Sensemaking Held Swedish Healthcare Together in COVID-19’s First Weeks

When the COVID-19 pandemic swept into Sweden in the spring of 2020, nurses and physicians faced an unprecedented collision of clinical uncertainty, shifting directives and personal risk. A new qualitative study published in BMC Health Services Research by Helena Månsson Sandberg, Mats Jong, Miek C. Jong and Erika Wall of Mid Sweden University, together with a co-author based at UiT The Arctic University of Norway, examines how these frontline workers managed their daily practice during the earliest and most disorienting weeks of the outbreak. The researchers frame their analysis through the concept of sensemaking, a perspective from organisational and psychological science that describes how people strive to clarify and understand what is happening when they encounter ambiguous, unexpected or confusing events. The study’s central conclusion is striking in its simplicity: sensemaking, operating simultaneously at organisational, interpersonal and individual levels, functioned as a kind of connective tissue that held clinical practice together throughout the uncertainty.

The evidence base for the study consists of individual interviews with 18 nurses and physicians, conducted between March and May 2020, precisely the window in which the pandemic first disrupted routine Swedish healthcare. The timing matters scientifically. Because the interviews took place while the crisis was unfolding rather than in retrospect, the data capture workers’ sensemaking in something close to real time, before memory had been smoothed by hindsight or by later knowledge about the virus. The researchers analysed the interview material using reflexive thematic analysis, a qualitative method in which researchers systematically code the data and iteratively develop themes, while remaining explicitly aware of how their own perspectives shape interpretation. Rather than testing predefined hypotheses, the approach allowed patterns of meaning to emerge from the accounts themselves.

The analysis revealed an overarching pattern: sensemaking operated as a way of holding clinical practice together throughout uncertainty. This pattern unfolded across three mutually interrelated levels. At the organisational level, sensemaking was anchored in how organisational structures contributed to stability in the organisation of work. In other words, formal frameworks, routines and directives were not merely administrative apparatus; they provided interpretive anchors that helped workers understand what was expected of them when the situation itself offered no clear script. The authors emphasise that clear organisational directives are important for fostering a shared understanding of how uncertain situations should be interpreted and managed in practice, a finding with direct implications for crisis planning in health systems.

The interpersonal level of sensemaking captured something equally vital: the understanding of uncertain circumstances was grounded in a collective understanding, in which healthcare workers reflected together and in relation to others. Confronted with questions that no individual could answer alone, such as how the disease presented, how it spread and how care should be reorganised, workers turned to colleagues as interpretive partners. Through conversation and shared reflection, tentative individual impressions were tested, refined and converted into workable collective understandings. The study’s implications section underscores this point, noting that healthcare workers need opportunities and time for interaction with colleagues, enabling them to collectively construct meaning and maintain a sense of stability when managing uncertainty. In crisis conditions, social interaction is not a luxury; it is a cognitive infrastructure.

The third level, the individual, captured healthcare workers’ capability and commitment to continuing to provide care despite uncertain circumstances. Even as guidelines shifted and knowledge about the virus remained fragmentary, individual clinicians drew on their professional knowledge, accumulated experience and personal sense of responsibility to sustain care. The researchers argue that it is important for healthcare organisations to acknowledge workers’ individual knowledge, experiences and capability to sustain clinical practice under such conditions. This finding reframes resilience during the pandemic not simply as endurance or sacrifice, but as an active interpretive achievement: clinicians continuously constructed workable courses of action from incomplete and evolving information.

From a theoretical standpoint, the study demonstrates the analytical value of treating sensemaking as a multilevel phenomenon rather than a purely individual psychological process. The three levels described in the findings are characterised as different but mutually interrelated, meaning that organisational structures, collegial reflection and individual commitment reinforced one another. Clear directives from above gave workers a common interpretive frame; collegial interaction allowed that frame to be adapted to local clinical realities; and individual competence enabled the frame to be enacted at the bedside. Disrupting any one of these levels, the analysis implies, could destabilise the whole system of meaning on which crisis response depended.

The practical implications for health services research and management are considerable. The authors state that sensemaking at organisational, interpersonal and individual levels should be an important consideration for healthcare organisations when facing future crises or other uncertain events. For planners, this suggests that pandemic preparedness should include not only material resources such as protective equipment and ventilator capacity, but also communicative and structural resources: unambiguous directives that reduce interpretive ambiguity, and protected time and space for colleagues to talk through evolving situations together. The finding is especially relevant for health systems that operate under high autonomy and decentralised decision-making, where the translation of national guidance into local practice depends heavily on collective interpretation.

The study also contributes methodologically to the literature on healthcare work during COVID-19. By interviewing nurses and physicians across the early weeks of the pandemic and applying reflexive thematic analysis, the researchers produced a thematically organised account of the work situation that complements quantitative studies of infection rates, staffing and burnout. The focus on sensemaking, a concept with roots in organisational sociology and qualitative psychology, connects the Swedish experience to a broader research conversation about how organisations and professions cope with radical uncertainty, a conversation that spans crisis management, organisational climate and the sociology of work.

The research was carried out at the Department of Health Sciences at Mid Sweden University, with open access funding provided by the university and financial support from AFA Försäkring, the Swedish collective agreement insurance provider, under grant number 200126. The authors report no competing interests. In line with the recommendations of the Internal Review Board at Mid Sweden University, the study, which focused on experiences and perceptions of the working situation rather than sensitive personal information, was not subject to the regulations of the Swedish Research Ethics Act. Participants received written information about the study’s purpose and their right to withdraw at any time, gave oral consent documented in the audio recordings, and were assured confidentiality, with data handled in accordance with GDPR and stored on a secure university server with restricted access, in compliance with the Helsinki Declaration.

As health systems worldwide continue to digest the lessons of COVID-19, this study offers a deceptively quiet insight with far-reaching consequences. The capacity of healthcare organisations to withstand crises may depend less on heroic individual effort than on the quality of the interpretive environment in which clinicians work: how clearly directives are communicated, how freely colleagues can reflect together, and how genuinely their individual expertise is recognised. Sensemaking, the Swedish findings suggest, is not an abstract academic construct but the everyday mechanism by which clinical practice survived the pandemic’s most confusing weeks, and a resource that future crisis preparedness would be unwise to overlook.

Subject of Research: Sensemaking among Swedish healthcare workers during the early weeks of the COVID-19 pandemic

Article Title: How Swedish healthcare workers managed the early weeks of the COVID-19 pandemic: sensemaking across organisational, interpersonal and individual levels

Article References: Månsson Sandberg, H., Jong, M., Jong, M. C., & Wall, E. (2026). How Swedish healthcare workers managed the early weeks of the COVID-19 pandemic: sensemaking across organisational, interpersonal and individual levels. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15826-y

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15826-y

Keywords: COVID-19, sensemaking, healthcare workers, nurses, physicians, pandemic, crisis management, organisational behaviour, qualitative research, thematic analysis, health services research, Sweden