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From the start, it became apparent that the staff of the clinic encountered several ‘sensemaking challenges’: how many scanners were needed? Who should scan the documents and when? Should there be changes to the workflow? What should be the processes for handling, distribution, registration, and further processing of documents? And why? Exceptions to initial assumptions surfaced as staff began to explore answers to these questions. The process of making sense took place through tentative plans, meetings, communication with the IT team and other hospitals services, mapping workshops, discussion and negotiation, that progressively involved the entire hospital, over a background of other concurrent change (e.g. the upgrade of the local area network infrastructure). Overall, ‘a seemingly trivial change (the installation of scanners) triggered a larger organisational change process than what had initially been expected.’[16][p24]. Completion of the project took time, but in the end, based on the experiences of the pilot, flexible procedures and organisational standards were developed, workflows were changed, scanning was implemented across all departments and this eventually completed the transition to paperless activities initiated with the initial EHR roll-out. 2.2. How the theory was applied to the case Aanestad and Jensen took collective mindfulness to be an organisational capability founded on processes of sensemaking. In seeking to understand the hospital implementation of the EHR system, they therefore asked what sensemaking processes occur during post-implementation adaptations and how these processes can be supported for the organisation to achieve this capability. Having had the opportunity to learn about the hospital decision of installing scanners to deal with paper records that remained in use after EHR roll-out, they observed the unfolding of this IT project, participated in meetings and interviewed the staff involved. They mapped the ‘sensemaking challenges’ encountered in the hospital by the people who were tasked with making sense of how to adapt their work practices around ‘the scanning’. Sensemaking activities were refined in terms of ‘making, giving, demanding and breaking sense’ [p24] which were then ‘translated’ into the five processes of collective mindfulness modified to be applicable to ‘an action-oriented context’. For example, preoccupation with failure was translated into preoccupation with constraints and preconditions. Deference to expertise, was manifested in the seeking out of an appropriate mix of expertise (Table 3). In this case study, the collective mindfulness lens reveals the collective cognitive processes and associated activities necessary to bring the initiative to completion hospital wide. The five dimensions are also proposed as an intervention towards future ‘successful’ implementations. This we discuss in the next section. V.LichtnerandJ.I.Westbrook /CollectiveMindfulnessandProcessesofSensemaking104