Faculty of Social Sciences and Business Studies Business School
MAKING SENSE OF COMMITMENT TO CHANGE Case of implementing information systems in health care
Master’s Thesis, Health and Business Vilma Vahtermo, 274628
January 19, 2018
1 Abstract
UNIVERSITY OF EASTERN FINLAND Faculty
Faculty of Social Sciences and Business Studies
Department Business School Author
Vilma Vahtermo
Supervisor Helena Kantanen Title
MAKING SENSE OF COMMITMENT TO CHANGE: Case of implementing information systems in health care
Main subject
Health and Business
Level
Master’s degree
Date 19.1.2018
Number of pages 78 + 4
Abstract
The aim of this research is to gain understanding about the sensemaking process of employees.
This is studied through a qualitative case study that examines how employees make sense of commitment to change and what is the relation of sensemaking and commitment to change.
The objective is to examine the path to commitment and to identify used and best practices for committing employees to change.
The methodology used in this thesis is qualitative case study approach, which is suitable meth- od to understand complex social phenomena in real-life events. The data is collected through five individual semi-structured interviews. The context of the study is implementation of in- formation systems in health care, and the study is placed in a Finnish municipality that has recently implemented a new electronic patient system. The participants include health care professionals that work in the same municipality. The data is analyzed utilizing literature on commitment to change and a sensemaking framework.
The results of the study suggested various factors affecting employees’ commitment to change dividing participants into externally and internally motivated employees. In this context of technological change, the most influencing factors for reaching commitment seem to be tech- nological issues and social interactions through communication. The individual sensemaking process by Weick was mostly identified in the data. However, there were no apparent indica- tions of sensemaking through extracted ques or as driven by plausibility, when concerning commitment. Throughout the interviews, it became clear that commitment can be achieved through sensemaking process that results in positive attitude towards the change.
The study expands the research in this field to include the perspectives of the employees and sensemaking. The results can help future managers to understand the perspective of the em- ployees better, thus assist in implementing similar changes with better success rate in the fu- ture as facilitators of sensemaking. As technology and legislation are developed further, also information systems need to be changed.
Key words: change, change management, commitment, sensemaking
2 Tiivistelmä
ITÄ-SUOMEN YLIOPISTO Tiedekunta
Yhteiskuntatieteiden ja kauppatieteiden tiedekunta
Yksikkö
Kauppatieteiden laitos Tekijä
Vilma Vahtermo
Ohjaaja
Helena Kantanen Työn nimi
Muutokseen sitoutumisen järkeistäminen: Tapaustutkimus tietojärjestelmien käyttöönotosta terveydenhuollossa
Making sense of commitment to change: Case of implementing information systems in health care
Pääaine
Health and Business
Työn laji Pro Gradu
Aika 19.1.2018
Sivuja 78 + 4 Tiivistelmä
Tutkimuksen tarkoituksena on kasvattaa tietämystä työntekijöiden järkeistämisprosessista.
Tämä laadullinen tutkimus tutkii kuinka työntekijät järkeistävät muutokseen sitoutumisen, sekä järkeistämisen ja sitoutumisen välistä yhteyttä. Tavoitteena on sitoutumiseen johtavien tekijöi- den ja käytettyjen sekä parhaiden tapojen tutkiminen työntekijöiden sitouttamiseksi.
Tutkimus noudattelee yksittäisen tapaustutkimuksen periaatteita, mikä on soveltuva strategia monimutkaisten todellisen elämän sosiaalisten ilmiöiden tutkimisessa. Aineisto on kerätty vii- den yksilöllisen teemahaastattelun avulla kohdehenkilöinä terveydenhuollon ammattilaiset.
Tutkimuksen kontekstina on tietojärjestelmien käyttöönotto terveydenhuollossa. Tutkimus on toteutettu kunnassa, jossa on otettu käyttöön uusi potilastietojärjestelmä. Aineistoanalyysi on toteutettu hyödyntäen muutokseen sitoutumisen teorioita ja Weickin järkeistämisen kehikkoa.
Tutkimuksen tulokset osoittivat useita sitoutumiseen vaikuttavia tekijöitä jaotellen työntekijät sisäisesti ja ulkoisesti motivoituviin työntekijöihin. Tässä tietojärjestelmämuutoksessa vaikut- tavimmiksi tekijöiksi nousivat teknologiset tekijät sekä sosiaalinen vuorovaikutus erityisesti kommunikaation avulla. Tutkimuksen löydökset noudattivat suurilta osin Weickin yksilöiden järkeistämisprosessia sitoutumiseen liittyen. Poikkeuksena löydöksissä olivat järkeistäminen poimittujen vihjeiden kautta sekä uskottavuuden tärkeys ennen tarkkuutta. Tutkimusaineisto osoitti, että sitoutuminen voidaan saavuttaa sellaisen järkeistämisprosessin avulla, joka johtaa myönteiseen asenteeseen itse muutosta kohtaan.
Tutkimuksen tulokset lisäävät ymmärrystä muutokseen sitoutumisesta työntekijöiden ja jär- keistämisen näkökulmasta. Tulokset voivat auttaa johtajia työntekijöiden näkökulman ymmär- tämisessä auttaen vastaavien muutosten onnistuneessa toteuttamisessa tulevaisuudessa. Tekno- logian ja lainsäädännön kehittyessä myös tietojärjestelmien muutos on ajankohtainen.
Avainsanat: muutos, muutosjohtaminen, sitoutuminen, järkeistäminen
3 TABLE OF CONTENTS
1 INTRODUCTION ... 5
1.1 Background of the study ... 5
1.2 The purpose of the study ... 7
1.3 Key concepts ... 8
1.4 The structure of the thesis ... 9
2 THEORETICAL BACKGROUND ... 11
2.1 Change management ... 11
2.2 Implementing innovations ... 15
2.2.1 Diffusion of innovations ... 16
2.2.2 IT Implementation process ... 19
2.3 Commitment ... 21
2.3.1 Commitment to change ... 22
2.3.2 Affecting commitment to change ... 24
2.4 Sensemaking ... 27
2.4.1 Sensemaking as individual process ... 29
2.4.2 Sensemaking and change ... 30
2.4.3 Sensemaking as a framework ... 33
2.5 Theoretical framework ... 37
3 RESEARCH METHODS ... 40
3.1 Methodology... 40
3.2 Research context ... 42
3.3 Data collection ... 42
3.4 Analysis of the data ... 45
3.5 Ethical considerations ... 47
4 RESULTS OF THE EMPIRICAL RESEARCH ... 48
4.1 The change process ... 48
4.2 Grounded in identity construction ... 53
4.3 Retrospective ... 56
4.4 Enactive of sensible environments ... 57
4.5 Social ... 59
4.6 Ongoing ... 63
4.7 Focused on and by extracted cues ... 64
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4.8 Driven by plausibility rather than accuracy ... 65
5 DISCUSSION AND CONCLUSION ... 67
5.1 Summary of the study ... 67
5.2 Key findings and the theoretical implication of the findings ... 68
5.3 Evaluation of the study, future studies and managerial implications ... 72
REFERENCES ... 74
Figure 1. Diffusion of Innovations: adapted from Rogers (2003)………17
Figure 2. Technology acceptance model: adapted from Davis (1989) ………20
Figure 3. Relationship of sensemaking, commitment and change………...38
Figure 4. Conceptual framework………..39
Table 1. Data collection………44
Table 2. Results of the content analysis: examples, themes and categories……....….46
Table 3. Factors affecting commitment positively………...51
Table 4. Factors affecting commitment negatively………..53
Appendices
Appendix 1.Interview scheme in Finnish
Appendix 2. Interview scheme translated in English
5 1 INTRODUCTION
This section of the thesis provides an introduction to the topic. First, the background of the study is provided, which will be followed by the purpose of the study. Thereaf- ter, some key terms are defined. Finally, the structure of the thesis is introduced.
1.1 Background of the study
It seems that in today’s world change is evident. Companies are constantly conducting some changes, such as mergers, expansions to new markets or new product lines.
Change is seen essential for companies to survive in increasingly competitive envi- ronment. It must be noted that success rate of change attempts in organizations has not been desirable. Undesirable success rate as well as globalization, technology and eco- nomic instability drive need for understanding successful change. (Helms Mills et al., 2009)
Implementing information systems in the health care sector in Finland is a timely phenomenon. According to Rissanen and Lammintakanen (2011), utilization of in- formation systems in the health care industry has progressed slowly when compared to other industries. However, when implementation of information systems takes place, it causes rapid changes in practices as well.
The Finnish health care sector is going through various changes nationwide to meet new requirements brought by digitalization. Nationwide information system services in health care are developed to include for example electronic prescriptions, nation- wide archive services and medical databases. Together these are referred as Kanta- services. These renewals aim in improving the continuity of the care and patient safe- ty. (HE 219/2013) These reforms change the requirements for information systems in health care so that system developers are required to develop electronic patient re- cording (later referred as EPR) systems that are compatible with Kanta-services (tie- to.fi; mediconsult.fi). Thus, new EPR systems are developed and implemented in health districts. Implementing these new Kanta-compatible systems has already start- ed in various municipalities.
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Implementing information systems has long been a focus of researches and practition- ers in this field. Emphasis has been given to identifying factors that affect the success of the implementation. However, still failures and delays in the implementation pro- cess are constantly reported. The failures in implementation lead not only to direct costs, but also in indirect costs such as lost opportunities. (Brown et al., 2007)
Rissanen and Lammintakanen (2011) further note that preparing for changes in infor- mation systems has been inadequate. The authors emphasize the importance of leader- ship in change processes and suggest that changes always lead to change resistance in some employees, so leaders have to concentrate on giving the needed guidance and support for the employees. The challenges in implementing information systems take place in managing the change process, especially in supporting the employees with adequate education and training, information and technical support.
Much of research in the area of change management has focused on identifying criti- cal factors affecting the success or failure of a change process. However, research lacks focus on explaining why various factors are important to successful change.
(Luoma, 2015). It is noted that filling the gap in this area is important; there is a need for further theoretical and practical understanding of the reasons behind certain factors contributing to successful change (Meyers et al., 2007; Luoma 2015). The information is expected to be useful for change management practices.
One of the essential elements contributing to successful organizational change is commitment (Meyers et al., 2007; Iverson 1996). This thesis views commitment to change from the perspective of employees. Alongside with the sensemaking process, the thesis examines the factors affecting successful change process. Whelan and Som- erville (2010) note that changes in organizations are actually about changes at an indi- vidual level, as change takes place in the behavior, practices, values and attitudes of the individual employees.
Thus, it seems that more research is needed to better understand this phenomenon.
This thesis aims in contributing to the change management research by studying commitment to change from the sensemaking perspective. This thesis views commit- ment to change from the perspective of employees. Alongside with the sensemaking process, the thesis examines the factors affecting successful change process. Whelan and Somerville (2010) note that changes in organizations are actually about changes
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at the individual level, as change takes place in the behavior, practices, values and attitudes of the individual employees.
1.2 The purpose of the study
The purpose of the study is to gain understanding about the sensemaking process that employees go through when committing to change. The aim is to examine the per- spective and experiences of employees in this context, through which a deeper under- standing of this phenomenon can be achieved. The change context in this study is a change in the information system in the sector of health care. Through this study, the knowledge on how employees experience such change processes and what are the factors affecting employees’ commitment to the change can be increased. Thus, based on the purpose and the aims of the research, the research questions are formulated as follows:
How employees make sense of commitment to change?
What is the relation of sensemaking and commitment to change?
In order to answer the research questions, some objectives are formulated. The objec- tives are to examine the process of sensemaking in the context of committing to change. The goals also include to examine the path to commitment and to identify used and best practices for committing employees to change.
By studying the sensemaking process, I aim in gaining deeper and richer understand- ing of the elements in the process and how they influence the commitment of the em- ployees. This will be done by building a theoretical framework and analyzing the ex- periences of employees. The contribution of this study is a description of the sense- making process of employees working in the health care sector.
The results of the research contribute to the existing literature by taking a new per- spective on the academic research regarding change management and commitment to change. This study expands the research by examining the perspectives of the ground employees and studying the phenomena from sensemaking perspective. The existing literature has left a gap in identifying reasons behind some factors, such as commit-
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ment, that affect to successful change. By describing how employees make sense of the commitment process, also its importance may be explained.
The results of the study have an important contribution to the existing change man- agement literature. The results can enhance the future managers’ understanding of the perspective of the employees, and assist in implementing future changes with in- creased success rate - as technology and legislation are developed further, also infor- mation systems need to be changed. Furthermore, this specific study acts as an im- portant reflection to the change that has taken place inside an organization. Thus, in this specific organization, it helps in evaluating the change process and its success.
1.3 Key concepts
The key concepts of the study include change, commitment and sensemaking. These are the central concepts of the study, since the aim is to describe the links between these three processes from the individual employee perspective.
The concept of change has various definitions. According to Van de Ven and Sun (2011), change can be defined as a temporal difference in the shape, quality or space of an organization. Another view by Van de Ven and Poole (2005) suggests that change is a sequence of events related to development and occurrence of change in organizations. Van de Ven and Sun (2911) note that change can be observed by meas- uring some factors of the same entity at two or more different time periods and by observing the differences that may occur in the measured factors. Change is often seen as a complex process which has various dimensions and should be examined from various perspectives. These will be further explained in section 2.1.
However, it is important to note the role of individuals in change processes. Whelan and Somerville (2010) note that changes in organizations are actually about changes at the individual level. This is because change actually takes place in the behavior, practices, values and attitudes of the individuals, in this case the employees of the organization.
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The conceptualization of Meyer and Herchovitch (2001) is often used when describ- ing commitment. Meyer and Herchovitch (2001:299) define commitment as ‘a force that binds individual to a course of action of relevance to a target’ and that it ‘can be accompanied by different mind-sets that play a role in shaping behavior’. According to them, commitment can be seen as a mind-set that has three categorizations: affec- tive attachment to the organization, perceived cost of leaving and obligation to re- main. These are labelled as affective commitment, continuance commitment and nor- mative commitment.
The concept of sensemaking means the ‘site where meanings materialize that inform and constrain identity and action’ (Weick et al., 2005; p.407). As a term it is self- explanatory as it simply means making sense of events. Materializing in this context refers to sensemaking being an issue of language, talk and communication as for ex- ample situations are brought into existence through talk (Weick et al., 2005). Weick (1995) explains that people generate sense in their words through conversations. This takes place when people convey something about their ongoing experiences. Accord- ing to Pekkarinen (2015), the ideal result of a sensemaking process is realizing the meaning of the event.
1.4 The structure of the thesis
The first chapter of this thesis introduced the topic of this study. Furthermore, the purpose, aims and objectives were introduced and key concepts developed. The fol- lowing chapters of this thesis examine the theoretical background and research meth- odology used in this study. Finally, findings and conclusions of the study are exam- ined.
Section 2 discusses the literature of change management and sensemaking. The sec- tion will first introduce the theoretical underpinnings of change management, which will be followed by a deeper discussion on the topic of commitment and commitment to change. This discussion will also be related to the technological perspective of im- plementing innovations. This is followed by examination of the concept of sensemak-
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ing. Finally, a theoretical framework combining different themes in this section is provided.
Section 3 introduces the methodological approach that has been chosen for this re- search. This section introduces the research methodology and the change context in this case. Furthermore, data collection methodology, the analysis of the data and ethi- cal considerations are included.
Section 4 in this study presents the results of the empirical research. First, general findings regarding the change context and commitment are briefly introduced. After this results are divided according to sensemaking themes.
Chapter 5 presents the conclusions of this study. It brings the empirical results of this study to the theoretical discussion through the discussion on the theoretical implica- tions of the findings. Finally, the study is evaluated critically and some suggestions for further research are provided.
11 2 THEORETICAL BACKGROUND
This section of the thesis provides an introduction to the previous literature upon the topic. Literature will be provided regarding change management and implementation of information systems. Furthermore, the topics of commitment and sensemaking are discussed. The focus of this section is on introducing the concepts of commitment and sensemaking and relating them to the context of change.
2.1 Change management
According to Rissanen and Lammintakanen (2011), in the current society, talking about change has become a norm. Change is often characterized as ongoing process with dramatic influence. According to Van de Ven and Sun (2011), change can be defined as the temporal difference in the shape, quality or space of the organization.
Another view by Van de Ven and Poole (2005) suggest that change is a sequence of events related to development and occurrence of change in organizations. Van de Ven and Sun (2911) continue that change can occur among different types of units in the organizations, including in the work of individuals, teams, units, entire organization or in the relationship of the organization to surrounding others. Furthermore, they note that change can be observed by measuring some factors of the same entity at two or more different time periods and by observing the differences that may occur in the measured factors.
According to Burke (2008), change is a complex process that should be examined from various perspectives and from different levels in the organization. These differ- ent levels include individual, team and entire system. However, it must be remem- bered, that all different organizational levels are connected to the other levels.
Changes have also been categorized in various different ways. Usually division is made on whether changes are planned or unplanned (e.g. Van de Ven and Sun, 2011;
Saboohi and Sushil, 2011; Burke, 2008). According to van de Ven and Sun (2011), the latter ones are consciously guided. Changes can also be accelerated form either internal or external reasons. As a comparison, unplanned changes usually are about
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adapting to changes in the environment or other external changes. Planned changes are often regarded as reforms. Reforms are regarded as positive changes that are con- sciously planned or executed. Burke (2008) makes a categorization between planned changes, continuous development and radical foundational changes. Changes are usu- ally divided into incremental and radical changes. Unplanned changes are seen as evo- lution or revolution, while planned changes can be divided in development and radical foundational changes. Additionally, Saboohi and Sushil (2011) divide changes to un- planned, planned, gradual and revolutional changes, and to static and dynamic chang- es. Furthermore, they divide changes into comprehensive and gradual as well as mac- ro and micro level changes. However, it is further noted that recently a balance be- tween these extreme divisions is attempted. Finally, a continuous perspective in man- agement has gradually evolved in the literature. Van de Ven and Sun (2011) note that changes can also be characterized by their width and depth. These characteristics af- fect the meaningfulness of the changes. Deep changes alter also the cultural aspects of the organizations.
Various scholars have presented their views on change and change processes (e.g.
Burke, 2008; Mintzberg et al., 2005). Scholars have created models to illustrate the processes. Usually these models view change as rational and linear process that is seen to proceed in clear steps (Rissanen and Lammintakanen, 2011; Brown, 2007).
Rissanen and Lammintakanen (2011) note that some authors have recently suggested opposing views seeing organizational changes as complex and having multiple layers.
These opposing authors note that changes are not always linear - instead they might be cyclical and surprising. This makes accurate planning and scheduling challenging.
Change models usually show a sequential process of stages that organizations need to complete for achieving a successful change. One of the first models explaining and describing the process of change is the change model by Lewin. According to Saboohi and Sushil (2011), Lewin’s model presents a three-step model for change, which in- clude the stages of defreezing, change and refreezing. Rissanen and Lammintakanen (2011) continue that the first step includes preparing for the actual change by which the organizational state of balance is shattered. The second step is the actual change where new organizational structure, process or situation is created. Finally, last stage of the process considers institutionalizing the new norms, structures or practices. This
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model has acted as the basis and inspiration for various other models (Rissanen and Lammintakanen, 2011; Saboohi and Sushil, 2011).
Burke (2008) presents change as a process that proceeds in 4 stages: planning, initia- tion, implementation and sustaining. This view sees contents separate from the change process. The contents of the change are seen to bring vision and direction to the change. The change process is suggested to require leadership and participation of employees. In comparison, Mintzberg et al. (2005) views change as a cube that in- cludes two dimensions: 1) the strategy of the organization and 2) the state of the or- ganization. Both dimensions can be either conceptual or concrete. The model sug- gests that if one factor in the organization is changed, everything beneath that factor need to be changed as well. The model also represents formal and informal dimen- sions, which refer to e.g. designed and arisen strategies. The change in this study rep- resents a change in the information system of the organization. The systems and pro- grams are seen as the lowest levels in the model, which suggests that the change does not require changes for example in the vision or culture of the organization.
Arikoski and Sallinen (2007) present a change model from the perspective of individ- uals. They present a model for reaching commitment to change, which is based on the assumption that change is based on learning, and is seen to lead to change in attitudes and behavior. In their model they suggest that individuals need to accept the change also at the emotional level. To reach acceptance, they go through a variety of emo- tions – fear, anger, sorrow and joy. In this model, change is seen to proceed in three stages: initiating the change, learning away from the old habits and learning new prac- tices. In the initiation stage, individuals tend to have strong reactions. It is seen that employees should be involved in the preparation and execution of change, and time should be given to employees to go through all of the stages in the process. Only the last stage is usually where individuals notice the need for change.
Whelan-Berry and Somerville (2010) suggest in their review and synthesis on change processes that literature usually presents change as a process consisting of the follow- ing stages: building a clear vision, bringing the vision to the group level, adopting the change, continuing the adopted models and institutionalizing the change. They also note that change processes need adequate resources in order for the changes to be adopted. Adequate resources are also needed in the stage of initiation. The authors
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suggest that there are various important factors affecting the adoption of employees - education, participation and reward systems. In addition, they suggest that actions of leaders, communications and aligned structures and processes affect most stages of the process after formulating a vision.
According to Rissanen and Lammintakanen (2011), these change models have been criticized for simplifying the reality. Furthermore, these models usually present a top- down approach to changes, and are seen suitable for step-by-step linear and restricted changes. Rather it could be stated, that these models seem too often neglect the role of the individuals in the organization. Instead they show ready-made models that leaders put in place in the organizations, while employees have a passive role. Thus, Rissanen and Lammintakanen (2011) do not see these models suitable for deep and radical changes. Whelan-Berry and Somerville (2010) also support this by stating that suc- cessful change requires also actions from the individuals - individuals need to change their values, attitudes and behaviors. However, it must be noted, that these models still facilitate understanding, analyzing and planning changes in organizations (Rissanen and Lammintakanen, 2011).
As a response to this functional view on change, a new view that follows social con- structionism is created to examine organizational changes and their management. This view emphasizes the discourse among multiple parties in the organization. According to this theory base, the change is built in the interaction between the members of the organization. The interaction comprises of maintaining, interpreting, transferring and understanding discourse in multiple meanings. (Rissanen and Lammintakanen, 2011).
It has been noted by various authors that leaders have a great role in making changes successful. It is further noted that the discourse in the change situation is important in initiating and guiding changes and in influencing the thinking and actions of the members of the organization. Informing employees and communicating with employ- ees has been noted to be one of the most important roles of the leaders. Furthermore, it is important to note, that this should be a two-way interaction. Two-way interaction provides an opportunity for the employees to participate and influence. Making em- ployees feel valued by allowing them to participate is seen to build trust among the employees. Two-way interaction also gives the initiator a chance to gain valuable in- put from the employees in planning and executing the changes. These issues can also
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relieve the anxiety and change resistance that may occur in employees. (Rissanen and Lammintakanen, 2011).
It has been noted that leaders have also a role in enhancing employees’ commitment to the change. Commitment is seen to be increased along with increased sense of so- cial cohesion, justice, safety and mutual trust (Rissanen and Lammintakanen, 2011).
2.2 Implementing innovations
In this thesis, the context is about change through implementation on innovations. In this case the innovation is a new information system. Implementation of information systems is usually viewed as a linear process (Klein and Knight, 2005; Rogers, 2003;
Cooper and Zmud, 1990), similarly to the change models as introduced before (Ris- sanen and Lammintakanen, 2011; Brown, 2007).
Various scholars have developed models to represent the process of implementation of information systems. Implementation process of innovations determines whether innovations are successfully integrated into organizations (Boddy et al., 2009). It has been noted by Cooper and Zmud (1990) that organizations must understand and man- age the process of implementation to be able to get the maximized benefits from the investments to the IT technology. This could be also related to the commitment - by managing the implementation process, the organization may enhance the commitment of employees to the new system.
According to Klein and Knight (2005), some common reasons for innovation imple- mentation failure include the following. Many technological innovations are unrelia- ble and designed in an imperfect way. It is noted that new technologies may for ex- ample have bugs and break downs, thus making people frustrated and annoyed. Some innovations may also be more complex than existing ones, thus requiring users to ac- quire new skills and knowledge. This may decrease satisfaction and pace of coming competent in usage. Another factor is the decisions made at high level of hierarchy against the wishes of the actual users. Furthermore, implementation may require role changes that the users might be difficult or uncomfortable to adapt to. Implementation is also seen time consuming, costly and a drag on performance in initial stages, which
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may not be acceptable for individuals or divisions under much pressure in an organi- zation. Finally, organizations are seen as rather stable, meaning that norms and rou- tines are not easy to change. This may result in implementation failure of performance or morale enhancing practices.
Klein and Knight (2005) also highlight some organizational characteristics that can increase the possibility of making implementation successful. Thus, it could be seen that lack of these items in an organization would increase the possibility of failure.
These factors include strong and positive climate for implementation, management support for implementation of the innovation, available financial sources as well as learning orientation.
In general, implementation process could be examined by looking at some well- known diffusion models. Some of these are Diffusion of Innovations by Rogers and Technology Acceptance Model by Davis (Vuonovirta, 2011). These both models ex- amine the interaction of individuals, the environment and the technology (Wirtanen, 2015). In the following sections these models are briefly presented to give a general description of the issue of successful implementation of innovations in an organiza- tion.
2.2.1 Diffusion of innovations
Implementation of innovations is often examined through diffusion of innovations, which is often related to diffusion in the markets. However, these models could be also examined internally in organizations (Rogers, 2003; Cooper and Zmud, 1990).
Rogers (2003) explains that diffusion of innovation is rather social process than tech- nical matter. It was noted that sometimes social networks affect the adaptation of in- dividuals as they adopt in hope of approval of the society. Related to this, for large diffusion it is important to target the right people, the ones that other follow to rather than social outsiders. This is seen as an important process for reaching critical masses in order for the diffusion process to become self-sustaining.
Rogers (2003) created a stage process for innovation implementation, which is called the innovation-decision process. According to Rogers (2003:14), this process is ‘an
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information-seeking and information-processing activity in which an individual is motivated to reduce uncertainty about the advantages and disadvantages of the inno- vation’. It is a process which decision-makers go through. The five stages are
1. first knowledge of innovation
2. forming attitude toward the innovation 3. decision to adopt or reject the innovation 4. implementation and use of the innovation, and 5. confirmation of the decision.
These are referred to as knowledge, persuasion, decision, implementation and confir- mation (Rogers, 2003). The process is illustrated in the figure below.
Figure 1. Diffusion of Innovations: adapted from Rogers (2003)
Knowledge comes as the existence of an innovation is learned - also understanding of its functioning is gained. Knowledge is affected by the characteristics of the decision making unit including their socio-economic characteristics, personality and communi- cation behavior. Persuasion happens when attitude towards the innovation is formed whether it is positive or negative. It is affected by how the decision making units per- ceive the characteristics of the innovation. Attitude is formed based on perceived
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characteristics of innovation: relative advantage, compatibility, complexity, trialabil- ity and observability. (Rogers, 2003)
In addition, decision takes place when the decision-making party does some activities that result in a choice of either adoption or rejection. Implementation happens when the innovation is used. Finally, confirmation happens as reinforcement for the made adoption-rejection decision is searched, which may also result in reverse decision if the decision-maker is exposed to some information that conflicts with the previous decision. Thus this last stage can lead to continued adoption, later adoption, discon- tinuance or continued rejection. (Rogers, 2003).
According to Rogers (2003) one of the most important issues in adopting innovations is that the customers, or in these cases the employees, understand the importance and the benefits of the innovation, which here is the new information system. It must be noted that innovation adoption and implementation are two different things. Adoption means the decision whether to use an innovation (Rogers, 2003). In comparison, im- plementation is associated with the targeted employees getting skilled, consistent and committed in using the innovation, thus it results in gaining the expected benefits from the innovation (Klein and Knight, 2005).
As noted by Rogers (2003), perceived attributes of the innovations play an important role in explaining the adoption rates. These characteristics include relative advantage, compatibility, complexity, trialability and observability. Relative advantage means the degree of improvements from the previous dominant idea. Compatibility refers to the degree of consistency with the values, experiences and needs of the potential adopters.
In addition, complexity refers to the difficulties in understanding or usage of an inno- vation while trialability means the degree on which the innovation can be experiment- ed. Finally, observability means the degree of visibility of the innovation to others. It is noted that the innovations which are characterized with greater relative advantage, compatibility, trialability and observability combined with less complexity are adopt- ed at faster pace than other innovations. Furthermore, especially relative advantage and compatibility play a crucial role in explaining the adoption rate of an innovation.
At the decision stage, the decision unit makes a decision on whether to adopt or reject the innovation, while implementation refers to the actual usage of the innovation. This process ends in confirmation, which means that the decision making units reevaluate
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their decision of whether to adopt or reject. This can lead to four solutions: continued adoption or discontinuance and later adoption or continued rejection. (Rogers, 2003).
From this model it can be seen that the implementation stage is a part of larger pro- cess an innovation needs to go through. Thus, all the other stages have an impact on whether the innovation is adopted or approved in the organization and this way the influence whether it is actually used in an organization.
2.2.2 IT implementation process
Another model by Zmud and Apple from 1989, introduces a model for IT implemen- tation, and it takes the perspective of technological diffusion. IT implementation in this case is defined as ‘an organizational effort directed toward diffusing appropriate information technology within a user community’. (Cooper and Zmud, 1990: 124).
The process consists of six stages including initiation, adoption, adaption, acceptance, routinization and infusion. Initiation refers to scanning the organizational problems and opportunities. Here, pressure to change evolves from organizational need, techno- logical innovation or from a combination of both. Adoption stage of the process in- cludes negotiations to ensure the support for the change, while adaption refers to re- vising and developing the organizational procedures as the IT application is installed and maintained. Acceptance stage includes committing organizational members to the usage of the application. The last stage of the process, infusion refers to increased organizational effectiveness that is accomplished through the usage of the technology (Cooper and Zmud, 1990).
This model was founded on Lewin’s change model. The initiation stage can be asso- ciated with the first stage of Lewin’s model, unfreezing. Furthermore, adaption can be related to the phase of change, while the last stages can be associated with the refreez- ing stage of the model. (Cooper and Zmud, 1990).
The technology acceptance model was developed to examine the computer-usage be- havior by Davis in 1989. It adapts a theory of reasoned actions (by Fishbein and Ajzen) to an acceptance model of IT users. The theory of reasoned actions suggests
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that beliefs influence attitudes. This is proposed to lead into intentions, which are seen to guide or generate behaviors. However, it is seen that this model has been quite rarely tested among professionals. (Hu et al., 1999).
Figure 2. Technology acceptance model: adapted from Davis, 1989
According to Vuonovirta (2011), the model explains the factors affecting the ac- ceptance and usage of information technology. The model suggests that perceived easiness of use and perceived usefulness are the primary factors affecting the attitudes toward using and behavioral intention to use an information technology. This is illus- trated in Figure 2 below. This model has been further developed to Technology ac- ceptance model 2. This model expanded the number of variables affecting the atti- tudes toward using and behavioral intention to use an information technology. This model considered also the effects of voluntariness, subjective norms, image, job rele- vance, output quality and result demonstrability. Here social norms refer to the expec- tations and attitudes in the community.
This model expands our understanding of the implementation of innovations. It sheds light to some of the important issues to be considered when introducing a new techno- logical innovation – the model emphasizes different factors that people value in order to decide their attitudes and intentions towards the usage of a technology.
21 2.3 Commitment
The research in change management has mainly focused on identifying critical factors affecting the success or failure of a change process. However, there is still need for more research on explaining the importance of various factors to successful change (Luoma, 2015). It has been noted that the role of employees – including the attitudes and behaviors towards the change – has been shown critical for successful change attempts (Shin et al., 2012; Arikoski and Sallinen, 2007). One of the essential ele- ments contributing to successful organizational change is commitment (Shin et al., 2012; Arikoski and Sallinen, 2007; Meyers et al., 2007; Brown et al., 2007; Iverson 1996). However, Shin et al. (2012) suggest that commitment to change can be chal- lenging to achieve since changes may be experienced as intriguing and disturbing the routines and social relationships that have been the key supports in the daily work.
There have been various definitions for commitment. In this study, the definition by Meyer and Herchovitch (2001) is used. Meyer and Herchovitch (2001:299) define commitment as ‘a force that binds individual to a course of action of relevance to a target’ and that it ‘can be accompanied by different mind-sets that play a role in shap- ing behavior’. The work of Mayer and Herchovitch (2001) has been widely cited by other scholars. They developed a general model for workplace commitment, and were among the first scholars to tap on this topic. They developed three characterizations of three types of commitment that have been widely used by other researchers. There were categorized based on different mind-sets of employees. These categories includ- ed affective attachment to the organization, perceived cost of leaving and obligation to remain. They suggested that commitment may be accompanied by any of these three mind-sets, which were labelled as affective commitment, continuance commitment and normative commitment.
Iverson (1996) notes that scholars have disagreed over the definition of organizational commitment. However, scholars seem to agree that commitment as a term can be used to describe both attitudinal and behavioral commitment. These two terms are seen as distinct but related. Attitudinal commitment is seen to represent ‘the degree of loyalty an individual has for an organization’, while behavioral commitment reflects ‘the pro- cess by which individuals link themselves to an organization and focuses on the ac-
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tions of the individuals’ (p. 128-129). It seems that common to these theories is that they reflect a link between the individuals and the organizations.
2.3.1 Commitment to change
It has been highly noted, that commitment is an essential element contributing to a successful organizational change (e.g. Brown, 2007; Meyers et al., 2007; Sidle, 2003;
Iverson, 1996). However, Meyers et al. (2007) note that there is only little empirical evidence to support this common claim.
Herscovitch and Meyer (2002) developed a model of commitment to organizational changes, which was used for systemic investigation of commitment in this context.
This model was based on Meyer and Herscovitch (2001) general theory of workplace commitment, which was introduced above. In their study Herscovitch and Meyer (2002), they proposed that commitment could take different forms and have different implications for the nature and level of employees’ behavioral support for a change.
In their study, Meyer and Herscovitch (2001) found evidence to support both their hypotheses when studying primarily female hospital nurses. In their study, they found that the nature of commitment is important in explaining why employees go beyond the minimum requirements of the organization and the change process. Employees with strong affective commitment (those who believe in the change and want to con- tribute to its success) or with high normative commitment (those who feel a sense of obligation to support the change) should be willing to do more than what is required.
This happens even if this requires some personal sacrifice. However, it was also found, that employees with high continuance commitment (those whose commitment is based on perceived cost of failing to support the change) would contribute only a little more than what is required.
Meyer et al. (2007) built on this study. In their research, they chose a very different change context and sample, bringing generalizability to the findings. However, they also found, that commitment to the change itself was a better predictor of behavioral support to the change when compared to commitment to the organization. They con- cluded that employee commitment is a key factor in implementing organizational
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changes. Furthermore, they extended this idea by suggesting that commitment to the change initiative might be even more important as compared to commitment to the organization itself.
In the study conducted by Iverson (1996), organizational commitment was also found to be one of the most important determinants of organizational change. Furthermore, organizational commitment was found instrumental in achieving organizational change as it was found to be an intervening variable for determinants in the model studied. Thus, it was suggested, that, as a determinant and mediator, organizational commitment should be integral to any change strategy.
Implementing information systems has also been widely researched as a process. Ac- cording to Brown (2007), this process is seen to progress as stages from initiation to infusion. Brown et al (2007) extended the study by Iverson (1996) by studying the role of five broad factors, which have been repeatedly associated with success and failure in the implementation process, in the process of implementing information systems. The items were selected though reviewing the existing literature. There five factors include 1) commitment, 2) knowledge, 3) communication, 4) planning and 5) infrastructure. In their study they identified commitment as the resources that were dedicated to IT and as the dedication to changing the procedures of the organization.
The resources included both financial and human resources.
Brown (2007) found that commitment is one of the main factors affecting successful implementation of information systems. In the study, communications and commit- ment was found as most important factors, as they were most frequently cited in the existing literature. Commitment gained importance steadily throughout the process, and it was found to be the most important factor in the stage of acceptance.
Arikoski and Sallinen (2007) show a model for individuals’ commitment to change.
This model is divided in eight stages: sabotage, resistance, resignation, neutrality, empowerment, acceptance, acting, cooperation and commitment. This model resem- bles a common view that individuals have a tendency to resist changes at first, but then people start to accept the changes and reorganize the attitude and practices.
24 2.3.2 Affecting commitment to change
According to Burke (2008), the reactions of the individuals can be affected. It is sug- gested that the ease of change is dependent on how much individuals believe they can define and execute the change. Thus, it is seen, that to reduce resistance to change, it is important that individuals feel they participate to the change process and can affect to the change. Thus, top-down approach to change is seen to increase resistance and it should be avoided.
This thesis views commitment to change from the perspective of employees. Along- side with the sensemaking process, the thesis examines the factors affecting success- ful change process. Whelan and Somerville (2010) note that changes in organizations are actually about changes at the individual level, as change takes place in the behav- ior, practices, values and attitudes of the individual employees.
Various scholars have studied the factors that affect employees’ commitment to change, that should be considered during the change process. Some of the factors af- fecting to commitment are found for example as communications, sense of procedural justice (Sidle, 2003) and leadership (Hill et al., 2012; Neves, 2011). This section pro- vides an overview of the factors that have been found to affect the commitment in the literature.
Parrish et al (2008) note various aspects that affect the commitment to change. Firstly, the change must be in alignment with the strategic vision of the organization. Fur- thermore, they see that the quality of the employee-leader relationship affects the level of commitment. Furthermore, they saw that the work motivation and the level of in- dependence in the work of the employees affect the commitment. Thus, they suggest for example, that the more motivated the employee is, the more likely the employee is to commit to both the organization and the change itself. These four issues were seen to affect affective and normative commitment positively and were seen as enablers for these types of commitments.
Whelan-Berry and Somerville (2010) suggest that participation in change process deepens the understanding about the change, and may lead to increased commitment.
Foster (2010) supports this view and suggests actions by which participation can be
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increased. These measures include dialogues, interviews and forums, which all en- courage sharing the visions and emotions of the individual. Brabant et al. (2007) ex- amine committing employees to reorganization, and suggest that making employees participate is important, but as important is to appreciate the employees that are un- willing to participate in the change process.
Rissanen and Lammintakanen (2011) as well as Brabant et al. (2007) see that employ- ees are valuable assets for the changes – the ideas of the employees should not only be listened, but managers and leaders should also act upon those ideas in the planning and execution stages. Brabant et al. (2007) further suggest that openness is in a key position for accepting reorganization and committing to the changes. Accepting and committing to the change was seen easier when employees are enabled to participate to the planning and execution of the change. Rissanen and Lammintakanen (2011) see that participation can decrease the anxiety and uncertainty of the employees, which increases the sense of control and trust towards the future. Furthermore, it is suggested that employees who feel they can individually affect the change – the education and training, scheduling etc. - are expected to possess affective or normative commitment to change (Parish et al., 2008).
Parish et al. (2008) note some further factors affecting to the commitment, which in- cludes consistency with the vision, the relationship between the employee and leader, motivation and feeling of independence. They suggest that good relationship with the supervisor and motivation towards the change results in less feelings of being coerced to implement the change. They also suggest that independence in work role makes individuals more committed to change.
Another factor affecting to commitment to change is suggested to be justice, both be- tween individuals and regarding knowledge (Rissanen and Lammintakanen, 2011;
Foster, 2010; Whelan-Berry and Somerville, 2010). The justice is reflected especially in the communications between the employees and supervisors. Communications should be detailed, timely and individual, explaining every stage of the change pro- cess. Here again, participation through education and feedback forums are suggested.
(Rissanen and Lammintakanen, 2011; Foster, 2010)
The importance of communications is also noticed by Whelan-Berry and Somerville (2010), who state that communications directed towards understanding the need for
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change is essential. Regular communications can increase understanding about the change, resulting in increased commitment. Furthermore, they note the importance of two-way communications, which includes sharing information and listening to others.
According to Rissanen and Lammintakanen (2011), healthcare sector varies from oth- er fields in that often decisions are made externally of the organizations, which often means the political decision makers of the municipalities. Thus, the changes in the field of health care are often involuntary at least to some extent. They further note that the specific features of the health care organizations, such as large size, hierarchy and competing interests of different professional groups, bring challenges to managing change. They note that the sense of justice is dependent on the level of knowledge employees have about the change, participation and cooperation. Commitment to change can be enforced by feeling of togetherness, equality, sense of safety and mutu- al trust. Especially the role of trust is highlighted – sense of justice leads to trust and trust requires sense of justice.
Hill et al. (2012) highlight the importance of the communications in commitment to change. They studied how hierarchy and transformational leadership affect the affec- tive and normative commitment of the employees. Transformational leadership style is often related especially to change situations and it refers leaders that create and communicate a vision, create empowering opportunities and stimulate people intellec- tually, and have personal credibility that affect in trust and admire (Herold et al., 2008). Hill et al. (2012) suggested that the effectiveness in communicating the change at the upper management levels has an important role. This was in both top-down and bottom-up communications. Top-down communications was found important for en- hancing the level of affective commitment, and it played an important role especially in the early stages of the change process.
Sidle (2003) studied the importance of commitment during the change processes. The findings supported the findings from other scholars introduced before. Increasing commitment was seen to require communications, for example regarding the purpose of the change early in the process. The feelings of justice were seen to affect the atti- tudes and behaviors of employees. Overlooking employee perceptions over procedur- al justice in the planning stage may affect the employees’ trust in executives negative-
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ly, their willingness to stay in the company and the sense of psychological contract to the company, referring to mutual obligations binding employees to the company.
Hill et al. (2012) studied the effects of direct leaders in the change context. Most of the research has been conducted focusing on top level or middle level managers. They found that the leadership style affected the level of affective and normative commit- ment especially at the early stages of the process. At first stages, employees reported higher levels of affective and normative commitment, when the leader used trans- formative leadership style. Hill et al. (2012) further suggest that when commitment is established through transformational leadership, the level of commitment may remain unchanged throughout the process.
Finally, related to leadership, Neves (2011) studied the relationship between supervi- sor competence and support and commitment to change. It was noted that supervisors, as change agents, play a key role in implementing the change successfully. Their study found that perceived supervisor support mediated a positive relationship be- tween competence and affective and normative commitment to change. However, supervisor competence was found to be negatively related to continuance commit- ment.
2.4 Sensemaking
Sensemaking refers to the ‘site where meanings materialize that inform and constrain identity and action’ (Weick et al., 2005: 407). As a term it is self-explanatory as it simply means marking sense of events. Materializing in this context refers to sense- making being an issue of language, talk and communication as for example situations are brought into existence through talk (Weick et al., 2005). Weick (1995) explains that people generate sense in their words through conversations. This takes place when people convey something about their ongoing experiences. According to Pek- karinen (2015), the ideal result of a sensemaking process is realizing the meaning of the event.
According to Weick (1995), sensemaking simply means the making of sense. The conceptualization of sensemaking has been examined from the perspectives of strate-
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gy and socialization. From the strategic perspective, sensemaking has been seen as a framework and directive force in interpretations (e.g. Westley, 1990; Goleman, 1985;
Dunbar, 1981). In comparison, socialization perspective sensemaking is a thinking process - or a recurring cycle - that uses retrospective accounts in explaining surpris- ing events (Louis, 1980). According to the latter perspective sensemaking starts when individuals make predictions about future events. After this people experience the events and the experiences may differ from the predictions. These surprises then trig- ger a need for explanation and for a process through which interpretations of the dis- crepancies can be developed (Louis, 1980).
Weick (1995) notes that sensemaking exists everywhere, since people can make sense of everything. Sensemaking has been examined in organizational contexts. Weick (1995) notes that in organizations sensemaking occurs especially in two common oc- casions: in cases of ambiguity or uncertainty. These two cases engage people in sensemaking due either being confused by too many interpretations (ambiguity) or being ignorant of any interpretations (confusion).
Sensemaking must be separated from interpreting. According to Weick (1995:13),
‘sensemaking is about the ways people generate what they interpret’. Furthermore, sensemaking consists of actions, activities and creation that lay down traces that are then interpreted and probably reinterpreted. This categorization suggests that sense- making is about activities or processes, while interpretation can be a process or a product as an interpretation that someone can ‘make’. However, the process of sensemaking is seen more similar with interpretation, than comparison or classifica- tion of events (Weick, 1995).
Various authors place some actions or mechanisms in the discussion of sensemaking.
Some scholars (e.g. Louis, 1980 and Westley, 1990) have the focus on individuals placing stimuli to the frameworks. This perspective is extended by Thomas Clark and Gaiola (1993) adding information seeking, meaning ascription and action into the discussion on sensemaking. This view sees environmental scanning and interpreta- tions included in the included mechanisms to sensemaking processes. Furthermore, Sackman (1991) extends the discussion by including the standards and rules associat- ed with perceiving, interpreting, believing and acting to the discussion. This perspec-
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tive further notes that the standards and rules are applicable in specific cultures and settings.
It must be further noted that often sensemaking, as a way of understanding events better, is seen to result in some action (Thomas et al., 1993; Sackman, 1991). Howev- er, Feldman (1989) argues that that often sensemaking does not result in any action.
Instead, it is seen that sensemaking may lead to understanding that actions should not be taken or that before taking any actions, the understanding of the event must be en- hanced. Thus, the result may be individuals possessing more and different type of information about the event rather than in any concrete actions.
2.4.1 Sensemaking as individual process
Sensemaking can be addressed at different levels of analysis (Weick, 1995; Wiley, 1988). Sensemaking can be examined at the three macro levels, which are seen above the individual level of analysis. According to Wiley (1988), these levels include inter- subjective, the generic subjective and the extra subjective levels. Intersubjective sensemaking takes place upon the synthesis and synthesis of two or more communi- cating parties. Generic subjective level is about the level of social structure and this level considers organizations instead of individuals. Finally, extra subjective level of analysis considers cultural level.
This view is supported also by Pekkarinen (2015) who notes that sensemaking can be approached from two perspectives: individual and social construct. The individual approach is based on individual habits, interpretation and learned models to make sense of new situations and their effects on action. The perspective of social con- structs emphasizes the joint process and ways to act in a changed situation.
According to Weick (1995), sensemaking is grounded in individual and social activi- ty. However, it is seen, that these two may not be even separable. Sensemaking as an individual process is about building personality (Pekkarinen, 2015; Weick, 1995).
People’s worldviews are affected by the upbringing, personal experiences and social context. Sensemaking is a process that begins when people face events and clues in their environment that they are not used to (Weick, 1995; Pekkarinen 2015). This the-
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ory has its bases on joint learning in organizations, the interactive relationships be- tween the members, and causality. (Pekkarinen, 2015)
Sensemaking can be further explained by some critical questions that help explaining the context in everyday life. How does something come to be an event for organiza- tional members? What does an event mean? Now what should I do? This is a way of confronting something unintelligible, thus bringing an event into existence and bring- ing meaning into existence. The second question stems from connections with the past experience and dialogue with other people. In comparison, the last question emerges from the presumptions people have about the future and projects that become clearer when they unfold. (Weick et al., 2005)
It is noted that rather than being the influence of evaluation on choice, sensemaking is about interplay of action and interpretation. It is suggested that if action is the central focus of change, interpretation is the choice of phenomenon. Sensemaking notes that smallness does not mean insignificance. Instead, small structures and short moments within the change processes can have rather large consequences. (Weick et al., 2005)
2.4.2 Sensemaking and change
Sensemaking has its origins within the organizational theory and it is often related to the studies about change in general and organizational change (Kezar, 2013; Weick et al., 2005). The concept is a central element in organizational theory, as it has a central role in determining human behavior (Weick et al., 2005). According to Weick (1995), organizations are social constructions that are created and recreated by individuals when they make meaning of their work life.
In the change context, sensemaking could be seen referring to understanding the change and making the change meaningful for the stakeholders of the change (Kezar, 2013). Weick et al. (2005) notes that it is difficult for people to engage in a change process if it is not made meaningful for them and they cannot see a connection to the change. Thus, it was seen that leaders can aid in making connections and sensing the meaningfulness by placing structures and processes in place. These can assist in creat- ing shared senses of organization such as task forces and dialogues for individuals.
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It is suggested that sensemaking can be started by five different kind of events catego- rized as 1) important planned, 2) important unplanned, 3) small planned, 4) small un- planned and 5) hybrid events. Implementing a new information system is considered as a small planned event. These planned changes in procedures affect either individu- als or small groups within the organization, and they occur in daily work. Thus, they may not be greatly reflected in the operation of the entire organization. (Sandberg and Tsoukas, 2014)
Weick (1995) suggests a relationship between sensemaking and commitment. This relationship is built upon the thought that ‘people try hardest to build meaning around those actions to which they commitment is strongest’ (p.156). When people are com- mitted, the sensemaking of individuals’ is focused upon the binding actions, behavior- al commitment.
The studies about sensemaking have usually taken a top-down approach by studying top managers’ perspectives (e.g. Pekkarinen, 2015 and Lammassalo and Hiltunen 2015). More lately, a shift has occurred to include also middle managers in the stud- ies. Only few studies have emerged with the perspective of employees (e.g. Bean and Hamilton, 2006; Bartunek et al., 2006). Furthermore, studies are usually made only at the first stages of the change process, as the usual assumption is that sensemaking would serve less pivotal role at later stages, once buy in is achieved (Kezar, 2013).
According to Bean and Hamilton (2006), sensemaking studies have usually focused on cognitive traditions, but also communicative approach has gradually gained im- portance. Bean and Eisenberg (2006) noted, that the studies on organizational sense- making have lacked of process focus. They also noticed a need for further studies on sensemaking in implementing new technologies.
As noted by Lammassaari and Hiltunen (2015), sensemaking has not been widely used as a method of analysis. However, more recently applying sensemaking as an analytic framework has evolved (e.g. Lammassaari and Hiltunen, 2015; Pekkarinen, 2015; Bean and Hamilton, 2006). Lammassaari and Hiltunen (2015) used all seven sensemaking properties in analyzing their narrative interview data. This was done in order to capture a comprehensive view regarding the sensemaking process of an exec- utive manager in the Finnish healthcare sector. This study provided a unique descrip- tion of identity construction through sensemaking in this context. Pekkarinen (2015)
