where
the potential development lies in order to create slow growth. This should trigger
commitment. The panels underlined the importance of finding something the
organization can understand and commit to.
CEO: “Make it simple. Then repeat and repeat and only make small adjustments. It has
to be recognizable.”
Academic who had to work with LEAN managers in relation to mindfulness:
“(…) I just called it PTPM [Personal Total Performance Maintenance] instead of
mindfulness.”
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Other times it may not be right to put a label on the process at all:
Academic: “Sometimes I complete explicit U-theory processes. They [organizational
members] do not necessarily need to know (…).”
By serving an unexpected clue in an expected way, organizational members can
commit parallel to increasing their capacity. Therefore, it is important to choose a label
that people can relate to. This provides evidence for the argument that one of the
essential decisions is choosing the right label or no label at all to provide a certain cue,
that people within the system is expected to extract. Organizational members will then
commit to a higher purpose and self-organize.
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5.2 Panel 5: Sensemaking in high reliability organizations
The findings in this section are based on results from the Delphi panel session with
Panel 5: medical doctors (MDs). The chapter is expected to meet the research
objective:
RO3: To explore factors from high reliability organisations that might enhance
sensemaking in organizational strategic change.
5.2.1 Factors from HROs that might enhance sensemaking in organizational
strategic change
The findings of the current state of sensemaking in HROs are shown in a graphical data
display.
Figure 24: Data display for current state of the HROs
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Structural dimensions
The findings from HROs within the medical context showed very clear evidence of high
structure, e.g. clear roles, systems and prioritization. Three concepts in particular were
referred to by the MDs as a way to enhance sensemaking and confidence in the
process. These are all part of the Advanced Trauma Life Support (ATLS)2, an
internationally recognized framework for the management of the injured patient:
Hands on and Commander
Triage
Defusing and Debriefing
Hands on and Commander
Hands on and Commander is a way of ensuring clear roles. One takes on the
Commander role and distributes roles to “Hands on”, the person who treats the
patient, and “Helping hands”. The process is structured by a code-system. The
Commander articulates status using codes and asks for silence to repeat the message
and delegates roles and tasks to the “Helping hands.” Everyone speaks up and reports
back to the Commander with statuses like: “A free, B in progress”. If any doubt arises,
this is reported back to the Commander. Every code has the full attention until it is
mastered. Panel members stress that although it is a simple and very structured
system, it leaves room for C to be taken care of before A if needed.
MD: “The highest goal is clear: keep the PT [patient] alive and provide the best possible
treatment.”
The clear roles provide safety and confidence because everyone knows what to do and
the “Hands on” knows that he can continue until the Commander speaks up.
This underlines the HROs’ preoccupation with failure and their encouragement of
“vigilant wariness” to ensure continuous alertness as well as the importance of
speaking up and clear roles.
2 http://www.facs.org/trauma/atls/index.html
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Triage3
Triage is a way of practicing holistic prioritization when several people are badly
injured at the same time.
MD: “The injured are divided into serious injuries, minor injuries and mental injuries.
Then, the injured are prioritized and given numbers in relation to whom to treat first.”
The team constantly keeps track and reassesses numbers and reports back to the
Commander. As the overall purpose is to save as many injured as possible, some very
badly injured can be sacrificed in order to save a higher number of people.
Defusing and Debriefing4
Defusing is the process of “talking it out” - taking the fuse out of an emotional bomb.
This gives the involved parties the opportunity to express their disaster related
memories, stresses, losses, and methods of coping, and to be able to do so in a safe
and supportive atmosphere.
Panel members stressed that the terms defusing and debriefing are very important to
enhance sensemaking:
MD: “It helps people release thoughts and feelings that might not otherwise be
expressed.”
The defusing session is normally a starting point. Further intervention is often required
and this can be anything from offering on-going support to scheduling and providing
formal debriefing sessions.
MD: “The psychological debriefing is a formal meeting, done individually or in small
groups. It is generally held shortly after an unusually stressful incident, strictly for the
purpose of dealing with the emotional residuals of the event.”
3 Triage is a French word meaning sorting/prioritization 4 Defusing/Debriefing & Psychological First Aid. John D. Weaver, http://www.eyeofthestorminc.com/index_files/DefuseDebrief.htmu
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This is a way to enhance sensemaking by creating a certain ethical code of conduct. By
putting labels on the two processes, everyone knows the rules and procedures. This
creates comfort and confidence to the process and people who participate in it.
Relational dimensions
Findings show the importance of confidence and saying thoughts out loud:
MD: "First, as I retold it, I got redemption. The patient was send to a psychologist, but
what about me? I just continue with the next patient. Because that´s what we are
expected to do.”
Findings also show the importance of sincerity and finding your own way to navigate in
order to make sense:
MD: “It´s very important to be true to yourself and your own principles. For instance, I
never read new patients’ journals, because if I do so, I wouldn’t meet them with an
open mind and they might as well have stayed with their former doctor. Most patients
think that it is weird until I explain to them why.”
This underpins both the importance of explaining the necessity of a choice or an
action, but also the importance of resisting oversimplification in order to be in an open
state that reduces cognitive shortcuts and encourages the use of “vigilant wariness”.
Cognitive dimension
Findings also showed improvisational skills and a high meta-level awareness including
a high holistically thinking. Several times, the MDs meta-reflected out loud and
showed an ability of overview and structure in thoughts:
MD: “There are several types of decision-making; depending on whether it is
emergency [crisis] or non-emergency situations [change] they should be handled very
differently.”
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In “change” situations, findings showed the importance of making appointments and
commitments to small changes that the patient can manage and agree on. When the
agreement is made, it is important to mobilize help within the patient’s system by
activating one or more capacities who can help redirect the change.
MD: “When I feel that there is a partnership with the patient about the decision, it
becomes a better and more correct decision. In deep conversations something can
happen in the crack between the patient and me. Sometimes, there is a clear path that
appears just by listening to the patient, like an "aha" experience. As if they suddenly
can hear themselves say it out loud.”
This shows the importance of only making arrangements that people have the capacity
to do something about and can commit to. When the decision is said out loud and
made social, commitment increases.
Findings also showed a mechanism inconsistent with the five principles of HROs (Weick
and Sutcliffe, 2007), showing that even HROs struggle with consensus thinking, as does
the traditional subject field:
MD: “It is not a problem if guidelines are only perceived as such, but if they are labelled
or read as "best clinical practice" it is a problem. It often happens. We must always be
aware of not doing that.”
This underpins that when findings are made public there is a risk of them being
perceived as the truth. When talking about the paradox of science, a MD said:
“No matter what we do differently there is always an effect of 15%” and gave several
examples within cardiology where placebo-treated patients had equally good results as
treated patients.
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Findings showed evidence of direct transference of two factors from HROs to the
traditional practice field. Related to the significant calm overview and high meta-
reflection level, findings show that for HROs it is important to be able to take control of
own emotions and alleviate fears to avoid sensemaking blockages in a stressful
situation.
The MDs used the metaphor “the eye of the hurricane” to describe these stressful
situations. The hurricane centre is relatively calm, but moving into the centre or out of
it is very chaotic. When situations get stressful it can be a signal to take a deep breath
and a short break to get an overview using a four step process: “stop, assess, prioritize
and delegate”, consistent with the holistically prioritization described on page 60.
MD: “…it is a way of going into a meta-position by controlling emotions and alleviating
the fear of not performing. In that way, I will avoid twirling around with all the others.”
A panel member now working as a medical consultant said:
“I still use it [hurricane eye and triage], although I am no longer in the hospital system.
It is no more a matter of life and death, but there are still very stressful situations, and I
am often being told that I seem so calm and that it affects the rest of the entire team in
a positive way.”
This underpins that when interruptions of important routines lead to system
breakdown, it creates a vicious cycle that worsens performance and quickly affects the
whole system in a negative way. This is a way to restrict the effects of the interruption
before they escalate. When the system stretches from equilibrium, it quickly finds its
core again and avoids bursting. Doing this requires a maintained capability for
resilience with deep knowledge of the system, ones co-workers and oneself. B
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5.3 Panel 3-4: Meta-reflections
The findings from this section are based on in-depth sessions with chosen consultants
and academics. The chapter focuses on patterns and limitations between the four
knowledge domains in the traditional subject field presented in section 5.1.
The chapter is expected to meet the research objective:
RO5: To describe sensemaking limitations in organizational strategic change.
The findings show three very strong sensemaking mechanisms:
Figure 25: Main sensemaking limitations within the traditional practice field
These mechanisms are considered to be general, strong sensemaking blockages within
the traditional practice field.
Circular intent but linear outcome
Panel members had a strong need to make sense showing a linear approach, although
they advocate for the opposite. Employee: “We must all contribute and we must have
a shared responsibility.” Five seconds later, the same employee said: “But it is the CEOs
responsibility to take responsibility for the strategy… isn´t it?”
This shows a strong need to make others accountable, but at the same time a need for
social acceptance. It also shows how strong the sensemaking mechanisms are, even for
professionals who have deep insight into social construction.
An Academic asked: “Why can´t it make sense that something does not make sense?”
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HROs are capable of exactly that and they handle sensemaking blockages with a
certain mind-set: “An organization that expects change may find itself puzzled when
something does not” (Weick, 1995:5). The paradoxes arise when circular thoughts
become linear by applying words and labels in the sensemaking space.
Strong need for labelling
When panel members struggled to makes sense of the dialogue sessions, they had a
strong need to label. When discussing Weick and Quinn’s (1999) three sequence model
for continuous change, a consultant exclaimed: “But how can you freeze something
that de facto cannot be frozen? This is like alcohol.”
When discussing strategy in new ways, an academic said: “This will demand a brand
new paradigm. What should the new paradigm be called?”
This provides evidence for the HRO principle of maintaining capabilities for resilience.
HROs know that they must freeze and simplify in order to understand and move on,
but they also know that what they will see is only a snapshot of many truths.
Strong need to place the responsibility
The biggest difference was found between panels discussing the nature and role of the
CEO in the strategic change process. It was very visible which position the different
panel members spoke from. Employees focused on what the management should do,
and had poor focus on what they themselves could do. The CEOs had poor focus on
their own capabilities, but focused more on creating the ideal environment and putting
the right team together. Both CEOs and employees were using the hierarchy to push
responsibility down or up, respectively.
The consultants mentioned that CEOs often demand a lot of their employees without
wanting to participate in similar challenges themselves. A consultant said: “The CEO is
often the biggest hurdle for change”. The same tendency for placing responsibility and
finding exact answers showed among academics, although they were generally more
nuanced in their approach and not so fast to fall into causality as consultants.
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6 Conclusions and recommendations
This chapter provides conclusions to the investigation linked to the purpose of this MC,
namely to generate new insights around the notion of sensemaking that might then
find use in organizations engaging in change.
The investigation is based on a Delphi study with five panels: employees, CEOs,
consultants, academics and medical doctors. The panels were gathered in physically
unstructured dialogue sessions to explore the research questions from the
perspectives of the traditional practice field engaging in organizational strategic
change – and by high reliability organizations (HROs) within the medical context,
defined by Weick and Sutcliffe (2007) as organizations with a set of mindful practices
that make them perform better than traditional practices in a turbulent context.
The conclusions are organized by the structure of the research questions as described
in section 3.1. The chapter closes with recommendations for the professional
sensemaker, i.e. the CEO, manager and consultant engaging in organizational strategic
change followed by describing implications at the individual and the collective level.
6.1 Conclusions
What is the role of sensemaking in organizational strategic change?
Sensemaking takes on a particular critical and important role in organizational strategic
change. What organizational members experience and engage in must make sense in
order to activate action and generate change – if the insights necessary to form the
bigger picture are lacking, taking action becomes difficult. Sensemaking is especially
important within a strategic context, as strategy often demands that the ideas of top
management make sense to the rest of the organization. In view of shortened planning
horizons and increasing complexity of business environments sensemaking happens
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faster and more frequently – and becomes increasingly important in order to gain
success with organizational strategic change.
Good and trusting relationships within the system, i.e. confidence, sincerity and an
open dialogue are found to be necessary parameters in order to create commitment
and action towards the strategic change. If sensemaking or confidence is week,
sensemaking blockages have fertile ground to grow and can block action.
Figure 26: The role of sensemaking in an organizational strategic change. Adapted from Tovstiga et al. (2005)
Sensemaking is essential in the move from tacit to explicit individual knowledge, and
fundamental to the collective integrating and institutionalizing where the
organizational strategic change emerges. What gets institutionalized in the
organization then again affects future individual expectations. Therefore, insights into
sensemaking mechanisms are especially important for the professional sensemaker in
order to stimulate and redirect the individual and collective behaviour towards the
desired strategic direction.
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What is the current state of sensemaking in organizational strategic change?
The way the traditional practice field works with organizational strategic change is
affected by the economic crisis and a general increase in complexity in business
environments in the way. As it no longer makes sense to make 5 or 10-year plans, the
planning horizons have become more narrow and strategy more tactical and
operational. However, the current state of sensemaking in organizational strategic
change shows an anomaly; strategy is drifting towards continuous change mainly
caused by environmental triggers. The current system and structure of traditional
organizations prevents the CEO, manager and consultant to perform within the system
in ways consistent with continuous change. This mechanism is illustrated below:
Figure 27: The current state of sensemaking in organizational strategic change. Adapted from Tovstiga (2010)
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The traditional practice field shows high awareness of how to approach strategic
change in new ways. However, it is found to be problematic to take a position too far
away from the public opinion and what has become institutionalized, especially in a
subordinate, organizational context in which organizational members are paid and
expected to perform, create meaning and to act in a certain way. This issue results in
an incomplete bigger picture for the professional sensemaker and action is blocked.
What factors might enhance sensemaking in organizational strategic change?
Findings from the recommended state by the traditional practice field as well as
findings from the current state of HROs show high consistency to the seven practical
questions for understanding the organizations wherewithal for sensemaking (Weick,
2001). The seven questions, if fulfilled, form the basis for an environment capable of
enhancing sensemaking and reducing blockages in organizational strategic change.
The traditional practice field is found to be very focused on the rebalance sequence of
continuous change and partly on the freeze sequence. On the opposite, HROs are
found to be very focused on the unfreeze sequence and partly on the rebalance
sequence. The red plus signs indicate insights and skills the traditional practice field
could benefit of focusing on and/or enhancing in organizational strategic change.
Figure 28: The focus of the traditional practice field and HROs. Adapted from Weick and Quinn (1999)
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The traditional practice field might not directly deal with matters of life and death, as
do the HROs. However, the traditional practice field might especially benefit from the
contributions of HROs when the stakes are high and e.g. customer reaching and
operational agility become new important competitive parameters. In addition,
insights into micro-level levers are necessary in the freeze sequence of continuous
change.
Factors to enhance sensemaking in organizational strategic change recommended by
the traditional practice field (Figure 23) and the current state of HROs (Figure 24) are
merged in the below figure. The red plus signs indicate the HRO contributions to the
recommended state of the traditional practice field.
Figure 29: HRO contributions to the traditional practice field
Evidence for direct transferability from HROs to the business context is found in
relation to improvisation, calm overview and holistically prioritizations. The remaining
proposed HRO practices must therefore be calibrated and validated in practice.
However, findings show very high consistency between the two contexts, both in
relation to structural, relational and cognitive dimensions.
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The main factors to enhance sensemaking in organizational strategic change are
creating a movement with a higher purpose within an environment of confidence,
sincerity, open dialogue and acceptance of paradoxes and ambiguity. In order to create
a movement with a higher purpose, it is important to find a balance in disturbing the
system. Performing within the context is important in order to be seen as a legitimate
player within the system. If the system is exposed to too much disturbance, it will
either burst because it is too far from equilibrium to find its way back or it will dismiss
or exclude the professional sensemaker - and one or several sensemaking blockages
can be activated and prevent action. If the system is not disturbed enough, nothing will
change in the sensemaking space, no action will be triggered and no change will occur.
The higher uncertainty and the shorter planning horizon, the more important HRO
practices of improvisation and calm overview become. During performances, HROs
enhance sensemaking by providing the confidence that structure, clear roles and
holistically prioritization gives. In addition, an ethical code of conduct of saying
thoughts and concerns out loud and mobilizing help within the system increases
confidence. After performances, HROs enhance sensemaking and organizational
memory by dialogue sessions with focus on verbally expressing experiences.
In order to enhance sensemaking in organizational strategic change the analysis
strongly indicates that the traditional practice field could benefit from shifting
between a micro and macro process approach. In addition, well-defined managerial
responsibilities, clear project priorities while also allowing the design process to be
highly flexible, improvisational and continuously changing and always with the higher
purpose at the top of the organizational memory. This is mainly due to two reasons:
Firstly, improvisation replaces the use of standard procedures and develops
organizational memory with positive effects on effectiveness and cost savings.
Secondly, continuous change produces change without confronting the system directly
or aggressively which avoids organizational members to relapse into old habits by
serving opportunistic steps to move in the right direction.
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What are the limitations to sensemaking in organisational strategic change?
The findings show a strong tension between the positivistic and social constructionist
approach. The possible limitations to sensemaking’s effective use within the traditional
practice field are paradoxically found within the system itself, i.e. the organizational
members, by a:
Circular intent but linear outcome
Strong need for labelling
Strong need to place responsibility
The traditional practice field struggled to make sense of paradoxes and finding exact
answers by exploring different knowledge bases to make sense. The result therefore
becomes random. Paradoxes and ambiguity trigger even more sensemaking, linear
outcome and even more need for labelling. In addition, the linear outcome results in a
very strong need to make others accountable. The CEO in particular is considered by
employees and consultants to be the biggest obstacle for organizational strategic
change as their own actions in practice often do not follow their intentions and what
they expect e.g. employees to engage in.
The limitations, which have the nature of sensemaking blockages, explain the
difficulties encountered in organizational strategic change. To reduce sensemaking
blockages and increase sensemaking in the strategic direction becomes the new
strategy for the professional sensemaker in order to redirect and facilitate small on-
going changes in organizations.
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6.2 Recommendations
The professional sensemaker, whether it is an internal position like a CEO or manager
or an external position like a consultant, engaging in organizational strategic change is
advised to start by considering the seven practical questions posed by Weick (2001) in
order to access the current state of the organization. If fulfilled, they form the basis for
an environment capable of enhancing sensemaking and reducing blockages.
Figure 30: Seven practical questions to the organization combined with factors to enhance sensemaking
If the seven questions are not fulfilled, actions must be taken in order to create the
optimal environment, with main factors found in the analysis (Appendix P) – written in
orange in the figure above. The higher purpose of the organization must be clearly
defined and the information from the seven questions used to define the gap between
the current and desired state of the organization in order to get a clear outset.
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The following recommendations for the professional sensemaker in order to enhance
sensemaking in organizational strategic change are explained by the three sequence
change process for continuous change:
Figure 31: Sequences for continuous change. Adapted from Weick and Quinn (1999)
In the freeze sequence
Make a sequence visible and show patterns in order to access current state.
Consider how to increase capacity within the organization in order to increase
commitment to the strategic change, e.g. the higher purpose.
Consider what triggers organizational members in relation to the higher
purpose and unfold with fewer blockages.
In the rebalance sequence
Speak the discourse of the system and look for a crack where the potential
development could lie.
Serve an unexpected clue in an expected way by changing labels or not using
labels at all.
Move around to listen, talk, redirect and show the way.
Speak up and repeat the key message and higher purpose with only small on-
going adjustments, if any.
Combine logic of attraction with understanding of what to avoid.
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In the unfreeze sequence
Ensure clear roles and responsibility in order to redirect expectations in the
desired direction and reduce sensemaking blockages.
Use holistic prioritization of a complex situation with the overall purpose of
using resources in the best possible way within the given context consistent
with the higher purpose of the organization.
Enhance sensemaking by staging a room with certain codes of conduct where
people can share thoughts and experiences in a safe environment.
Be ready to start the three sequence process over again if the collective
sensemaking drifts away from the desired state and before rules and
procedures get institutionalized.
Let improvisation and learning loose in more mindful ways, but under
controlled conditions (systems).
The position of the professional sensemaker
To the internal professional sensemaker, it is especially important to nurture the
culture with a long approach view and ensure that external consultants have insights
into both macro-level transformation and micro-level levers.
To the external professional sensemaker it is especially important to match the client’s
approach and the organizational culture, by speaking the discourse and looking for the
crack where the potentially development lies.
To be a professional sensemaker, whether it is in an internal or external position, is
also to come to terms with the fact that there have always been and will always be
organizational members who prefer to see no change happening at all. In that case,
the professional sensemaker is recommended to trigger change by facilitating implicit
processes and not necessarily always, as Tovstiga (2010) suggests, manipulating
outcome through informed action or, as Weick and Quinn (1999) suggest, making
patterns and schemes visible.
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6.3 Implications
Implications with respect to new insights into sensemaking in the context of
organizational strategic change are separated into two different levels – the individual,
e.g. the professional sensemaker and the collective, i.e. the organization.
The degree of implications for the CEO, manager or consultant depends strongly on
the current status of the professional sensemaker and the culture of the specific
organization, in respect to how positivistic an approach and how static an organization.
If the organization is comparatively more static and positivistic, a higher degree of
implications is to be expected.
Implications for the professional sensemaker
In order to benefit from the insights into sensemaking in relation to organizational
strategic change deep fundamental changes can be necessary for the CEO, manager or
consultant primarily focused on macro-level transformation, in order to enrich macro-
level transformation with micro-level levers.
The drift of strategy towards a more tactical and operational nature makes
professional sensemakers facilitators rather than experts. This role and way of
managing is demanding as it requires courage, sincerity and a special openness
combined with deep self-insight and a high knowledge surplus in order to maintain a
calm overview and to be able to improvise within the system. To facilitate an
organizational strategic change process also demands for the professional sensemaker
to dare to let sensemaking loose in order to let organizational members self-organize.
In order to take the approach of continuous change, the professional sensemaker must
also be able to switch between top-down and bottom-up, choosing the approach and
toolbox that match - and move from a strategic to a more situational approach. The
role as a facilitator is more about providing scaffolds that serve as cognitive or
emergence accelerators for sensemaking than about staying in control at all times.
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Implications for the organization
The drift of strategy towards a more tactical and operational nature includes the need
to redefine strategy and see strategy as a dynamic process, while nurturing the
courage to accept paradoxes and ambiguity. In order to do so, change must be seen as
constant, evolving and cumulative and changes at the micro-level must be seen as a
pattern of endless modification in work processes and social practices. This requires a
flexible organizational structure and a culture capable of continuous adaption.
Going towards a HRO culture emphasizes deep structural changes for most traditional
organizations. Instead of struggling with paradoxes, organizational members can with
benefit learn to accept that some things do not make sense – and learn to simplify in
new mindful ways instead of simply casually, habitually or instantly put labels on what
they experience consistent with the HRO principles of anticipation and containment.
Towards an integration of the two levels
To facilitate sensemaking at the individual level does not necessarily ensure
organizational sensemaking and collective action. To be successful with organizational
strategic change requires integration between the individual and collective level. As
the culture is embedded in the system, the professional sensemaker must be aware of
what system is created – and well as how the system create the sensemaker, i.e. the
dominating mechanisms and themes organizational members talk about. In order to
integrate the individual and collective level, the professional sensemaker(s) must start
slowly to infect the organization with the new behaviors using the recommended
principles of this MC, e.g. creating a movement with a higher purpose, that makes
organizational members self-organize and infects further organizational behavior.
To be a professional sensemaker and/or HRO is to embrace the complexity that may or
may not be in any given situation. It is not about preconceived notions that the world
should be simpler or more complicated. It is about clarity, not simplification.
Something might emerge from sensemaking in a form that is just as complex but more
clear. To be a professional sensemakers and/or a HRO is not only a way of approaching
strategic change. It is a way of seeing, helping others see and a way of life.
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7 9BReflections
This chapter provides a discussion of my reflections of my theoretical, practical and
personal learning from undertaking this MC. Background and evidence is to be found
in Appendix Q in the form of a Research Log Diary, structured after Mills (2010:788).
7.1 Evaluation of findings
The findings show a high consistency with the chosen current thinking. The analysis
shows this discrepancy, although the respondents participating in my panel are
considered to be the most curious and open, and therefore might not be fully
representative. They chose to drive to West Denmark to spend an evening helping me
on a busy workday and proved to be very interested in my process.
The difference between the chosen current thinking and the findings of this MC is the
perspectives of the traditional practice field and the panel members’ practitioner-
minded, action-oriented approach to strategic change in turbulent environments - and
of course in particular the contribution from a knowledge domain outside the
traditional practice field; the HROs within the medical context.
The new insights came especially from the panel of MDs, probably because they
manoeuvre in a very different discourse compared to the traditional practice field.
Had I known that from the start, I think I would have chosen to go even further into
the knowledge domain of the MDs. It was amazing to experience how they simply
described what they did, while I used theories and labels to organize their experiences
and actions.
I have been amazed to find such a significant amount of detailed empirical data – so
much so that the challenge was to sort and select only the most appropriate for this
purpose. The substandard material has been saved for later articles and further
calibration and validation in practice. The best outcomes were the very concrete
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examples, especially from the MDs, and the two in-depth dialogue meetings with
consultants and academics, which were very rich on meta-reflections.
The findings have been influenced by the philosophical stance I took in the
methodology section. They have had great influence on the output, as I have been a
significant co-creator of the entire process. It was the only right stance for me to take,
as it is difficult to go back to causality once the door to social constructivism has been
opened and capacity has been increased. However, I have not secluded beneficial
approaches from either of the methods. Rather, I have tried to combine them to
achieve a more nuanced result. Social constructivism and positivism can benefit from
each other, as long as you are aware of what you do and with what purpose. If I had
used a different design approach it would off course have affected the ultimate
outcome. Even now, if I should redo this work it would have a different outcome. Had I
chosen a positivistic approach with deductive methodology and questionnaires for
data collection, I think I would have had flatter result without the odd comments and
colourful examples that especially led to the new insights.
7.2 33BExperience of the research process
The research process has been a combination of heaven and hell. I loved the subject
matter and it took up my thoughts from December 2010 to September 2011. I did not
like the structure necessary in order to conduct the Delphi study in an academic
context. Nor did I like the writing and felt it took me forever, both because of the very
broad and complex subject matter and the fact that I had to conduct a major research
based project for the very first time in a foreign language. However, I enjoyed reading,
reflection on theory, the interaction with panel members and especially the
construction of frameworks and figures.
I am a typical right-brainer: seeing wholes, painting with wide brush strokes,
envisioning end results by using drawings and working from feelings. Therefore, it was
very important to me that the process was inspirational to me and anyone who
participated in the process. I put a lot of effort into making the dialogue meetings
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interesting for each panel member by writing personal invitations that used different
approaches for different personalities.
The Delphi method has been a beneficial and very exiting method, especially because
it has been adapted to the richer media, such as face-to-face meetings and phone calls,
and the process has developed simultaneously. It has been just as inspiring as it has
been time consuming, expensive and an excellent learning process.
I have learned to invite more people than I need to do a Delphi study, even though
people have agreed to participate and confirmed the agreement. My goal was to have
50 people in the panels. I had 43, but I would have had more than the desired number
if not nine people failed to show up on the day of the panel meeting. In my case, a
little more than twenty percentage of the invited participated, and for evening
meetings in West Denmark I find the attendance to be quite good. I knew 80
percentages of the invited persons in advance. By now, I have expanded my network
with ten competent and inspiring people. Furthermore, I have had interesting mail and
phone contact with another 20 people I did not know previously.
I especially learned how small variations in questions can create big differences. For
example, when the MD panel was asked: “How do you do in practice?”, I received very
specific examples and tools. In comparison, the four other panels were asked: “How
would you recommend doing in practice?”, which lead to more general and superficial
descriptions. Luckily, the panel members were very talkative and self-driven, and as we
had plenty of time to discuss, examples came within the four hour meetings anyway
and all four research questions were more than fully covered. It was inspirational to
share my thoughts and discuss findings with people who had deep insight into the
subject field.
My biggest challenge was to make the research questions, and especially the research
objectives made back in December 2010 fit my very large and broad investigation after
it was conducted. I wanted the research questions to fit as they were approved by my
MC supervisor, G. Tovstiga. When I read Mills (2010), I was able to put labels on what I
had actually been doing, and I could see that I had to both refine and narrow down the
research questions and objectives after the empirical evidence was collected. It teased
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me a lot and I had great difficulty in finding the right angle – and sticking to it. Along
the way, I chose a wrong path and had to rewrite big parts of the MC. I realize that I
could have saved a lot of time if I had applied more structure to my research process
from the start. However, I do not regret the detours or the great amounts of work,
because I have learned a lot and this process led me to exactly this result, of which I
am very satisfied. I have learned a lot about research methodology and of
sensemaking, strategy and change, but also of several other knowledge realms which
sensemaking sits at the intersection of and which I intend to investigate further.
7.3 The limitations to this Management Challenge
The recommendations of this MC will come to compete with day-to-day fire fighting in
organizations. It proved to be quite difficult for me to gather especially the CEO panel,
which had more important tasks to do. There is also a significant risk that managers
cannot embrace paradoxes and absurdities and the fact that they have to change
themselves within the very same system that pays them to act in a certain way. They
most often seek tools and methods that are enabling acceleration. But when these
tools are within themselves, it requires change of the hardest kind affecting both
identity and capacity.
This MC is very broad and embraces several knowledge realms, which creates a risk of
it not being concrete enough to be usable in practice. However, the findings of the MC
follow the principles of our health school by which we have a very high success rate:
we do not provide participants with diet plans or fitness schedules, but with insights
and tools that will make them capable of making the right decisions each day. We also
encourage small on-going changes and to point out a “driver” to help in the process.
This MC aims to provide the professional sensemaker with insights to enhance
sensemaking in strategic change. But every professional sensemaker must find his or
hers own path and chose the insights and actions appropriate for the given situation.
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Finding your own way is impossible if everything is planned ahead and any
improvisational skills will be blocked.
Interestingly, the main limitation to sensemaking and the insights seems to be the
Western society – the very system we are and live in – colouring the entire corporate
system and educational system. The panel members agreed that our actions are
lacking behind the knowledge we actually have.
The human mind and nature will continue to be a blockage unless we learn to accept
and make sense of when something that initially does not make sense. However, the
insights emerged from this MC should decrease these blockages.
7.4 Achievement of personal objectives
My personal objectives were to increase my competencies within sensemaking and
research methodology, in order to work more strategically with sensemaking, strategy
and change - and move from a broad to a deep knowledge. The MC process has helped
me significantly in that direction. In addition, I have expanded my professional network
and created several contacts that can lead to future inspiration and collaboration.
My personal objective in the long run, to create differentiation within the consultancy
business, coloured the choice of the strategic focus in this MC and is already unfolding.
In the last couple of months I have been signed on for several jobs within sensemaking,
strategy and change, because of recommendations from Delphi panel members.
A revisit into the Personal Development assignments from year 1 (Greve, 2009) and 2
(Greve, 2010) shows a very persistent pattern of desire for more structure. I still work
in an unstructured manner. The reason why I have yet to do something radical about it
is that this way of working normally works for me, which reveals a strong cognitive
shortcut. However, I do organize, plan and manage various activities quite well,
although I bounced back to old patterns several times. But I also took the consequence
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of the need for more time and said no to several jobs and other invitations that I would
have normally accepted.
When looking back at this process, I see that my journey has followed the Tovstiga et
al. (2005) model for sensemaking in an organizational context. However, the
framework has been used in a different setting with me as a bricolour: I chose the
theory I found interesting because I had a hunch that they were usable [intuiting].
Then I conducted the empiric investigation [interpreting] and made it fit the current
thinking [integrating] and the SenseMaker ApS product portfolio [institutionalizing].
When closing this MC, one question in particular pops into my mind: “Do we really
have to use or build on something known and socially accepted to be acknowledged?”
I think so, both in order to make sense and to speak the discourse of the system. The
challenge to being a professional sensemaker is to match the collective capacity
contributing to social intelligence, rules and procedures supporting more mindful
practices. Hopefully, I have managed to do just that.
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Appendices
Appendix A: Example of dialogue meeting invitation, GB
Appendix B: Pictures of notes from five panels
Appendix C: Employees’ participant information and signatures
Appendix D: Employees’ abstract, DK
Appendix E: CEOs’ participant information and signatures
Appendix F: CEOs’ abstract, DK
Appendix G: Consultants’ participant information and signatures
Appendix H: Consultants’ abstract, DK
Appendix I: Academics’ participant information and signatures
Appendix J: Academics’ abstract, DK
Appendix K: Medical Doctors’ participant information and signatures
Appendix L: Medical Doctors’ abstract, DK
Appendix M: Overview of dominating themes from five panels, GB
Appendix N: Academics’ in-depth dialogue meeting abstract, DK
Appendix O: Consultants’ in-depth dialogue meeting abstract, DK
Appendix P: Fine coding and broad thematic coding
Appendix Q: Research Log Diary, GB
Appendices are removed from the published version due to confidential information
about Delphi panel members and the author´s research log diary. The above
appendices can be available by relevant interest in the research process.