When I first learned about the tool of Appreciative Inquiry, I was not a fan. Although I've been a writer for almost two decades, I was trained in the scientific method in medical school. I tend to be skeptical of ideas with effects that are not easily quantifiable. I was doing some background research before interviewing two experts in the field, Richard Frankel, PhD, and Gene Beyt, MD, MS, for the AMA Steps Forward program, a series of modules to support greater efficiency and joy in practice.
The definitions I read, published in peer-reviewed journal no less, sounded extremely ethereal and free-form to me. Take this definition for example, "The essence of Appreciative Inquiry, then, is the study of what 'gives life' to organizations, teams, and people when they are at their best." (May 2011) I thought, how is something so amorphous as "giving life" going to solve the problems we see in health care today?
I spoke many times with Drs. Frankel and Beyt as I worked on the AMA module. I interviewed their colleagues. I reviewed the background studies on the effectiveness of Appreciative Inquiry. And I became a fan. Why? What swayed my thinking?
I don't have the space in this post to give an in-depth review of Appreciative Inquiry, but I want to highlight the three factors that changed my mind.
1. The idea that positive thoughts are energy boosters and negative ones are energy sappers.
2. Case reports of clinical teams that have tried Appreciative Inquiry.
3. The resonance with observations about my own life.
First, in our interviews Drs. Frankel and Beyt explained it this way: when a team (or a practice or a clinic) has a problem, focusing solely on the problem to be solved can sap everyone’s energy, enthusiasm, and even their ability to see creative solutions. By focusing on the group’s inherent strengths and by fostering positive interactions among group members, the collective positive energy increases the chance that the group will have the focus and stamina it takes to engage in change and to sustain positive gains. This made sense to me.
Second, in our interviews I learned about the experiences of clinical teams that used Appreciative Inquiry. One example was a psychiatry unit that was struggling to improve patients’ transitions from the inpatient to outpatient setting—patients were discharged but did not follow up with outpatient services and wound up in crisis and back in the inpatient unit.
Working through the process of Appreciative Inquiry, staff from the two settings, many of whom had worked together virtually for years but never met, convened for a two-day, facilitated Appreciative Inquiry event. By identifying the group’s strengths and values first, they developed a strong camaraderie and a sense of confidence in their ability to fix the communication gaps that had plagued the sites.
Fueled by their renewed (and common) sense of meaning in their work, inpatient and outpatient staff worked together to create a consistent process for discharge planning and the sharing of information between sites. They developed a common form for documentation to improve communication and planning. As a result, the discharge process became more streamlined, with fewer frustrations all around. As a secondary benefit, the sites’ patient satisfaction scores increased. The story and the direct quotes from attendees moved me. I would have valued being part of a group that came together in such a positive, affirming way.
Third, the power of focusing on the positive is something I’ve experienced in my personal life. When I’m preparing for a presentation, it is far more energizing to concentrate on what’s gone well in previous talks and on positive feedback I’ve received from generous readers than to focus on past episodes of stage fright or negative comments sent my way.
What does Appreciative Inquiry have to do with fixing health care? In a clinical environment that is extremely draining to many clinicians, catalyzing positive change can feel impossible. Physicians and nurses who are exhausted and demoralized by documentation tasks and ever-diminishing patient contact may be unable to rally the energy required to steer the changes we need right what’s wrong with our health care system. But clinician input and leadership are exactly what we need. Appreciative Inquiry alone cannot solve all the issues in health care, but a little injection of positive energy can’t hurt.
Questions to consider:
May N, Becker D, Frankel R, Haizlip J, Harmon R, Plews-Ogan M, et al. Appreciative Inquiry in Health Care Positive Questions to Bring Out the Best. Brunswick, Ohio: Crown Custom Publishing, Inc. 2011.