1. Appreciative Inquiry a transformational change process at the program level – Adding new skills and techniques to your toolbox Michelle Archuleta, HP/DP Director Tuba City Regional Health Care Corporation Tuba City Regional Health Care Corporation SDPI Grantee Meeting November 14, 2007

3. What is Appreciative Inquiry? It is based on the simple idea that organizations move in the direction of what they ask questions about. It is based on the simple idea that organizations move in the direction of what they ask questions about. For example, when groups study human problems and conflicts, they often find that both the number and severity of these problems grow. For example, when groups study human problems and conflicts, they often find that both the number and severity of these problems grow. In the same way, when groups study high human ideals and achievements, such as peak experiences, best practices, and noble accomplishments, these phenomena, too, tend to flourish. In the same way, when groups study high human ideals and achievements, such as peak experiences, best practices, and noble accomplishments, these phenomena, too, tend to flourish. Thus, appreciative inquiry distinguishes itself from other change methodologies by deliberately asking positive questions to ignite dialogue and inspired action within organizations. Thus, appreciative inquiry distinguishes itself from other change methodologies by deliberately asking positive questions to ignite dialogue and inspired action within organizations.

4. The Appreciative Approach A strategy for intentional change that identifies the best of ‘what is’ to pursue dreams and possibilities of ‘what could be’ a cooperative search for strengths, passions and life-giving forces that are found within every system that hold potential for inspired, positive change. A strategy for intentional change that identifies the best of ‘what is’ to pursue dreams and possibilities of ‘what could be’ a cooperative search for strengths, passions and life-giving forces that are found within every system that hold potential for inspired, positive change. (Cooperrider & Srivastva, 1987) (Cooperrider & Srivastva, 1987)

5. Assumptions In every community something works. In every community something works. What we focus on becomes our reality. What we focus on becomes our reality. Reality is created in the moment - there is more than one reality. Reality is created in the moment - there is more than one reality. The act of asking questions influences the community in some way. The act of asking questions influences the community in some way. People have more confidence and comfort to journey to the future when they carry forward parts of the past. People have more confidence and comfort to journey to the future when they carry forward parts of the past. If we carry forward parts of the past, they should be what is best. If we carry forward parts of the past, they should be what is best. It is important to value differences. It is important to value differences. The language we use creates our reality. The language we use creates our reality.

6. Interview’s Question 1: About You To begin, can you tell me what is it that you do now? What most attracted you to your present work? What do you find meaningful, or of value, in your current work? To begin, can you tell me what is it that you do now? What most attracted you to your present work? What do you find meaningful, or of value, in your current work? Question 2: High point or peak experience As you look over your experience with the SDPI grantee program, there have been many ups and downs, peaks and valleys. Can you think of a time that stands out as a “high point” for you - a time when you felt most alive, most engaged, or really proud. As you look over your experience with the SDPI grantee program, there have been many ups and downs, peaks and valleys. Can you think of a time that stands out as a “high point” for you - a time when you felt most alive, most engaged, or really proud. What was it about you and others around you that made it a peak experience? What was it about you and others around you that made it a peak experience?

7. Interview’s (continued) Question 3: Creating a transformational program environment. Question 3: Creating a transformational program environment. A transformational program is one that is reflective, seeks to understand, opens itself to differences, and raises levels of interacting with one another. A transformational program is one that is reflective, seeks to understand, opens itself to differences, and raises levels of interacting with one another. What does your DP/HH Program need to create and nurture to be transformational? What does your DP/HH Program need to create and nurture to be transformational?

8. Harvesting Personal Inquiry Personal Inquiry Reflection Reflection Learning Learning Shared vision Shared vision Story Story Conversation Conversation

9. Discovering our Positive Core Each story determines the “root causes of success”. Each story determines the “root causes of success”. Why did the positive story occur? Why did the positive story occur? What were the contributing factors? What were the contributing factors? Consider the best practices, values, training, leadership, resources, structures, systems, processes, relationships that support success. Consider the best practices, values, training, leadership, resources, structures, systems, processes, relationships that support success.

10. Low Energy E F NO TIME TO MAKE IT HAPPEN OVERWHELMED TRADITIONAL APPROACH Top Only – Few involved answers from experts Focusing on what’s wrong Searching for “Root Cause” of Failure/Decay if you look for problems, you’ll find and create more problems “Fix” the past Obstacles treated as barriers HOW DOES THIS HAPPEN ?!? Mechanical Chalk Lines STATIC, INERT, DEAD EXAUSTED! » Vibrant « » Alive «

11. In-Sync HIGH Energy E F Whole Greater than Sum of Parts Energy CAN’T be stopped APPRECIATIVE APPROACH All (or all levels) involved solutions from within Focus on WHAT WORKS Search for root causes of success “If you look for successes, you’ll find and create more successes” Create the Future Obstacles treated as Ramps into NEW Territory HOW DOES THIS HAPPEN ?!? MORE ALIVE! » Vibrant « » Alive « Time Flies NEW Possibilities Unexpected CREATIVITY ORGANIC, EMERGENT

12. Problem Solving Appreciative Inquiry Problem Solving Appreciative Inquiry “Felt Need” Valuing the best of “what is” Identification of the problem Analysis of causes Envisioning “what might be” Analysis of possible solutions Dialoguing “What should be” Innovating “What will be” Innovating “What will be” Basic Assumption: Basic Assumption: An organization is a problem An organization is a mystery to be solved. to be embraced.

13. The AI “4-D” Cycle DISCOVERY DISCOVERY Appreciating What Gives Life? … The best of what is … DESTINY L DESTINY L earn, adjust & DO Create/Sustaining What will be … DESIGN Determine/Constructing What should be … DREAM DREAM Imagine/Envisioning What might be … Positive TOPIC Choice

14. Where Has AI Been Used? How?

15. Case Studies Organizational Change TCRHCC – Division of Nursing Summit TCRHCC – Division of Nursing Summit 250 nursing staff employees 250 nursing staff employees Created Advisory & Planning Team (Aug/Sept ’07) Created Advisory & Planning Team (Aug/Sept ’07) Host Nursing Summit in Spring ’08 Host Nursing Summit in Spring ’08 Change Agenda: Change Agenda: Break thru barriers – dept level, mgt, internal, external Break thru barriers – dept level, mgt, internal, external 3 personnel systems, NPEA, IHS>638 corporation 3 personnel systems, NPEA, IHS>638 corporation Shared Leadership at all levels/ownership Shared Leadership at all levels/ownership Investment in nursing staff Investment in nursing staff December 10: one day, cross-disciplinary mini summit for a ‘kick off’ to launch change agenda. December 10: one day, cross-disciplinary mini summit for a ‘kick off’ to launch change agenda.

16. Navajo Area Physical Activity/Fitness Appreciative Inquiry Summit Involves Navajo Area HP Coordinators and community partners. Involves Navajo Area HP Coordinators and community partners. Developing our change agenda Developing our change agenda 8 Service Units, area/local priorities 8 Service Units, area/local priorities “How to remember ourselves within our Navajo context” “How to remember ourselves within our Navajo context” Can we keep saying, “Taa ajee teeago”? Can we keep saying, “Taa ajee teeago”? Do we need to change? Do we need to change?

17. Navajo Area Diabetes Conference – Summer 08 Strategic Planning for next 5 years Strategic Planning for next 5 years Blend of AI, Open Space, World Cafe’ Blend of AI, Open Space, World Cafe’ Internal and External Stakeholders Internal and External Stakeholders Whole system approach Whole system approach

18. “There is no power greater than a community discovering what it cares about” M argaret Wheatley, Turning to One Another What will it take for our DP/HH programs to get to this level of change? What is keeping us from achieving our own ‘inquiry’ of what we care about, with our programs, our communities and ourselves?

19. Thank You “No problem is solved with the same thinking that created it.” - Albert Einstein