Appreciative Inquiry in

Healthcare
Matt Russell, MD, MSc
Faculty Development and Diversity
Seminar Series
April 22, 2013

Proposed Agenda

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

Todays objectives

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-preci-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 systems 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
%20Training%20Slides2-02.ppt#387,59,Slide 59

Deficit Based Change :

Unintended Consequences
Much lamented fragmented responses
Slow: Puts attention on yesterdays causes
No new positive images of future
Visionless voice... fatigue
Weakened fabric of relationships &
defensivenessnegative 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
Discovery
What
Whatgives
giveslife?
life?
(The
(Thebest
bestof
ofwhat
whatis)
is)

Appreciating
Appreciating

Destiny
Destiny
How
Howto
toempower,
empower,learn,
learn,
and
andadjust/improvise?
adjust/improvise?
Sustaining
Sustaining

Affirmative
Topic Choice

Dream
Dream
What
Whatmight
mightbe?
be?

(What
(Whatisisthe
theworld
worldcalling
callingfor)
for)

Envisioning
EnvisioningResults
Results

Design
Design
What
Whatshould
shouldbe--the
be--theideal?
ideal?
Co-constructing
Co-constructing

What would you call it?

(all these things taken together)

Achievements
Strategic opportunities
Product strengths
Technical assets
Innovations
Elevated thoughts
Best business practices
Positive emotions
Financial assets

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

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/