Page - 99 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

1. Introduction: the theory of collective mindfulness Mindfulness is a state of being attentive to new information, new meanings, and different points of view [1]. It is not about meditation. The theory of collective mindfulness originated in the mid-1990s from research that applied an organisational lens to the investigation of high reliability organisations (HRO) [2-4]. Among the originators of the theory were Karl Weick, Karlene Roberts, Kathleen Sutcliffe and other members of ‘the HRO Project’ at Berkeley (University of California). HROs are organisations operating in high levels of complexity and risk, but where serious accidents are extremely rare. Examples of these type of HRO are naval and armed forces, fire services. These organisations cannot afford to learn from trial and error as other organisations might do; instead, their ‘first error is the last trial’ [3][p32]. The theory of collective mindfulness arose from the investigation of these HROs as a way to explain how they are able to work in highly complex environments and yet ensure few major errors occur. Collective mindfulness is an organisational state of being, or way of working, which is characterized by ‘a quality of organizational attention that increases the likelihood that people will notice unique details or situations and act upon them’ [2][p410]. It emerges from five ongoing reliability-enhancing (collective) cognitive processes geared towards anticipating and containing the unexpected (Table 1): preoccupation with failure, reluctance to simplify interpretations, sensitivity to operations, commitment to resilience, and deference to expertise [2, 3]. The first three processes sustain an organisation’s capacity to anticipate, and make sense of, ‘the unexpected’. For example, to anticipate a fault in equipment. The last two processes focus on dealing with, and containing, the problem, before it results in an accident or harm. Through the enactment of these processes, an organisation shows the capacity for resilience. Table 1. Five dimensions of collective mindfulness (adapted from [2, 3, 5]) Dimensions Definition Preoccupation with failure An ongoing wariness that errors are possible; paying attention to things going right, those that do not go right, and how things could go wrong; small failures and near misses are treated as indicators of potentially bigger issues. Reluctance to simplify interpretations Not taking the past as the only guide to the present. Making fewer assumptions, questioning usual wisdom, uncovering blind spots, bringing more perspectives to achieve understanding. Sensitivity to operations Creating and maintaining an integrated ‘big picture’ of the current situation in the moment, through real time information. Similar to situation awareness, it involves the envisioning of possible future states and knowledge of interconnections. Commitment to resilience Awareness that it is impossible to eliminate uncertainty or anticipate all situations. Capacity building. The enlarging of individual and organisational capabilities to enable recovering from the unexpected (what cannot be anticipated). Capabilities include widening of ‘repertoires of actions’, skills at improvisation, ‘recombination’ and adaptation, ad hoc networks. Ways to achieve this include incorporating lessons from the past, training and learning from feedback. Deference to expertise (also referred to as flexible decision structures or under- specification of structures) Enabling the persons with the greater expertise to handle the problem and make decisions regardless of rank or hierarchy. This requires flexibility in organisational structures. V.LichtnerandJ.I.Westbrook /CollectiveMindfulnessandProcessesofSensemaking 99