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Sensemaking involves turning circumstances into a situation that is comprehended explicitly in words and that serves as a springboard into action. In this paper we take the position that the concept of sensemaking fills important gaps in organizational theory. The seemingly transient nature of sensemaking belies its central role in the determination of human behavior, whether people are acting in formal organizations or elsewhere. Sensemaking is central because it is the primary site where meanings materialize that inform and constrain identity and action. The purpose of this paper is to take stock of the concept of sensemaking. We do so by pinpointing central features of sensemaking, some of which have been explicated but neglected, some of which have been assumed but not made explicit, some of which have changed in significance over time, and some of which have been missing all along or have gone awry. We sense joint enthusiasm to restate sensemaking in ways that make it more future oriented, more action oriented, more macro, more closely tied to organizing, meshed more boldly with identity, more visible, more behaviorally defined, less sedentary and backward looking, more infused with emotion and with issues of sensegiving and persuasion. These key enhancements provide a foundation upon which to build future studies that can strengthen the sensemaking perspective.

Background Studies show that implementing huddles in healthcare can improve a variety of outcomes. Yet little is known about the mechanisms through which huddles exert their effects. To help remedy this gap, our study objectives were to explore hospital administrator and frontline staff perspectives on the benefits and challenges of implementing a tiered huddle system; and propose a model based on our findings depicting the mediating pathways through which implementing a huddle system may reduce patient harm. Methods Using qualitative methods, we conducted semi-structured interviews and focus groups to obtain a deeper understanding of the huddle system and its outcomes as implemented in an academic tertiary care children's hospital with 539 inpatient beds. We recruited healthcare providers representing all levels using a snowball sampling technique (10 interviews), and emails, flyers, and paper invitations (six focus groups). We transcribed recordings and analysed the data using established techniques. Results Five themes emerged and provided the foundational constructs of our model. Specifically we propose that huddle implementation leads to improved efficiencies and quality of information sharing, increased levels of accountability, empowerment, and sense of community, which together create a culture of collaboration and collegiality that increases the staff's quality of collective awareness and enhanced capacity for eliminating patient harm. Conclusions While each construct in the proposed model is itself a beneficial outcome of implementing huddles, conceptualising the pathways by which they may work allows us to design ways to evaluate other huddle implementation efforts designed to help reduce failures and eliminate patient harm.

We develop theory about how growing at work is an interpretive accomplishment in which individuals sense that they are making progressive self-change. Through a study of how employees interpret themselves as growing at three organizations, we develop a theoretical account of how employees draw from contextual and personal resources to interpret their growing in ways that embed their idiosyncratic experiences within an organization. The data suggest that employees develop three different types of growing self-construals: achieving, learning, and helping. We use our data to ground theory that explains the development of growing self-construals as deeply embedded in organizations. At the same time, we suggest that growing self-construals reflect individual agency through how individuals work with available resources to weave interpretations of themselves into their growing self-construals. We further suggest that growing self-construals influence the actions employees take to support a sense of progressive self-change.

When employees make sense of discrepancies between what leaders say they want and how they act (eg, differences in declared organisational policy and informal supervisory practice), they discern the organisation's collective unconscious values, beliefs and assumptions. [...]culture is shaped through this ongoing social verification process. 13 16 Safety culture is a dynamic process that is continually supported, shaped and co-created daily, which makes it hard to control. [...]culture is not an infallible form of behavioural control even though it is often alleged as a primary cause of myriad organisational disasters.

Mindfulness as depicted by Levinthal and Rerup (2006) involves encoding ambiguous outcomes in ways that influence learning, and encoding stimuli in ways that match context with a repertoire of routines. We add to Levinthal and Rerup's conjectures by examining Western and Eastern versions of mindfulness and how they function as a process of knowing an object. In our expanded view, encoding becomes less central. What becomes more central are activities such as altering the codes, differentiating the codes, introspecting the coding process itself, and, most of all, reducing the overall dependence on coding and codes. Consequently, we shift from Levinthal and Rerup's contrast between mindful and less mindful to a contrast between conceptual and less conceptual. When people move away from conceptuality and encoding, outcomes are affected more by the quality than by the quantity of attention.

Our aim was to understand actions by primary care teams to improve medication safety. This was a qualitative study using one-on-one, semistructured interviews with the questions guided by concepts from collaborative care and systems engineering models, and with references to the care of older adults. We interviewed 21 primary care physicians and their team members at four primary care sites serving patients with mostly low socioeconomic status in Southwest US during 2019-2020. We used thematic analysis with a combination of inductive and deductive coding. First, codes capturing safety actions were incrementally developed and revised iteratively by a team of multidisciplinary analysts using the inductive approach. Themes that emerged from the coded safety actions taken by primary care professionals to improve medication safety were then mapped to key principles from the high reliability organisation framework using a deductive approach. Primary care teams described their actions in medication safety mainly in making standard-of-care medical decisions, patient-shared decision-making, educating patients and their caregivers, providing asynchronous care separate from office visits and providing clinical infrastructure. Most of the actions required customisation at the individual level, such as limiting the supply of certain medications prescribed and simplifying medication regimens in certain patients. Primary care teams enacted high reliability organisation principles by anticipating and mitigating risks and taking actions to build resilience in patient work systems. The primary care teams' actions reflected their safety organising efforts as responses to many other agents in multiple settings that they could not control nor easily coordinate. Primary care teams take many actions to shape medication safety outcomes in community settings, and these actions demonstrated that primary care teams are a reservoir of resilience for medication safety in the overall healthcare system. To improve medication safety, primary care work systems require different strategies than those often used in more self-contained systems such as hospital inpatient or surgical services.

Preventable harms from medications are significant threats to patient safety in community settings, especially among ambulatory older adults on multiple prescription medications. Patients may partner with primary care professionals by taking on active roles in decisions, learning the basics of medication self-management, and working with community resources. This study aims to assess the impact of a set of patient partnership tools that redesign primary care encounters to encourage and empower patients to make more effective use of those encounters to improve medication safety. The study is a nonrandomized, cross-sectional stepped wedge cluster-controlled trial with 1 private family medicine clinic and 2 public safety-net primary care clinics each composing their own cluster. There are 2 intervention sequences with 1 cluster per sequence and 1 control sequence with 1 cluster. Cross-sectional surveys will be taken immediately at the conclusion of visits to the clinics during 6 time periods of 6 weeks each, with a transition period of no data collection during intervention implementation. The number of visits to be surveyed will vary by period and cluster. We plan to recruit patients and professionals for surveys during 405 visits. In the experimental periods, visits will be conducted with two partnership tools and associated clinic process changes: (1) a 1-page visit preparation guide given to relevant patients by clinic staff before seeing the provider, with the intention to improve communication and shared decision-making, and (2) a library of short educational videos that clinic staff encourage patients to watch on medication safety. In the control periods, visits will be conducted with usual care. The primary outcome will be patients' self-efficacy in medication use. The secondary outcomes are medication-related issues such as duplicate therapies identified by primary care providers and assessment of collaborative work during visits. The study was funded in September 2019. Data collection started in April 2023 and ended in December 2023. Data was collected for 405 primary care encounters during that period. As of February 15, 2024, initial descriptive statistics were calculated. Full data analysis is expected to be completed and published in the summer of 2024. This study will assess the impact of patient partnership tools and associated process changes in primary care on medication use self-efficacy and medication-related issues. The study is powered to identify types of patients who may benefit most from patient engagement tools in primary care visits. ClinicalTrials.gov NCT05880368; https://clinicaltrials.gov/study/NCT05880368. DERR1-10.2196/57878.