Abstract International Clinical microsystem festival 2014 Scientific Day
Annika Nordin
Make sense of sensegiving - How external change agents make sense of a sector change
Background knowledge
A quality register is an automated and structured gathering of information about persons with the specific
purpose of systematic and continuous development and securing of the quality of health care. The collected data
can also be used in research, to produce statistics and to facilitate comparisons 1. The Swedish government has,
together with the Swedish Association of Local Authorities and Regions (SALAR) signed a joint strategy
concerning quality registers. The agreement is based on the vision that quality registers are widespread and well
entrenched in all relevant parts of the Swedish health care.
Local problem
The poster (and the working-paper) deals with how a quality register (Senior alert) used external change agents
to implement the register nation-wide. The largest challenge was to find relevant units within each affiliated
organisation and to inspire concerned staff to work accordingly to the register. The external change agents
functioned as sensegivers; 2 their task was to influence the sensemaking of the staff.
Intended improvement
The basis for the poster (and the working paper) is an organization engaging external change agents to minimize
the “implementation gap”3. The intended improvement was that all relevant organizations started to use Senior
alert systematically. The external change agents played an important role and this was at the time a new
approach for spreading a quality register.
Study question
The purpose is to describe how external change agents make sense of their sensegiving. Additionally, the
purpose is to describe how the sensemaking emerges over time. The research questions are twofold:
o How do external change agents make sense of their sensegiving?
o How does the sensemaking develop over time?
Methods
This is a qualitative, inductive, longitudinal interview study (Kvale & Brinkmann, 2009)4. The primary data
collection technique is semi-structured interviews (Yin, 2003)5.The external change agents had differing
employment time and to ensure the longitude aspects of the study, only change agents that participated at the
first interview, and still had an employment one year later, were selected for the study. All together eight
external change agents and 16 interviews were included. Each interview was ended by the reflective question
“What is Senior alert, actually?”, and this is a key-question in the study. All interviews are transcribed and will
be analysed by using conventional content analysis6.
Preliminary results
In the years 2010-2012 all county councils/regions and 280 of 290 municipalities affiliated to the register and
the numbers of persons working with Senior alert increased from approx. 1000 to 18 000. Preliminary data
indicate that the external change agent change their sensemaking over time. The tendency seems to be that the
change agents at the time of the first interview emphasize an organizational perspective for their sensemaking
and that they at the time of the second interview use an elderly-perspective for their sensemaking. Additionally
they come to use fewer and more similar words, for their sensemaking. The next step in this study will be to
complete the analysis and to continue with discussion, interpretations and conclusions.
Reference
1. Lundström, S., Axelsson, B., Hedman, P. A., Fransson, G., & Fürst, C. J. (2012). Developing a national quality register in end-of-life care: The Swedish
experience. Palliative Medicine, 26(4), 313-321.
2. Gioia, D. A. & Chittipeddi, K. (1991). Sensemaking and sensegiving in strategic change initiation. Strategic Management Journal, 12(6), 433-448.
3.Bevan, H., Glenn, R., Bate, P., Maher, L., & Wells, J. (2007). Using a Design Approach to Assist Large-Scale Organizational Change: "10 High Impact
Changes" to Improve the National Health Service in England. The Journal of Applied Behavioral Science, 43(1), 135-152.
4. Kvale, S., & Brinkmann, S.E. (2009). Den kvalitativa forskningsintervjun. Lund: Studentlitteratur.
5. Yin, R.K. (2003). Case Study Research Methods (6th ed). Fort Worth: Dresden Press.
6. Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative health research, 15(9), 1277-1288.