Interruptions, incessant multi-tasking, mobile equipment thus continuous reconfiguration of the physical space, noise, people, flux….
How do people that work in emergency centres know what’s going on?
How do they make sense of what’s happening, who do they talk to and then what happens?
How does the formal processes e.g. policies and procedure enable (or disable) them from responding to expected and unexpected challenges?
Exploring the above has consumed me for the past few years. Using a multi-layered research design, I’ve studied five large busy government emergency centres in Cape Town. First was an ethnographic study, and it was utterly fascinating to take an outsider stance, observing and ask naive questions about what’s happening and why things are done in specific ways.
To understand the formal systems doctor and nurse policies, procedures and rules was studied, and the managers was interviewed separately. External managers e.g. human resources, finance, risk, bed flow was also interviewed. This part of the project was largely influenced by Karl von Holdt’s work on South African government bureaucracies; Schein’s on culture, Weick and Sutcliffe’s high reliability organizations and Klein’s naturalistic decision-making and macrocognition.
This was followed with a SenseMaker® study. EC doctors and nurses were invited to share a story; after telling it, they answered a set of specially designed questions. The questions were based on a fusion of two sense-making theories; Karl Weick’s process of collective sense-making in organizations and Gary Klein’s data/frame model of sense-making.
The SenseMaker® tool provided me with a double set of data, the questions are quantified and visually displayed so that we can easily search for patterns and then a narrative analysis will add the final layer of insights. For this part of the study I extensively relied on David Snowden’s methods, both the SenseMaker® tool and conceptual Cynefin framework was developed by him.
I’m planning a series of blogs discussing my work of the past few years, watch this space for more regular blogs from now on!
And on Thursday I’ll be presenting a teaser of the SenseMaker findings at the 4th African Conference on Emergency Medicine in Rwanda #AFCEM or http://www.afcem2018.com/