COVID-19 is a crisis that is disrupting societies, economies and health and social care systems. We are all trying to make sense of what is happening, what it means to us and how to respond. This is akin, perhaps, to finding oneself in a foreign land with the map of a different country. The experience can be frustrating, confusing and disorienting. Making sense of our experience – whether at a personal, organisation or societal level – is critical to how we navigate through the terrain and adapt.

Having made it through the initial stages of the crisis, health and social care systems are now preparing themselves for a potential second wave. This requires a process of looking back in order to learn and staying in the present to make sense of a highly complex, emergent and evolving situation. This entails processing information and insights from multiple, yet related levels. These include what has and is being learnt about:

• Clinical practices and treatments
• Patient Care
• Managing safety and risk
• Scientific and clinical research
• The impact of the virus on and behaviour of different communities and populations
• Effective working practices
• How to lead people and teams
• The relationships between health & social care systems
• The impact of local and national political messaging, and not least,
• How to manage one’s own emotions and well-being.

Processing this level of complexity is challenging, particularly given its dynamic and unknown nature. And because, we are simultaneously hearing competing and contradictory narratives about what is happening and what to do. No single person can see the full picture given its complexity (if indeed this exists or is possible). We can only make sense by listening to and talking with others.

The need to learn

In a crisis, our means of understanding events are disrupted. Unexpected and unknown changes require us to revise our assumptions and interpretation of events. What we expect to happen, doesn’t. What we think will work, proves to be ineffective. Life suddenly becomes very uncertain and whatever we do, feels risky. This leaves us feeling disoriented, confused and frightened. Disruption also means change; and change involves loss. Both real and imagined. These losses may be tangible and clear. They may equally not be immediately apparent or obvious, only emerging when we expect something and find it’s not there.

When a situation changes beyond recognition, we have to act without an established theory or explanation to guide our response. If we act too quickly however we risk act on the basis on faulty assumptions.  We know from studies of major accidents, such as the meltdown of the nuclear reactor at Three Mile Island or the Challenger Space Shuttle disaster, that taking the time to question your assumptions or anticipate what might happen can be the difference between a crisis and a disaster. Some form of action however may be required to determine what is the situation. We need therefore to both act and reflect-on-action to learn about what works in practice.

Crises also create an opportunity for meaningful change because we are forced to act, to question our assumptions and to experiment.  This opens up new possibilities and opportunities for innovation. In recent months, many have been pushed outside of their comfort zones and have had to challenge limiting beliefs or draw on abilities and resources they were unaware they possessed.

The challenge of anxiety

Sensemaking is however challenged by anxiety. Not knowing, having to learn something anew or having to go through a period of feeling incompetent, all trigger anxiety. One response is to reduce our anxiety by simplifying what is happening and creating false certainties. Another is to avoid or deny ‘the realities’ of the situation or to close down too quickly to a conclusion or course of action.

Leadership in a crisis therefore necessitates the containment of such anxieties to enable those involved to face what is actually happening and take reasoned actions. This requires the creation of an environment in which individuals can be vulnerable and minimises fears of being judged, shamed or feeling incompetent.

Leadership: a catalyst for change

Leaders can be a catalyst for learning and change if they are able to facilitate sensemaking and critical reflection on what has and is happening, what has worked and what needs to be done next.  The following are suggestions that can help this process:

• Take time to stand back with others to scan the broader context, emerging trends and consider the different scenarios that my unfold and their implications for your part of the health and social care system.
• Take time to connect with people from different parts of the health and social care system to explore your different perspectives and experiences. Notice when your perceptions and underlying assumptions are challenged!
• Create time with your peers and teams to pause and reflect on what is going on in your system, particularly when you feel under pressure and notice the pull to act.
• Frame the central challenges and opportunities that your organisation now faces so decisions and changes are intelligible and coherent to those who are affected. Be open about your assumptions and intentions.
• Create space and time for people to share stories of their experiences, to express their emotions and feelings about what is happening and to share insights about what’s proved to work or not work, and finally

All of the above can help you to develop, evaluate and evolve your strategies, tactics and actions for adaptive to the challenges that your system faces both now and in the future.

The contents of this blog are based on Dr Andrew Day’s book: Disruption, Change & Transformation in Organisations. https://www.taylorfrancis.com/books/9780429287084 

This blog was originally published on 22nd May 2020 on Metalogue Consulting website https://metalogue.co.uk/2020/05/22/the-importance-of-sensemaking-in-a-crisis/.

Dr Andrew Day 

Andrew Day is a partner in Metalogue Consulting (https://metalogue.co.uk) a strategic organisation development consultancy who specialise in organisation design and development.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.