Appreciative Inquiry in Healthcare Matt Russell, MD, MSc Faculty Development and Diversity Seminar Series April 22, 2013

Proposed Agenda Opening Exercise (5) Debrief (10) Didactic (20) Professional Exercise (5) Debriefing and commitment to change(15) Evaluations and feedback (5)

Asking the Powerful Questions Narrative Exercise

Narrative Think back to a time when all of the pieces “fell into place” and you and your team were able to deliver exceptional care to a patient: –Who participated? What did they do? –What allowed this to happen-to make things go well? –How did it feel to be a part of this experience?

Narrative Debriefing

Today’s objectives To define appreciative inquiry (AI) and contrast with deficit-based modalities of change To illustrate applications of AI techniques in healthcare. To practice AI techniques and identify opportunities within our own environments.

Ap-pre’ci-ate, v., 1.valuing; the act of recognizing the best in people or the world around us; affirming past and present strengths, successes, and potentials; to perceive those things that give life (health, vitality, excellence) to living systems 2. to increase in value, e.g. the economy has appreciated in value. Synonyms: VALUING, PRIZING, ESTEEMING, and HONORING.

In-quire’ (kwir), v., 1. the act of exploration and discovery. 2. To ask questions; to be open to seeing new potentials and possibilities. Synonyms: DISCOVERY, SEARCH, and SYSTEMATIC EXPLORATION, STUDY.

What is AI? “The cooperative search for the best in people, their organizations, and the world around them. It involves systematic discovery of what gives a system “life” when it is most effective and capable in economic, ecological, and human terms. AI involves the art and practice of asking questions that strengthen a system’s capacity to heighten positive potential. It mobilizes inquiry through crafting an “unconditional positive question” often involving hundreds or sometimes thousands of people” Cooperrider, D.L. And Whitney, D., Appreciative Inquiry: A Positive Revolution in Change. In P. Holman and T. Devane (eds.), The Change Handbook, Berrett-Koehler Publishers, Inc.,

 Constructionist Principle: The way we know is fateful.  Principle of Simultaneity: Change begins at the moment you ask the question.  Poetic Principle: Organizations are an open book.  Anticipatory Principle: Deep change= change in active images of the future.  Positive Principle: The more positive the question, the greater and longer-lasting the change. %20Slides2-02.ppt#387,59,Slide 59

 Identify Problem  Conduct Root Cause Analysis  Brainstorm Solutions & Analyze  Develop Action Plans Metaphor: Organizations are problems to be solved   Appreciate “What is” (What gives life?)   Imagine “What Might Be”   Determine “What Should Be”   Create “What Will Be” Metaphor: Organizations are a solution/mystery to be embraced. ning%20Slides2-02.ppt#387,59,Slide 59

Deficit Based Change : Unintended Consequences  Much lamented fragmented responses  Slow: Puts attention on yesterday’s causes  No new positive images of future  Visionless voice... fatigue  Weakened fabric of relationships & defensiveness…negative culture  out of sync with the embedded economy of speed, partnerships, alliances, & e- commerce

and

Appreciative Inquiry “..distinguishes itself from critical modes of action research by its deliberately affirmative assumptions about people, organizations, and questions”. “Human systems grow and construct their future realities in the direction of what they most persistently, actively, and collectively ask questions about.” Ludema, JD, Cooperrider DL, and Barrett, FJ Appreciative Inquiry: The Power of the Unconditional Positive Question. content/uploads/2012/05/Ludema-Cooperrider-Barrett-goed.pdfhttp:// content/uploads/2012/05/Ludema-Cooperrider-Barrett-goed.pdf

AI: The Basic Questions “What in this particular setting or context makes organizing possible? What gives life to our organization and allows it to function at its best?” “What are the possibilities, latent or expressed, that provide opportunities for even better (more effective and value- congruent) forms of organizing? ” Ludema, JD, Cooperrider DL, and Barrett, FJ Appreciative Inquiry: The Power of the Unconditional Positive Question. content/uploads/2012/05/Ludema-Cooperrider-Barrett-goed.pdfhttp:// content/uploads/2012/05/Ludema-Cooperrider-Barrett-goed.pdf

Appreciative Inquiry 4-D Cycle

Discovery “What gives life?” (The best of what is) Appreciating Discovery “What gives life?” (The best of what is) Appreciating Dream “What might be?” (What is the world calling for) Envisioning Results Dream “What might be?” (What is the world calling for) Envisioning Results Design “What should be--the ideal?” Co-constructing Design “What should be--the ideal?” Co-constructing Destiny “How to empower, learn, and adjust/improvise?” Sustaining Destiny “How to empower, learn, and adjust/improvise?” Sustaining Appreciative Inquiry “4-D” Cycle Affirmative Topic Choice

What would you call it? (all these things taken together) Achievements Strategic opportunities Product strengths Technical assets Innovations Elevated thoughts Best business practices Positive emotions Financial assets Organization wisdom Core competencies Visions of possibility Vital traditions, values Positive macrotrends Social capital Embedded knowledge Business ecosystem eg. suppliers, partners, competitors, customer

Appreciative Inquiry Applications in Healthcare

12 Ways to Use Appreciative Questions in Healthcare To improve patient care To establish a therapeutic relationship To identify family capacities for care To inspire healthy behaviors in our patients To strengthen interdisciplinary teams To build camaraderie and trust To celebrate success To create a healthy work environment To make the most of meetings To foster appreciative leadership To illuminate “best practices” in quality and safety To promote learning May N, Becker D, Frankel R, et al. (2011)Appreciative Inquiry in Healthcare: Positive Questions to Bring Out the Best. Crown Custom Publishing Inc

Exercise #2 Application of AI in our work-life: “here and now”

Exercise #2: AI “here and now” Think of a domain of your work-life in which you may like to apply the principles of Appreciative Inquiry. Create an “unconditional positive question” you may use to kick-off your AI project Think of a venue in which you will commence you AI project (team meeting, project task force, QI committee) Identify the stakeholders/contributors to your area of study. Who will you engage in this process?

Debrief

Commitments to change

References Ludema, J. (2001). From Deficit Discourse to Vocabularies of Hope: The Power of Appreciation. Appreciative Inquiry: An Emerging Direction for Organization Development (First ed.)From Deficit Discourse to Vocabularies of Hope: The Power of Appreciation May N, Becker D, Frankel R, et al. (2011)Appreciative Inquiry in Healthcare: Positive Questions to Bring Out the Best. Crown Custom Publishing Inc. American Association of Critical-Care Nurses. (2005). AACN standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. American Journal of Critical Care, 14(3), Cooperrider, D.L. And Whitney, D., Appreciative Inquiry: A Positive Revolution in Change. In P. Holman and T. Devane (eds.), The Change Handbook(1999), Berrett-Koehler Publishers, Inc., Steinert Y, Naismith L, and Mann K. Faculty Development Initiatives Designed to Promote Leadership in Medical Education. A BEME Systematic Review: BEME Guide No. 19. Medical Teacher, 2012, Vol. 34, No. 6 : Pages

References Shendell-Falik N, Feinson M, Mohr BJ. Enhancing Patient Safety: Improving the Patient Handoff Process Through Appreciative Inquiry. J Nurs Adm Feb; 37(2): Cottingham AH, Suchman AL, et al. Enhancing the Informal Curriculum of a Medical School: A Case Study in Organizational Culture Change. J Gen Intern Med June; 23(6): Quaintance JL, Arnold L, and Thompson GS. What Students Learn About Professionalism From Faculty Stories: An ‘Appreciative Inquiry’ Approach. Academic Medicine. 2010, 85(1) Higginbotham EJ, Church KC. Strategic Planning as a Tool for Achieving Alignment in Academic Health Centers. Trans Am Clin Climatol Assoc. 2012; 123: Carter CA, Ruhe MC, et al. An Appreciative Inquiry Approach to Practice Improvement and Transformative Change in Health Care Settings. Quality Management in Health Care. 2007; 16(3)