More and Less Effective Updating: The Role of Trajectory Management in Making Sense Again

Abstract

This study examines how updating—the process of revising provisional sensemaking to incorporate new cues—occurs within teams during unexpected events. I compare how 19 teams of emergency department staff managed the same unexpected event (a broken piece of equipment) in a medical simulation scenario. Using a microethnographic approach to analyze video recordings of these teams, I conduct a fine-grained examination of how updating takes place and find considerable variation in its effectiveness across teams. I show that the effectiveness of updating depends not only on how teams remake sense but also on how they engage in trajectory management, balancing the work of updating with their ongoing work (in this case, patient care). Trajectory management practices related to monitoring cues and managing engaging tasks facilitated effective updating and allowed teams to detect and identify the problem caused by the broken piece of equipment and correct it before it led to serious consequences. More-effective teams monitor and rapidly interpret cues, confirming them with others and evaluating changes over time; they then investigate cues, develop plausible explanations, and quickly test them, monitoring cues for feedback. Less-effective teams fail to monitor and confirm cues with others, overlook or misinterpret cues, and delay investigating cues and developing plausible explanations; they also delay testing explanations, often being sidetracked by patient care tasks.