A sensemaking lens on reliability

Summary This study assessed the applicability of current theories of reliability in dynamic settings by exploring the sensemaking processes experienced by a sample of medical residents around lapses in reliability of patient care. Important differences in lapses surfaced, particularly with respect to whether actors were aware that a lapse was occurring in real-time and whether there was anything they could do or say to mitigate or prevent the lapse. In over half of the incidents recounted, the actors did not become aware of the lapse in reliability until after the consequence of the lapse had occurred or the consequence occurred simultaneously with the recognition of the lapse. In other incidents, they faced a critical moment in which they had to decide whether and how to act to intervene in real-time. In the majority of these critical moments, residents had an issue of concern to voice that could have helped mitigate or correct the lapse but instead they remained silent. Issues related to identity and relationships appeared to either inhibit or promote voice during critical moments. We end with ideas for how our findings can inform existing work on reliability in healthcare and the growing literature on voice and silence in organizations. Copyright # 2006 John Wiley & Sons, Ltd.