Appreciative Inquiry in
Healthcare
Matt Russell, MD, MSc
Faculty Development and Diversity
Seminar Series
April 22, 2013
Proposed Agenda
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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
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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., 245-263.
 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.
http://appreciativeinquiry.case.edu/uploads/Cooperrider%20AI%20Training
%20Slides2-02.ppt#387,59,Slide 59
 Identify Problem
 Conduct Root Cause
Analysis
 Brainstorm Solutions &
Analyze
 Develop Action Plans
 Appreciate “What is”
(What gives life?)
 Imagine “What Might Be”
 Determine “What Should
Be”
 Create “What Will Be”
Metaphor: Organizations are
problems to be solved
Metaphor: Organizations are a
solution/mystery to be
embraced.
http://appreciativeinquiry.case.edu/uploads/Cooperrider%20AI%20Trai
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, & ecommerce
http://rufiojones.files.wordpress.com/2011/04/eeyore.jpg and
http://theosbornegroupblog.com/wp-content/uploads/2013/01/pollyanna.jpg
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. http://www.2012waic.com/wp-
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 valuecongruent) forms of organizing? ”
Ludema, JD, Cooperrider DL, and Barrett, FJ Appreciative Inquiry: The Power of
the Unconditional Positive Question. http://www.2012waic.com/wpcontent/uploads/2012/05/Ludema-Cooperrider-Barrett-goed.pdf
Appreciative Inquiry
4-D Cycle
Appreciative Inquiry
“4-D” Cycle
Discovery
“What gives life?”
(The best of what is)
Appreciating
Destiny
“How to empower, learn,
and adjust/improvise?”
Sustaining
Affirmative
Topic Choice
Dream
“What might be?”
(What is the world calling for)
Envisioning Results
Design
“What should be--the ideal?”
Co-constructing
What would you call it?
(all these things taken together)
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Achievements
Strategic opportunities
Product strengths
Technical assets
Innovations
Elevated thoughts
Best business practices
Positive emotions
Financial assets
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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.)
• 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), 187-197
• 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., 245-263.
• 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 483-503
References
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Shendell-Falik N, Feinson M, Mohr BJ. Enhancing Patient Safety: Improving
the Patient Handoff Process Through Appreciative Inquiry. J Nurs Adm.
2007 Feb; 37(2): 95-104
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. 2008 June; 23(6):715-722
Quaintance JL, Arnold L, and Thompson GS. What Students Learn About
Professionalism From Faculty Stories: An ‘Appreciative Inquiry’ Approach.
Academic Medicine. 2010, 85(1)
118-123
Higginbotham EJ, Church KC. Strategic Planning as a Tool for Achieving
Alignment in Academic Health Centers. Trans Am Clin Climatol Assoc.
2012; 123: 292-303
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). 194-204
• http://appreciativeinquiry.case.edu/