Sensemaking approach tested to track a complex Alberta health innovation

Health system innovations designed to improve access to care are complex, and their consequences are not always predictable. A team of Canadian researchers has now published an account of their attempt to use a sensemaking methodology to monitor and evaluate a large-scale health system innovation in Alberta, documenting both what succeeded and what did not. The study, published in BMC Health Services Research, offers a candid field report on the practical difficulties of building situational awareness in a live healthcare setting.

The work took place between May 2022 and October 2023. The researchers set out to test whether a sensemaking approach, developed in their earlier work, could be extended to provide near real-time feedback on a large-scale health system innovation. Their focus was the FAST program, an innovation aimed at improving healthcare access in Alberta’s surgical referral system.

To gather data, the team designed two complexity-informed data collection instruments using the Cognitive Edge SenseMaker tool. They attempted two things: first, to operationalize these instruments across diverse patient populations and providers, and second, to engage stakeholders in collaborative sensemaking of the insights that emerged from the data. The goal was to capture evolving contexts and impacts as the innovation unfolded, rather than evaluating it retrospectively.

Over the study period, test data yielded 221 patient entries and 104 provider entries concerning surgical referral experiences. These entries provided raw material for the sensemaking process, offering perspectives from both sides of the referral pathway on how the innovation was playing out in practice.

However, the central scaling effort did not succeed. Attempts to deploy the data collection instruments within formal healthcare channels, with the aim of reaching a diverse representation of patients and providers, proved unsuccessful.

Rather than abandoning the effort, the researchers pivoted. They redirected their attention to capturing information about the impacts of the data collection strategies they had enacted. From these efforts, they generated a diagrammatic representation of the sensemaking methodological approach, which they named Illuminate 360°.

The Illuminate 360° approach consists of an iterative cycle with five stages: data collection, analysis, monitoring and reflection, decision-making, and action planning. Central to the framework is the integration of regular sensemaking sessions with relevant parties. According to the authors, these sessions facilitate clarity on the phenomenon of interest and generate insights that can be translated into action.

In their conclusions, the researchers acknowledge that scaling the methodology through formal channels proved unfeasible within the project’s parameters. Nevertheless, they argue that their findings offer critical insights into building situational awareness for complex healthcare interventions. They contend that the Illuminate 360° approach, when grounded in implementation science frameworks and theories, can generate timely, co-created data to inform healthcare improvement and support data-driven decision-making.

The study is presented as a lessons-learned contribution rather than an efficacy trial. Because the instruments were tested rather than fully scaled, the reported entries reflect test data within the project window, and the authors’ claims about the framework’s potential rest on their field experience rather than on demonstrated outcomes at scale. For health services researchers and improvement teams, the account documents both the promise of sensemaking methods for real-time evaluation and the practical barriers that arise when such methods meet the formal structures of a health system.

Subject of Research: Feasibility of using sensemaking methodology to build situational awareness for a large-scale health system innovation in Alberta

Article Title: Lessons from the field: attempting to use sensemaking to build situational awareness in Alberta’s FAST program

Article References: Ofosu, N. N., Jabbour, B., Beesoon, S., Berzins, S., Heatherington, M., Robert, J., Brindle, M., & Campbell-Scherer, D. (2026). Lessons from the field: attempting to use sensemaking to build situational awareness in Alberta’s FAST program. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15889-x

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15889-x

Keywords: sensemaking, health services research, situational awareness, surgical referral, implementation science, complexity science, health system innovation, real-time evaluation, Alberta, qualitative methods, stakeholder engagement, Lessons