Debate

The role of conversation in health care interventions: enabling sensemaking and learning

Michelle E Jordan¹ , Holly J Lanham² , Benjamin F Crabtree³ , Paul A Nutting⁴ , William L Miller⁵ , Kurt C Stange⁶ and Reuben R McDaniel Jr²

¹  Department of Educational Psychology, College of Education, The University of Texas at Austin, Austin, Texas, USA

²  Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, Austin, Texas, USA

³  Department of Family Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey, USA

⁴  Department of Family Medicine, Center for Research Strategies, University of Colorado Health Sciences Center, Denver, Colorado, USA

⁵  Department of Family Medicine, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania, USA

⁶  Departments of Family Medicine, Epidemiology and Biostatics and Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA

author email corresponding author email

Implementation Science 2009, 4:15doi:10.1186/1748-5908-4-15

Published:	13 March 2009

Abstract

Background

Those attempting to implement changes in health care settings often find that intervention efforts do not progress as expected. Unexpected outcomes are often attributed to variation and/or error in implementation processes. We argue that some unanticipated variation in intervention outcomes arises because unexpected conversations emerge during intervention attempts. The purpose of this paper is to discuss the role of conversation in shaping interventions and to explain why conversation is important in intervention efforts in health care organizations. We draw on literature from sociolinguistics and complex adaptive systems theory to create an interpretive framework and develop our theory. We use insights from a fourteen-year program of research, including both descriptive and intervention studies undertaken to understand and assist primary care practices in making sustainable changes. We enfold these literatures and these insights to articulate a common failure of overlooking the role of conversation in intervention success, and to develop a theoretical argument for the importance of paying attention to the role of conversation in health care interventions.

Discussion

Conversation between organizational members plays an important role in the success of interventions aimed at improving health care delivery. Conversation can facilitate intervention success because interventions often rely on new sensemaking and learning, and these are accomplished through conversation. Conversely, conversation can block the success of an intervention by inhibiting sensemaking and learning. Furthermore, the existing relationship contexts of an organization can influence these conversational possibilities. We argue that the likelihood of intervention success will increase if the role of conversation is considered in the intervention process.

Summary

The generation of productive conversation should be considered as one of the foundations of intervention efforts. We suggest that intervention facilitators consider the following actions as strategies for reducing the barriers that conversation can present and for using conversation to leverage improvement change: evaluate existing conversation and relationship systems, look for and leverage unexpected conversation, create time and space where conversation can unfold, use conversation to help people manage uncertainty, use conversation to help reorganize relationships, and build social interaction competence.