Locating Uncertainty in Hospital Leader Sensemaking and Sensegiving of Organizational Change: A Single Case Study
Sara E. Barry, Ph.D. is a 2022 graduate of the PHD Program in Leadership and Change at Antioch University.
Sara Barry at her Dissertation Defense.
From L-R: Dr. Lisa Day (on-screen), Committee Member, Dr. Elizabeth Holloway, Committee Member, Dr. Donna Ladkin, Committee Chair.
- Donna Ladkin, Ph.D., Committee Chair
- Elizabeth Holloway, Ph.D., Committee Member
- Lisa Day, Ph.D., Committee Member
ambiguity, board member, cartography, case study, culture, executive, health care, hospital, middle manager, perceived location of uncertainty, relational leadership, sensegiving, sensemaking, strategic organizational change, uncertainty
Leaders planning strategic change face significant ambiguity and uncertainty due to the complex, fast-paced, and volatile nature of organizational life. What one leader sees as an opportunity, another may view as a threat depending on their past experiences, their existing mental models, and their perceptions of uncertainty. Sensemaking and sensegiving theories provide a framework for how leaders retrospectively make sense of new and disorienting information through recursive cycles of interpretation, action, and learning, and seek to influence the meaning-making of others towards a shared vision of the strategic change. Despite decades of research using these theories, studies have yet to examine leaders’ perceptions of the locations of uncertainty (i.e., environmental, organizational, or individual) and how they impact leader sensemaking and sensegiving processes. Through a case study of a Vermont hospital, I reviewed documents and artifacts, observed meetings, interviewed leaders (i.e., trustees, executives, and directors) and developed an understanding of the hospital’s social/political/historical/cultural context. The study revealed that leaders perceived uncertainty around five trigger situations. Leaders varied in their perceived locations of uncertainty by their level of leadership with all leaders perceiving moderate to high environmental uncertainty, executives and directors perceiving significant organizational uncertainty, and directors most likely to identify individually located uncertainty. Similarly, the specific qualities of uncertainty and leader sensemaking processes varied by perceived location of uncertainty and level of leadership. Of note, leaders were not always able to recognize their own perceptions of uncertainty. The case revealed an unexpected finding in the hospital’s positive and relationally-oriented culture which served a protective effect in leader sensemaking of organizational change. Together, the study’s findings highlight the need for leaders to attend to the perceived location(s) of change-related uncertainty and proactively discuss them with other stakeholders to manage uncertainty and successfully achieve strategic organizational change. This dissertation is available in open access at AURA: Antioch University Repository and Archive, https://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu/.
Barry, S. E. (2022). Locating Uncertainty in Hospital Leader Sensemaking and Sensegiving of Organizational Change: A Single Case Study. https://aura.antioch.edu/etds/876
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Sara E. Barry
ORCID Scholar ID #: #0000-0002-8448-2523
As a leader and change agent, Dr. Barry has focused her career on improving systems of care to achieve better health. Dr. Barry received her PhD from Antioch University’s Graduate School of Leadership and Change in Yellow Springs, Ohio, her master’s degree in public health from Dartmouth Medical School, and her undergraduate degree in psychology from Randolph Macon Woman’s College. Dr. Barry is a seasoned leader working to improve health systems by building and sustaining collaborative partnerships and implementing innovative payment and care delivery reforms. She has worked for various not-for-profit academic and healthcare organizations and currently serves as the chief operating officer of OneCare Vermont, a statewide accountable care organization of more than 5,000 healthcare providers voluntarily working together to improve the health of the population through implementation of value-based care reforms. Prior to her tenure at OneCare, Dr. Barry served on the faculty in the department of pediatrics at the University of Vermont College of Medicine, where she was responsible for strategic planning, program and policy development, grant writing, staff development, and fiscal and operational management of the Vermont Child Health Improvement Program. Her research focused on improving care for children and families by engaging healthcare providers in data-driven quality improvement strategies such as promotion of evidence-based practices; technology-driven workflows and registries; and cultural changes to promote health equity and inclusion.
Dr. Barry is a seasoned educator, facilitator, and coach having worked with hundreds of clinical teams to achieve measurable outcomes. She has consulted nationally with health care delivery and health care improvement organizations, using innovative pedagogical methods improve the capacity of the clinical workforce to achieve significant improvements in health care delivery and health outcomes. Dr. Barry’s research interests include leading through uncertainty, strategic organizational change, sensemaking and sensegiving, qualitative methods including multi-axial case study research, epistemology and decision-making in research methodologies, systems-thinking, networks and partnerships, organizational culture, relational leadership, population health, value-based care, healthcare reform, and leadership in practice.