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Making Sense of Sensemaking
a breakdown in team sensemaking where critical cues were ignored and the teams
failed to synthesise the existing information”. The latter sentence may be a good
description of what happened on the bridge of the frigate HNoMS Helge Ingstad
before it collided with the tanker Sola TS in Hjeltefjorden on November 8, 2018
( AIBN, 2019). The comprehensive report from the accident investigation board takes
into account a broad set of factors contributing to the accident, like organizational
factors, leadership, teamwork, training and technology, on the frigate and the other
involved actors Sola TS and the Fedje VTS ( AIBN, 2019). But as a case of breakdown
in team sensemaking, it is interesting to take a look at what happened on the bridge
of HNoMS Helge Ingstad minutes before the collision.
On the bridge of HNoMS Helge Ingstad, the structure of team sensemaking was
hierarchical ( Klein et al., 2010). In such a structure, the data should flow from different sources to a common node, in this case the officer of the watch ( OOW), who puts
the pieces together and directs the search for new data. The OOWs role was being
responsible for conveying a clear and authorative picture of the situation ( AIBN,
2019). To use Kleins’ vocabulary, the OOW was the data synthesizer, which is a difficult task as the relevant information resides in different places.
During the watch handover sometime between 03:36 and 03:53, the OOW about
to be relieved and the oncoming OOW observed an object ( the tanker Sola TS) at
the Sture Terminal starboard of the frigate’s course line. It was observed both visually and on the radar display, however shown as an Automatic Identification System
( AIS) signal without speed vector. During discussion between the two OOWs, they
formed a clear perception ( selected a frame) that the “ object” was stationary near
the shore. According to the data/ frame theory of sensemaking ( Klein et al., 2007)
when a frame is selected it is used to guide further information seeking. During the
handover, the first opportunity to gather further data was missed as they did not use
the AIS to obtain more information about the “ object”. The relieving OOW’s mental
model was from this point very stable and the subsequent d ata-seeking and actions
were based on his selected frame of reference.
Since the “ object” was understood as stationary, it was not tracked by any of the
radars; hence the bridge system did not generate any alarms to indicate that the vessel was on collision course with Sola TS. The “ object” was primarily observed visually, and when Sola TS first started maneuvering out from the quay, this was done
so slowly that it was difficult to perceive any movement from the bridge on HNoMS
Helge Ingstad. Further visual observations by the bridge crew did not change the
impression of the “ object”. None of the bridge team members saw the navigation
lights on Sola TS; they only observed the strong deck lights. When the OOW saw that
a little distance had appeared between the shore and the “ object” on the radar, this
cue was explained by assuming that the distance between the shore and the “ object”
on the radar screen was due to the frigate having come closer to the point which the
“ object” lay alongside.
The information the OOW received from the rest of the bridge team gave no indication that the “ object” posed any risk to the voyage. The team’s capacity to monitor
the traffic situation was reduced due to a temporary unmanned starboard lookout
position. In addition, the OOW and the bridge team were focusing on training activities and on the three vessels approaching in the opposite direction on the port side of
Making Sense of Sensemaking
a breakdown in team sensemaking where critical cues were ignored and the teams
failed to synthesise the existing information”. The latter sentence may be a good
description of what happened on the bridge of the frigate HNoMS Helge Ingstad
before it collided with the tanker Sola TS in Hjeltefjorden on November 8, 2018
( AIBN, 2019). The comprehensive report from the accident investigation board takes
into account a broad set of factors contributing to the accident, like organizational
factors, leadership, teamwork, training and technology, on the frigate and the other
involved actors Sola TS and the Fedje VTS ( AIBN, 2019). But as a case of breakdown
in team sensemaking, it is interesting to take a look at what happened on the bridge
of HNoMS Helge Ingstad minutes before the collision.
On the bridge of HNoMS Helge Ingstad, the structure of team sensemaking was
hierarchical ( Klein et al., 2010). In such a structure, the data should flow from different sources to a common node, in this case the officer of the watch ( OOW), who puts
the pieces together and directs the search for new data. The OOWs role was being
responsible for conveying a clear and authorative picture of the situation ( AIBN,
2019). To use Kleins’ vocabulary, the OOW was the data synthesizer, which is a difficult task as the relevant information resides in different places.
During the watch handover sometime between 03:36 and 03:53, the OOW about
to be relieved and the oncoming OOW observed an object ( the tanker Sola TS) at
the Sture Terminal starboard of the frigate’s course line. It was observed both visually and on the radar display, however shown as an Automatic Identification System
( AIS) signal without speed vector. During discussion between the two OOWs, they
formed a clear perception ( selected a frame) that the “ object” was stationary near
the shore. According to the data/ frame theory of sensemaking ( Klein et al., 2007)
when a frame is selected it is used to guide further information seeking. During the
handover, the first opportunity to gather further data was missed as they did not use
the AIS to obtain more information about the “ object”. The relieving OOW’s mental
model was from this point very stable and the subsequent d ata-seeking and actions
were based on his selected frame of reference.
Since the “ object” was understood as stationary, it was not tracked by any of the
radars; hence the bridge system did not generate any alarms to indicate that the vessel was on collision course with Sola TS. The “ object” was primarily observed visually, and when Sola TS first started maneuvering out from the quay, this was done
so slowly that it was difficult to perceive any movement from the bridge on HNoMS
Helge Ingstad. Further visual observations by the bridge crew did not change the
impression of the “ object”. None of the bridge team members saw the navigation
lights on Sola TS; they only observed the strong deck lights. When the OOW saw that
a little distance had appeared between the shore and the “ object” on the radar, this
cue was explained by assuming that the distance between the shore and the “ object”
on the radar screen was due to the frigate having come closer to the point which the
“ object” lay alongside.
The information the OOW received from the rest of the bridge team gave no indication that the “ object” posed any risk to the voyage. The team’s capacity to monitor
the traffic situation was reduced due to a temporary unmanned starboard lookout
position. In addition, the OOW and the bridge team were focusing on training activities and on the three vessels approaching in the opposite direction on the port side of