Prospective sensemaking in the operating theatre

This paper reports a study of sensemaking in operating theatres. We explored the role of sensemaking processes in the safe and efficient performance of surgical procedures. The study is based on observations, semi-structured interviews, and informal conversations with surgeons, anaesthetists, operating nurses, and anaesthetic nurses. We found that the members of the operating team paid great attention to what might happen during the next seconds, minutes, and hours. They thus built a capacity for anticipation which enabled them to collaborate smoothly and prepared them to handle undesired but foreseeable occurrences. According to Karl Weick, organisational sensemaking is retrospective in the sense that we make sense of our actions and experience after they have occurred. However, our findings suggest that prospective sensemaking is a precondition for safe and successful completion of surgical procedures. Instead of waiting for things to happen and making sense of them in retrospect, the operating team constructed plausible projections of what might happen and how they might handle such plausible futures. Prospective sensemaking is thus less event-driven than retrospective sensemaking. We argue that safe and efficient performance of surgical procedures depends on the quality of prospective sensemaking. We comment on how technology (including procedures) can support prospective sensemaking. Finally, we discuss the relationships between prospective sensemaking and related terms, such as heedful interrelating, mindfulness, situation awareness, and anticipatory thinking.