Event ID: 2118950
Event Started: 3/28/2013 2:43:34 PM ET
Please stand by for realtime captions.
Welcome to the creating positive change conference call. I will be your operator for today's call.
At this time, all participants are in a listen and -- listen only mode. I will turn the call over your
post, -My partner is Linda is also present. We are reducing readmission for your beneficiaries. An
attempt to assist these communities in organizing moving forward, we were -- mode overall
improvement. We are pleased to introduce at this time -- pressure cooker the Colorado care
pressures dedicated to empowering providers, patients, leaders to improve the quality and
deliberate Healthcare Services were 20 years. The past six years, -- in Colorado and across
country to improve care transition and reduce the risk of unnecessary hospitalizations by
focusing on patients and families activation and engagement. At this time, we're going to open it.
Following the presentation, there will be time for question and answers.
Thank you very much. Thank you to everyone. I am delighted to be here. You can look at this
slide later, but I have to make a point here that I have to acknowledge and thank so many of the
people who intruded not only information materials to the research in pursuit of inquiries, but
any of you who are excited about this and want to know where to go, the appreciative inquiry
comments is a wonderful resource. So, again, welcome. I love this picture. I think this guy is
happy. It makes me smile. Like to start off my presentation with this, especially when I am
talking about this topic. So, our objective today, we have one hour. I really want to keep my
talking part down to 30 or 35 min. to give plenty of times for question and answers. We won't
fully explore appreciative inquiry in the amount of time, but hopefully I can help you gain a
better understanding of what preshift inquiry really is and how it works, generally. I will tell you
a few of the stories about how preshift inquiry has been used in healthcare. One story that meant
a lot to me, beyond healthcare. Also, some ideas of how you can apply appreciative inquiry to
your own work. I will talk about what is most widely accepted as the model or framework.
During our question and answer portion, I would really love to hear from any of you who have
ideas or if you already use appreciative inquiry, I would love to have you share your experience
with us as well. So, there is me.
Work for the Colorado quality improvement organization. I worked on various projects, both in
our local communities in Colorado as well as around the country. We have a contract to actually
help support all of the states in their work which is really archly quite wonderful for us because
we get to hear all of the wonderful stories, ideas, and best practices around the country. I will
start off with and appreciative self inquiry. You can use your chat function if you wish to answer
some of these questions or think about them yourself and write them down. I very much believe
and have observed that learning is very highly participatory. What I get out of a learning
opportunity has much to do with me as -- and what I contribute as the teacher and the material.
So, I like to ask you, what would you like to learn from this webinar? What would you like to get
out of the topic today? What can you contribute to others' learning? And, classic appreciative
inquiry questions here. If you imagine, one hour into the future, and it has been a fabulous
Congress,, government -- fabulous webinar -- fabulous conference call and webinar, what can
you do to make it good for yourself as well as others? I will give you just a minute to think about
that.
Now you know a little bit about me. Again, if you can use the chat function, and I am going to
try to pull it up here so I can see, I'll probably ask my folks in South Dakota if you can monitor
the chat and see what kind of responses we are getting. I many of you are from hospitals, critical
access hospitals, nursing facility. AAA isn't area agency on aging or --. If you are from those
organizations, you would know what AAA is. Some of you who don't, if you don't know what it
is, we highly recommend you get in touch with those people. If you are a hater or home health
agency, nonmedical home care, which we don't have a letter here for, but if you're from eight
nonmedical healthcare company, we would love to know that. Hospice or -- care, one term acute
care. Trade Association. Assisted living. Mental health. Or, something else that we haven't stood
here. -- Haven't listed here. I will give you a few seconds to type into the chat. How is that.
It is going well. You have five physician organizations. You three. Access. You -- three critical
access. You have a laboratory. Another clinical access. You have a nice variety E
Terrific. We are going to move on, but if you didn't get a chance and would like to weigh in,
please do. How familiar are you with appreciative inquiry already? Are you familiar in concept
or even in using it. Somewhat familiar quest you know what it is, but perhaps you haven't used it
yet. Or, is this the first time you heard about it?
It looks to me that not everybody is familiar with it. Most of them not at all or, just somewhat.
That definitely helps. A collaborative and highly participative systemwide approach to go what
we mean by that is, generally, you are truly wanting to hear from everybody in the system. We
want everybody to participate. I will talk about preshift inquiry interviews. Lot of it is done in
interview style, with questions that are very carefully crafted, truly seek and identify what is
underneath the best practices. What gives life to those. We can see how, in many our own
hospital or office or a competing hospital or office organization has a really good process in
place. And, how often have we tried to adopt something? We of the same form or same process,
but maybe we don't get the same results. Appreciative inquiry goes beyond identifying best
rectus, but really understanding what makes this work in my organization. What makes our
strengths flourish. Again, it's really about looking at a system that is performing optimally, which
does not mean that we only go to high-performance, and an underlying assumption here. And
observation actually. In every system, something works. So, it is really study what is working
here. Where have we been successful. Since we did appreciative inquiry, all of the quality
organizations around the country, we have all been involved in quality improvement for various
number of years. Many of you on the phone are doing so quite will assure -- as well. Were of the
problem. Where are the gaps? There's nothing wrong with that, but often times we miss what is
actually working in the system or organization. In appreciative inquiry really distinguishes itself
from other change processes by really, purposely asks questions to know information and also
igniting the change. Igniting constructive conversation. Inspiring action. Helping to create a
nurturing relationship, which I have learned in my years, and a lot of the work I do right now,
that it really comes back to relationship. How can we build positive, instructive relationship. It is
really -- appreciative inquiry is the act of preaching what is best in individuals and a group of
people. The world around us, the company, what are doing well. We really appreciate strengths
and successes. Often times, when there is fear of the future.
We say, okay, we have to find a new great wonderful tool. What has made you successful so far?
Is not about resting on your morals, but really understanding what is and up. Of course, the
inquiry part is all about the questions we ask. How we speak to each other. Questions we ask
ourselves. It's really about what we study. Essentially, the direction we will go. Focusing too
much on the problems need to to many problems. So, first, and appreciative inquiry in 60
seconds or less. David and Sharon should were really sort of the founders of this methodology,
so to speak. Of course, many researchers before them really helped them with their thinking on
this. David was a doctoral student in organizational element. Suresh was his advisor. Essentially,
they ask what will happen. So many organizational elements look at the problems, instead of
stunning what goes right. The first story, appreciative inquiry started in healthcare. It started in
Cleveland with the Cleveland clinic purchasing a little hotel across the street from the Cleveland
clinic. They wanted to use it for patient families, visitors, you know, a place to put people up or
patients in the clinic. And, as I said, is -- it is a little hotel. It was just kind of limping along as it
was and the world change and morale plummeted. They went to case Western, and they wanted
to put his ideas to the task. What happens if we focus on the positive? The way he first did this,
actually have the entire staff go to a five-star hotel in Chicago.
Their requirements were to observe, to process observations and observe the staff. Observe the
customers interacting with the staff and they are out what it is they were doing the right. The
only stipulation was, only focus on what is going well. And, but -- part of what you wanted to do
is not have to fire everybody in the hotel and start a new staff, this often the first place ago, often
when a new leader comes and. If you want to retain -- he wanted to retain staff. At the end of this
week, with them observing, they were so excited by what they have seen and focusing only on
the positive and what is going on, and started talking amongst themselves and the staff in
Chicago and the staff at the hotel in Chicago were also very enthused by what their observers
had told them. Basically, long story short, when they came back to Cleveland, they actually
improved the processes so they became a four-star hotel in a very short time period. It was six
months to a year. It was simply by observing the positive. Trying things out and figuring out how
it works. What can we do to make it better. So, the second story that really was meaningful to me
in terms of thinking about why we would even want to study the positive. It actually came out of
the study and Asia where they were looking at numbers. They couldn't quite figure out what we
need to do. What can we do to improve, especially in children, and decrease and alleviate
malnourishment.. Some kids are actually fairly healthy, but they couldn't get asked what was
going on with these children that was different from the rest of the village. Part of it was because
of taboo. A couple of families that were doing something different, they would normally talk
about it normally. It turns out, they were actually listing shellfish. That is normally not done. By
asking the right questions, the figure out what was happening with the positive outliers, they
were able to get this information and ultimately go step -- a step further to create a culture
change.
Before I go on and lose somebody, want to assure you that preach that inquiry is not just about
feeling good. It combines quality improvements with these appreciative techniques. We want to
be able to identify and things are going just we wrong in a system. Unless we understand what is
going right, we often see cases, like customer service for instance, where in our traditional
approach, let's say we have eight let's say we have 896% customer satisfaction rating. Often
times what we do is, we say that is great, what is going on with that 4%? What can we do
differently. We assess over the 4% that are not satisfied. Again, there is some value to that, but
often times, we change what is going right and our customer service ratings actually end up
going down. So, let's look at these two approaches just a little bit. Traditional approach or
deficit-based approach, often times we see some kind of problem. Or, there is some self need that
something needs to change. I would say, often times there could be a positive or negative focus.
The act itself is a very good approach. It really comes back to what questions we are asking. Our
brains are problem-solving machines. Whatever questions we pose, our brain will want to answer
that. So, the questions we ask ourselves are very important. In the traditional problem-solving
approach, we only ask about the problems. We analyze possible solutions to the one problem and
we develop an action plan. That is what we all do. The underlying as such am -- underlying
assumption with this, there are problems that need to be fixed. The appreciative inquiry
approach, again, we are really looking, and changing our filter a little bit and really valuing that
96%, for instance. Rather than going through this deficit-based approach to figure out what is
going on with the or percent that aren't satisfied, that study the 96% that are. Figure out what the
best is that is happening right now. Imagine what might -- match what might be and figure out
what our strengths and practices are. Figure out what enables me to deliver on that. How can we
pick it up a notch.
We figure out what might be, then you figure out what you can implement.
Was approaches are valid. I have been reading recently about this and particular and it has been
interesting. The problem-solving approach is often linked to mechanical systems. It might even
be best applied in that arena. Mechanical systems, that might bear -- to be where we need -- my
favorite and my personal story, my smart phone goes black and about 2 seconds even though the
screen of it is set for 10 min. What the smart phone, there aren't any buttons. On July upon what I
see on the screen. To me, that is not smart and I cannot figure what is going wrong. That is a
problem solving approach. What we choose to focus on, if we only focus on what is broken or
the problem, often times like in sap our energy. Last, on the far right-hand side of the screen, our
basic assumptions. In every system, something is working and it is really important to understand
what is working and how it is working. People have more confidence and comfort to move into
the feature, especially if it is a highly unknown and uncertain future if they can carryforward
parts of the past. Of course, what we really want to carryforward our parts of the past the work.
When we are interviewing and asking those questions, with appreciative inquiry, we are not just
getting data, we are starting to change, just by asking the questions. Lastly, this is important,
influencing not only all of my work, but my life as well. What we focus upon becomes our
reality. So, a little bit about the deficit a focus. Often times, what we see, we are definitely seeing
that we are going out into communities only focusing on the problem. Why do we had -- have
readmissions? We often see people with fragmented responses. Especially when we, in this
arena, and we have all been working this -- at this release do you know, sometimes it can be a
long list which can sap our energy. So, we need that vision. We need to build in that
accountability of leadership. Again, focusing on just the deficits often does not lead to that. This
last bullet here, what I often see is, we can identify those best practices. But sometimes, people
truly cannot adopt what the other guys did. Taking an appreciative approach where they
succeeded in the past, it gives people a lot more confidence. They believe that they can do this.
Okay. I was doing a little bit of research and I found it interesting that, in this is even all over the
Internet, I often found these types of pictures. People -- people are energetic. They seem open.
These have been my experience as well. It is not just touchy-feely. Think about yourself after a
prolonged period of only identifying what is going wrong. Often times, I don't think we end up
with pictures like this. But, for the research, to those who need a little bit more to chew on, lots
of studies have been shown. I think appreciative inquiry started in healthcare. When questions
they were asking each other changed and they were asking about, not only what do you do that
works, but having somebody asked them, a question about, describe the time when you treated
patients and the results were better than you expected. What they found at the end of that, with
people not really open and willing to share, they found they were much more likely, with these
types of question to collaborate with each other.
Many people have contributed the studies they have done, and where they have applied. There
are several good projects that have been done partners retention and hiring, which I think is very
promising, especially since what we are facing. Also using appreciative inquiry to valuate. Often,
it is very critical when we get to the evaluation phase. Again, I think using a combined approach,
traditional valuation methods and appreciative inquiry is really wonderful. The results are more
than we could hope for. Leadership training and development's, community developments, many
stories use appreciative angry and patient care not for just improving the system but how we
interact with patients. That is near and dear to my heart. A lot of who I work with and am most
passionate about is not only coaching and empowering communities to work together, but also
the patients and their families. Little bit about why it works. I think I touched on most of these.
We are really identifying and building upon what works. The second let here, there are two ways
to interpret that. Change could mean literally, rather than investing a lot more time and money in
retraining person, appreciative inquiry can actually encourage the existing staff. It -- we are
much more invested. If we realize we are part of the system, it is not just a job or that frustrating
thing I do in that building, but it is actually something I want to be a part of, it helps to see the
need for change, because it is not just about, we are not doing well right now and not good
enough, and we need to do something better. But, it's, we have done really well in these areas
and, we can do even better going forward. We see more people having a shared urgent -- vision
versus somebody either pop down or some external it saying we need to do it this way. The
system is actually creating their own shared vision and carrying it forward.
So, as with the assumption that, what we focus on, words are very powerful. The words that we
use are very important, as the old adage said. So, we won't get into that in detail on this call.
How they construct questions are very important. I want to talk a little bit about research that led
to forming appreciative inquiry. We know from some very famous studies that changing an
image of a student behavior actually changes how the teacher behaves. Alternately, you can
improve or we can the student performance. It very interesting, but kind of disturbing. Part of
what goes into preshift inquiry is what we learned from sports and other research. This
visualization of your goals and what you want to see happen is very powerful to helping you
actually not only meet your goal but also help you learn. I have a couple of stories. One in
particular with a bowlers. They took a group of boulders and, again, what we often see, we want
to laminate failures, right? Think that elimination of failures will improve performance, but the
actually do the exact opposite. With this study, the actually took two groups and they had one
group focus only on videos of their tournaments and they would look for when they went wrong.
The other group did the same thing, but they look for when they went right. Those that viewed
on what they -- those focusing on what they did right had 100% improvement than those that
focused otherwise. What you close your eyes right now and do not think about -- and think about
a cow be raised in an emerald green field. How many of you --, any of you were not able to think
about that. Although we may use words like don't think of an elephant or don't do this or it is not
like that, our brain will only see the image of that positive. Something that exists versus
something that we don't want to have exist. The next one here, and having trouble advancing my
slides. Perhaps I am not envisioning it the way I need. There we go. From some studies that have
been done in the realm of sociology, again, what we study becomes our reality. We have seen in
several studies, when groups are only studying problems and conflicts, often see the number and
severity of those problems that they identify actually increase.
We have also seen that when groups study ideals, achievements, peak experiences, and best
practices, those also increase. It can work both ways.
The placebo effect. Again, we have seen this. Many studies in healthcare. In studies with surgery
patients, per instance. Or, even in medical studies when, the doctor believes medication will
help, the patient needs much more confidence. Oftentimes, what we find one third to two thirds
will actually respond positively even with placebo. Lastly, the idea of positive rate you. In our
internal conversation with ourselves as well as with each other, the internal dialogue is very
important. Pre-and post operative patients, per instance. Studies an organization where we see a
ratio of at least two positives versus one negative, those are much more likely to heal faster.
Project are generally going to perform better. There have been some really interesting studies
with relationships showing that, in couples, certain researchers who are trained in this can
actually predict whether a couple is going to succeed or not or divorce aced upon the ratio of
negative to positive comments within their dialogue. So, just a question for yourself. I think I am
running a little long, so we may just have you think about this and write it down on your own
piece of they were -- piece of paper rather than using chat. What is the positive to negative ratio
in your own dialogue? 01? Zero being the left side of the ratio. Versus, the negative. What effect
might that be having? How it works. Generally, the order that you want to go in, when you are
taking on using an appreciative inquiry approach, first you really want to discover the positive.
What is actually happening. Not only those best practices, but it's really about gaining the stories.
We have talked a lot about that, but in appreciative inquiry, we are looking for stories rather than
just a listed list. The questions are designed to get stories from people. Generally, back to the
visualization. We remember back on the time when we were part of a high-performing team,
and, we actually help each other grow. As a team, we not only met our objective or exceeded our
objectives, those of you in the audience can start thinking about that. Remember a time when you
are on a team? It might be one you are on now or from work or church or, a civic organization,
who knows, but when you think about the story, your mind recalls details that you didn't
normally get when you just did brainstorming exercises where you write down one or two words
on the list. When we can gather the stories, you can really understand the positive much better.
Once we have those stories, we have positive images of the future that we can actually obtain
because we have seen it in the past. This is the -- cycle. You start with a discovery, and that is
where you ask the initial questions. Remember a time when Turco tell me a story of.
There is one big question. And then there are some probing questions. What was it about the
people or organization? What was it about you that contribute did to success? And then you start
dreaming. What you discovered what best practices are, and what gave life to those, then you
start dreaming, what can we do with this? What can we make of this for the future? And then you
design it. You get down to brass tacks, so to speak and you figure out what you need to do to
implement and make this better. Destiny, of course, is how you MPower. -- MPower -- -MPower empower.
Everything about your questions. Did you do this? Yes or no. That won't tell you very much. All
away over two, the what if questions. Those will be very powerful. I just want to point out a why
question. They can be very powerful. But generally, again, really take note that you had to be
careful when he asked those questions. We can get defensive when people ask us why. There's
nothing right or wrong about that, but is just what it is. Think about that. That is another question
we often want to ask. Why did you do that. Depending on how it is asked, you can really change
the response that we get.. So, question for all of you. Again, this is something for you to think
about. Going back to human systems, move in the direction of what we study and talk about.
Images we create in our mind. What images are you creating in your mind? What images is your
organization creating for yourself? What are you talking about? What are you studying? The big
question is, how much do you know about your problems? Your barriers? Failures? Challenges?
How much do you know about your organization? Your team? Your system? How much do you
know about factors that contribute to enabling you to be your best. I hope that the answer to this
last bullet definitely outweighs the answer to the previous or is at least equal. But, definitely, it is
something I come back to a lot in my life. Once again, how much do I know about the problems
and how things are working?
I will skip over this slide. I want to point to a couple of studies that I found that might be
interesting to you. This one, I thought it was very interesting because, we are looking at
practicing improvement. Change in healthcare. This is a very distinct study using appreciative
inquiry. I thought it would be very interesting to do all. I definitely recommend looking further
into it. This one as well. Especially with our work in reducing readmissions and improving
patient safety. This also looks at nurse satisfaction as well. Here are some recommended books.
The one I will point out is actually a compendium of interview questions, which, once you start
getting into appreciative inquiry, realized it is invaluable. When you start getting into it,
constructing those questions, all resources you can get are very help full. There is the link for the
comment. Now, I will open it up for questions.
We will now begin a question and answer session.
I am showing we do not have any audio was just at this time.
Any chat questions that people want to type and?
I have a question for you. Has this sparked any ideas for you?
I think with community organizations, especially when we talked about readmission, it is good to
recognize the positive as much as recognizing the problem.
Yes. Actually, a couple committed the projects that we have done recently. Many of you may
know the attention Grand Junction Colorado has gotten from many different angles. One of the
things we did, we went to grand judge and did and appreciative inquiry. That was definitely an
example of studying what has basically been perceived as the best by many different metrics. We
went to understand, what is it about Grand Junction? Why do they have low-grade mission and
high-quality? We did interviews of leaders of many different organizations. The hospitals. The
hospice. Nursing facilities. We even interviewed a series of nuns because of the hospital
association with a particular order of nuns. It was absolutely fascinating. I would, actually,
someday, gather all of our interviews and see if they are interested in publishing something.
They have such wonderful stories to tell. We wouldn't normally have gotten those were even
asked about them. That actually ended up being the result of that appreciative inquiry. It was
published as part of the story.
The other thing we just completed in January, we wanted to understand why a particular amenity
had such low cost for long-term acute care services. That is a very technical question. What we
found in that community, we had patient families, civic organizations there from all over the
place. And a question like that, you need to figure out what is going on. Everybody needs to
come together to make this thing happen. We are just starting to compile a report on that. Not
only did we get good information, but now the community is even more committed to being even
better, basically. That is a great example where they didn't rest on their laurels.
There is a question in check, can you see it?
I'm looking at it now.
Has this been used when valuing individual performance?
Yes. Most definitely. In my coaching that I've done, actually, when I did a more individual life
coaching, I used and appreciative approach and had question buckles that were designed that
way. I have found I appreciative performance appraisals, appreciative of valuation questions,
again, for individuals as well as far teams. Even now I use and three should a job interview. So,
rather than just ask the usual question, when looking to hire somebody, I found a couple of goals
for preshow job interview questions. As I said, look at the appreciative inquiry comments. This
great information there. I am happy to share what I have found.
We have one question on the line from Patrick McAllen. Please go ahead.
Thank you. My question has to do with your perception of the difference between appreciative
inquiry and motivational interviewing. Where DC the two working together or where they are,
the mentoring?
Yes. Id. only see them as complement three. And really, I would say, for the difference, the main
difference that I see between appreciative inquiry and motivational interviewing, in appreciative
inquiry, you are very intentionally focusing on just the positive. Whereas, all of your questions
reflect that. Think of a time where you were at your best work with big the time where you were
following, depending on what you're using it for, you are following your diet or whatever. I think
those are great questions. Where motivational interventions and is a classic example, is when we
see resistance or people -- challenges. Really like to exercise but not -- nobody my family
exercises I can do this and there's no time. Some of those techniques of motivational
interviewing is mirroring back what people said. So, you're not necessarily focusing on the
positive. Sometimes you are showing people what you just told me. And again, where we see
this as miraculous, even though it is exactly what I just said, they think, I could do better. It is not
that bad.
How I see it as complement three is, helping people think about when they have been successful,
especially when they feel like to keep bailing. They are not meeting their goals. They keep
falling off the wagon. Really having that vivid image of success is hugely powerful. The other
part is in celebrating what they are doing and really understanding. You know? What made this
successful for you? How was this? What worked this time? Lot of it goes back to people helping
create images in their mind. Was are my first thoughts on that. Great question.
I don't see anything in the chat box either.
I think, what we will do at this time, is close. First of all, I want to thank Lisa for your time. The
lecture was excellent. We can certainly help you link up with her if you need answers. In
conclusion, I like to remind everybody that we are going to continue with our educational
section. We will offer office hours opportunity on April 30 from into one. That a central daylight
time. It will be a dedicated presentation discussing the method and patient education. With had
the session already. It will be an opportunity for you. We also have plans for a medication
reconciliation with Dr. Jane in June. Please feel free to contact either Linda or myself if you have
questions concerning today's presentation. The audio and written transcript will be available on
our website which is --. We will also be sending for you a survey monkey participation survey. If
you return that something get idea what other future needs you might have, we will thank you
again for joining us and have a wonderful spring. Not?
Thank you. This concludes today's conference. Thank you for your participation. You may now
disconnect.
[ Event Concluded ]