Healthcare and patient journeys

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Never has the need to take a complexity-informed approach to healthcare been more apparent; one that puts lived experience and context at the centre of a logic of care. As the COVID-19 pandemic has highlighted with greater urgency than we have felt in a generation, healthcare sits at the intersection of hundreds of questions: the natural science of research and investigation, the needs of people in pain, the pressures on and from their families, the structures of economic systems, and the needs and capacities of people trying to deliver it all come together to create a knot that cannot be unravelled. Like any complex, entangled, human problem, health must be approached as a whole.

Our SenseMaker® tool and surrounding methods have been used in the context of healthcare across the world for over a decade, across a wide variety of subjects which are both patient-facing as well as around structural and workforce issues. These approaches aim to democratise the research and engagement process by placing the respondent at the intersections of statistics and storytelling, asking them to be the owner of their own narrative. Located within an ecosystem of participatory methods, whether you’re looking to understand the experiences of healthcare professionals and leaders, patients and their relatives, or get a pulse check on employee wellbeing, our programme provides a platform for real-time distributed network response to key issues, as well as in defining collective insight to taking action.

As a membership-focused organisation, The Cynefin® Centre aims to provide practical and methodological scaffolding for practitioners in healthcare looking to make use of sense-making in their organisations and beyond. By joining our healthcare programme, you will be connecting to a wide and diverse community of practice, a movement of practitioners and organisations looking to make meaningful change for social good.

Due to the varied work we have built in the area of health, we can offer levels of service varying from tailor made bespoke projects, to tried and tested pulse survey options and signifier libraries around issues such as staff wellbeing and leadership journaling amongst others.

You can read more details on the practicalities of joining one of our programmes, in the brochure here.


Projects / reports on SenseMaker in health and care

An Oral History of Nursing during the pandemic, Royal College of Nursing, Northern Ireland - this project has since been launched UK wide

10,000 More Voices: Improving patient experience in Northern Ireland, Public Health Agency, Northern Ireland, UK

10 000 More Voices: Experience of Paediatric Autism and Child and Adolescent Mental Health Services Project, Public Health Agency, Northern Ireland, UK

Exploring drivers of child and early forced marriage in Zimbabwe and Philippines, Women's Refugee Commission

Understanding of what good clinical and care multi-professional leadership would look like in an Integrated Care Systems (ICS) context, Skills for Health, UK

Community voices, Palm Health Foundation, Florida, USA

Using SenseMaker to Understand Girls' Lives: Lessons Learnt from Girl Hub, Girl Hub, Rwanda, Ethiopia, Nigeria

Exploring theatre safety using SenseMaker®, NHS Ashford and St Peters Trust, UK

Women's experiences of the BRCA service, Ashford and St Peters Trust

Experiences of youth and adolescents' sexual and reproductive health in Rwanda and Northern Nigeria, Save the Children

An evaluation of the School for Change Agents, and continuing partnership with NHS Horizons, UK

Patient journey and teenagers and young adults' experiences of cancer clinical trials, University College London, UK

Leadership journaling, various


Peer-reviewed articles on SenseMaker / Cynefin in health and care

… SenseMaker overview

Making sense of complexity: using sensemaker as a research tool


… SenseMaker use cases

Illuminating and mitigating the evolving impacts of COVID-19 on ethnocultural communities: a participatory action mixed-methods study

Parenting in Adversity and Individual Perceptions of (In)Access to Health and Social Support Services: A Sensemaker® Study

Interprofessional sense-making in the emergency department: A SenseMaker study

Patient involvement in understanding steroid side effects, University of Leeds, UK

Exploring Student and staff wellbeing during COVID, University of Georgia, USA

The effects of mindfulness training on emotion regulation in Vietnamese pre-adolescents: A SenseMaker study

Making sense of child, early and forced marriage among Syrian refugee girls: a mixed methods study in Lebanon

The Value of Active Arts Engagement on Health and Well-Being of Older Adults: A Nation-Wide Participatory Study

“I Don’t Know Where I Have to Knock for Support”: A Mixed-Methods Study on Perceptions and Experiences of Single Mothers Raising Children in the Democratic Republic of Congo

Methodological reflections on the use of SenseMaker® for Impact M&E of Adaptation in the Mekong Delta (AMD)

Cholera in the Time of MINUSTAH: Experiences of Community Members Affected by Cholera in Haiti

'They came with cholera when they were tired of killing us with bullets': Community perceptions of the 2010 origin of Haiti's cholera epidemic

Mechanisms for productive public consultation in NI: empowering adults and developing collaboration

Exploring the potential of virtual reality technology to investigate the health and well being benefits of group singing

Voicing resilience through subjective well-being: community perspectives on responding to water stressors and COVID-19

Covid-19, indigenous peoples, local communities and natural resource governance

Understanding multiple health risks for low-income communities in Cape Town: water stress, COVID-19, and climate change

Your Voice Matters, a pilot qualitative study of integrated care in Ireland.

10,000 Voices: service users' experiences of adult safeguarding

"Even Peacekeepers Expect Something in Return": An Exploratory Epidemiological Analysis of Sexual Interactions between UN Peacekeepers and Haitian Females


… Cynefin

The Application of Cynefin to General Practice

Creating a healthcare variant CYNEFIN framework to improve leadership and urgent decision-making in times of crisis

A learning approach to community response during the COVID-19 pandemic: Applying the Cynefin framework to guide decision-making

Leadership emergence: the application of the Cynefin framework during a bio-social HIV/AIDS risk-reduction pilot

Informal and Incidental Learning in the Clinical Learning Environment: Learning Through Complexity and Uncertainty During COVID-19

A multi-ontology view of ergonomics: Applying the Cynefin framework to improve theory and practice

Re-imagining decision making: addressing a discrete social driver of HIV/AIDS through the lens of complexity science

Weak signal detection: A discrete window of opportunity for achieving ‘Vision 90:90:90’?

How the Cynefin Framework from Complex Adaptive Systems Theory and Action Research can inform voluntary medical male circumcision social marketing practice


Book Chapters

Researching practice or practicing research: Innovating methods in healthcare and the contribution of Cynefin, Annabelle Mark and Dave Snowden

Applied systems thinking for health systems research: A methodological handbook

When disease requires a complexity framework


Other related peer-reviewed articles

The ENCOMPASS framework: a practical guide for the evaluation of public health programmes in complex adaptive systems

Epistemic injustice in academic global health

Health care as a complex adaptive system: Implications for design and management