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We examine how interpersonal behavior and social interaction influence team sensemaking and subsequent team actions during a hospital-based health information technology (HIT) implementation project.

Over the course of 18 months, we directly observed the interpersonal interactions of HIT implementation teams using a sensemaking lens.

We identified three voice-promoting strategies enacted by team leaders that fostered team member voice and sensemaking; communicating a vision; connecting goals to team member values; and seeking team member input. However, infrequent leader expressions of anger quickly undermined team sensemaking, halting dialog essential to problem solving. By seeking team member opinions, team leaders overcame the negative effects of anger.

Leaders must enact voice-promoting behaviors and use them throughout a team’s engagement. Further, training teams in how to use conflict to achieve greater innovation may improve sensemaking essential to project risk mitigation.

Health care work processes are complex; teams involved in implementing improvements must be prepared to deal with conflicting, contentious issues, which will arise during change. Therefore, team conflict training may be essential to sustaining sensemaking.

Future research should seek to identify team interactions that foster sensemaking, especially when topics are difficult or unwelcome, then determine the association between staff sensemaking and the impact on HIT implementation outcomes.

We are among the first to focus on project teams tasked with HIT implementation. This research extends our understanding of how leaders’ behaviors might facilitate or impeded speaking up among project teams in health care settings.

What I refer to as a “monological” tendency is clearly seen in Spector and Kitsuse’s definition of their central term: …we define social problems as the actions of individuals or groups making assertions of grievances and claims with respect to some putative conditions (2001, p. 75).There is no mention here of audiences who hear such claims and grievances. The definition suggests that social problems are spoken into existence unilaterally by those who are especially aggrieved by perceived conditions of group life. Speakers are thus of primary importance, while listeners are not. There is likewise no reference to interactions between speakers and their audiences.