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unexpected changes are inevitable, given the adaptive complex sociotechnical system where implementation takes place, and the inevitable limitations of all technologies. The case study hospital EHR implementation is not an exception. The theory of collective mindfulness applied to this case gives insights into the ways ‘the unexpected’ (i.e. the inevitable surprises during implementation) is dealt with, that may turn a problematic implementation process into a ‘success’. In the specific case study described, the organisation demonstrated the capacity to support the discovery of ambiguities, solve emerging issues and progress with an otherwise ambiguous ill-defined project (‘the scanning’). The five dimensions of collective mindfulness were present, both to anticipate and contain the unexpected (e.g. issues for others’ clinical work generated by changes in workflows). Crucial elements and fundamental premises for collective mindfulness were: widespread questioning of assumptions, of preconditions and of effects of decisions; collective discussion; under- specification of structures; support from project management. These enabled sensemaking activities akin to those practiced in user-centred system design, such as ‘co- design sessions’ and ‘workflow mapping exercises’. The project team also encountered barriers that made the sensemaking activity more difficult. For example, clinicians were too busy to participate in meetings; expertise in ‘their part of the workflow’ was missing from the ‘appropriate mix’ necessary to understand repercussions of proposed changes across the whole process. This was addressed by taking note of necessary questions that one of the team members would ask doctors after the meeting. There was also the inevitable tension of most HIT implementations between standardisation and local customisation. The solution that worked for this hospital was the design of a ‘hierarchy of standards’: a level 1 hospital- wide procedure, and a level 2 specific to each local department. This structure allowed for a standardised flexibility where local work redesign would take into account interconnections with other departments. Overall, the case shows how ‘mindful managers of change’ ‘can draw on the five characteristics of mindfulness to ensure more productive organizing to support mindful sensemaking’ [16, p26]. 4. Discussion and conclusion The theory of collective mindfulness has been challenged on a number of grounds. HROs as an organisational type remain ill-defined; achieving reliability is not necessarily equivalent to achieving safety; and the five mindful organising principles could be viewed as representing more ideals an organisation may aspire to than a description [17- 19]. The five principles are not sufficient on their own for an organisation to operate safely, but need to build on structural preconditions, such as human resources practices that foster trust and respect, and selection and allocation of resources, including IT [20]. The HRO model represents the appropriate organisational response to a certain type of risks and environment, but must not be considered the right response for all environments [21]. Recommendations for practice drawn from the theory may be challenging to put into effect as they involve, for example, changing organisational culture or communication practices. Despite some criticisms and limitations, the theory of collective mindfulness has been used in healthcare as foundation for informing the development of interventions proposed to improve quality, safety and resilience [18, 22]. However, the theory of V.LichtnerandJ.I.Westbrook /CollectiveMindfulnessandProcessesofSensemaking106