Appreciative Inquiry: Leading Positive Change in Health Care

International Medical Education Day

October 23, 2013

FAIMER’S Overall Goal:

Enhance health professions education to improve the health

of communities

(c) Corporation for Positive Change

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Appreciative Inquiry:Leading Positive Change in Health Care

Diana Whitney, PhDPresidentCorporation for Positive Change

What is Appreciative Inquiry (AI)?


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Appreciative Inquiry is…


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A philosophy of human organization and change.

A high engagement process for positive change.

The study of the factors and conditions that give life, and vitality – to people, teams and organizations – when they are at their best.

AI does not claim that we are always at our best.

AI does say that focus on what works is the most effective way to learn, grow, create enduring positive change and get the results we want.


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UVA Medical SchoolRestructuring of Curriculum & Teaching

Methodology

Invited team of leading faculty To redesign in their subject areas. To coordinate with other subject areas. After 4 months - nothing. Meeting ended in a list of problems.


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Appreciative Inquiry: From Cell to Society Medical Curriculum

Another meeting – Volunteers.

Conducted Appreciative Interviews Highpoint in Medical Education? Significant Changes in Health Care Today? Dreams of Graduation Day 2014?


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Principles for Curriculum Restructuring

Interviews were inspiring and informative!

Stories were used to craft a Set of Principles that enabled everyone to go forward.

Committees formed, new curriculum done in time for the next school year!


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Positive Deviancy & AI

Positive Deviancy

Assumes: Some people do better than others.

Study those who get better results.

Disseminate best practices.

Appreciative Inquiry

Assumes: We all have our good days and our bad days.

Study everyone at their best. Brings out the best of

everyone. Fosters individual and

collective learning of best practices.

AI is an Alternative to Problem Solving… and Deficit Based Change


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Deficit Based Change“Diagnostic Action Research”

Data Gathering Data Sharing and Feedback Clarify the Problem Brainstorm Solutions Create a Plan for Change Implement the Plan Measure Results


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The Medical Model

Patient Complaint: Problem focused Differential Diagnosis:

What is the worst thing that could happen? Interventions: How do I prevent / fix it? Break it apart: Labs, x-rays, procedures Diagnosis: The problem “named by the expert” Action Plan: Often includes behavior modification


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Slow: Puts attention on yesterday’s causes

No new positive images of future or

information about strengths available for

change

Produces“vocabularies of human deficit”

Downward spirals of energy and morale,

fatigue

Weakens teamwork & relationships

Creates dependency on experts

Deficit Based Approaches haveUnintended Consequences


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Ap-pre’ci-ate, v1. Valuing; the act of recognizing the best in people and 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, economically and socially.

Synonyms: VALUING, PRIZING, ESTEEMING, and HONORING.


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In-quire’, v.

1. The act of exploration, investigation and discovery. 2. To ask questions; to be open to seeing new potentials and possibilities.

Synonyms: DISCOVERY, SEARCH, STUDY, and SYSTEMATIC EXPLORATION.


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Task 1 Paired Appreciative Interviews (p 2-3)

At your table, pair up with someone that you know least well. Virtual Participants: Pair up OR if you

are by yourself, make some notes on your worksheets that have been sent

Philadelphia: Fellows pair with a board member, guest, or project advisor OR Y1 Fellows with Y2 Fellows, etc.

Interviewers Use guide Time for interview:

15 minutes/person Encourage and draw

out your partner Take good notes

(on his/her worksheets)

Keep focus on your partner

HAVE FUN!

Interviewees Think about

positive experiences

Be as descriptive as you can - HDTV stories

Stories of life-giving experiences

HAVE FUN!


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Group Management Roles Discussion Leader – Be sure everyone

has a turn to talk, on topic. Time Keeper – Be sure group completes

task within timeframe given. Recorder – Writes group comments on

flip chart or note pad, as spoken. Reporter – Presents group input.


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Task 2:Small Group Data Sharing (p 4)

1. Everyone: introduce your partner by sharing the most

inspiring story you heard during the interview.

2. As a group discuss what each story taught you about

successful positive change.

3. Based on your stories, generate a list of Factors that

Contribute to Successful Positive Change.

4. Recorder prepare a copy of your group list to hand in or

to email to us (virtual participants).

5. Reporter prepare to share ONE item from your group list.


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Reports from Groups

Each group will share ONE of the many factors they discovered that contributes to successful positive change.

We will collect the lists from all groups, compile them together and send them out to everyone in attendance today.

Five Principles of Appreciative Inquiry

1. Constructionist Principle

2. Principle of Simultaneity

3. Poetic Principle

4. Anticipatory Principle

5. Positive Principle


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Theory: Social Construction of Reality Meaning is made in relationship. Human organizing and change are

conversational. To change organizations, communities and

people we need to change the conversation – who talks to whom about what.

A “dialogical approach” to change management.


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Wisdom from an Umpire

Some call them as they are…

Some call them as they see them…

They ain’t nothing until I call them…


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What do you see? What do you call it?


http://www.planetperplex.com/en/ambiguous_skulls.html%2312

Principle of SimultaneityChange begins the moment we ask a

question.

Inquiry is Intervention The questions we ask are fateful.

They determine what we find.

They create the world as we know it.


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Stress at Work


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The Questions We Ask Influence

What people remember.

How they feel.

What people talk about

to each other.

The Inner Dialogue of

our organization

s.


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Joyful Productivity


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Poetic Principle We can choose what we study.

We can choose our Life Metaphor: People are like machines, if we break down we

need to be fixed.

People are sources of unlimited potential for learning, healing and transformation.

Root causes of failure or…Root causes of success


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ImagineWhat might happen if you ask people:

Tell me about a time when you felt healthy, vibrant and able to do what you wanted to do…

What was the situation?

What were the root causes of your health and vitality?

Positive Principle


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Change requires large amounts of positive energy, affect and social bonding.

The more positive and life-giving the question, the more positive and sustainable the change.


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Barbara Fredrickson’s Research

Positivity Ratio 5/1 and Human Flourishing

Positivity increases Vagal Tone - positive emotions, positive social connections, and physical health influence one another in a self-sustaining upward spiral dynamic.

Anticipatory Principle Why do people behave as they do?

Past? Present? Future?

The Images and Beliefs we hold about the future impact our present behavior.


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Three Additional Principles


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1. Wholeness Brings Out the Best

2. Acting “As If” is Self-Fulfilling

3. Free Choice - People Commit to What they help Create

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DiscoveryAppreciate“What is”

Discover

Appreciate“What is”

DestinyCreate

“What will be”

DesignDetermine

“What could be”

DreamImagine

“What might be”

Appreciative Inquiry 4 D Process

STRENGTHSASSETS


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How Else Has Appreciative Inquiry Been Used in Health Care?

University of Kentucky Hospital

Methodist Medical Center

St. Joseph Health Center

CHOP and Lovelace Health System

Materials and equipment management

Enhance customer satisfaction

Physician/nurse communication

Nurse morale and retention


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Reframing problems to affirmative topics

From Nursing Turnover

Lack of Ownership

Professional Silos

To Nursing Retention

Taking the Risk of Responsibility

Inter-Professional Respect


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The Art of the Question

What did you notice about the Appreciative Inquiry questions that made them unique and powerful?


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Appreciative Questioning

Appreciative questions help people discover and transform the stories they tell about themselves and their worlds – in order to change their performance – and be more effective.


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4-D Flow of Questions Discovery:

Questions seeking a high point experience of your topic. Dream:

Questions seeking images of the world full of your topic. Design:

Questions seeking images of your topic in action: the activities, leadership, relationships, organization and/or lifestyle that are needed to realize your topic.

Destiny: Questions about specific outcomes, positive changes

and results when your topic is a reality.


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Task 3Identifying Issues for Change (p 4)

At your table discuss the issues in health care and health education that you think might benefit by using AI.

Select one issue and record it on a piece of 8 x 11 ½ paper.

(Write neatly so it can be read by others)


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Task 4Crafting Appreciative Inquiry Questions (p 5)

As a group:1. Reframe the Issue you received as an

affirmative topic – if needed.2. Write a 4-D Flow of Questions that can be used

to do inquiry into the affirmative topic.3. Recorder: Prepare to hand in your group’s issue,

affirmative topic and set of questions.4. Reporter: Prepare to share your affirmative

topic and set of questions with the whole group.


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What are your questions about Appreciative Inquiry?


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Task 5Now What Will You Do? (p 6) Go back to your original interview partner.

Turn to page 6 in the worksheets to talk about Small Actions that will Make a Big Difference

Thinking about your initial interviews, and about everything that you have heard this morning… What 2 – 3 things can you do now that will

make a positive difference?

Who else needs to be involved?

How will you engage them?


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Additional Resourceswww.positivechange.org

Books, Articles, Videos and more…

Diana WhitneyCorporation for Positive Change

[email protected]

http://www.positivechange.org/

Business

Appreciative Inquiry: Leading Positive Change in Health Care