Journal Article ReviewAndrea Dvorak

‘If we can’t do more, let’s do it differently!’:

Using appreciative inquiry to promote innovative ideas for better health care work

environments .

-Richer, M., Ritchie, J. & Marchionni, C. (2009)

Class Readings: What is Appreciative Inquiry

Scherer and Alban

Uses interviewing and storytelling to explore the past while looking at the positive aspects of ‘what is working’ in the organization as a basis to ‘what might be’

Combines data collection with a large-group meeting where the stories gathered are used as building blocks to design new initiatives for the future

Aim is to generate new knowledge that expands the realm of the possible and helps members of an organization to envision together a desired future

Rothwell and Sullivan

Requires a paradigm shift from focusing on what is going wrong to what is going right and then trying to leverage what is going right into new, higher level visions of a positive future

A way of being, a model, a conceptual framework, and a process to guide change

Search for the best in people, their organizations, and the world around them

Focuses on what is going right, what is motivating, what is energizing, and what are the key strengths of a setting

The most exciting development in thinking about change in recent years

Class Readings: The 4-D Model of Appreciative Inquiry

Rothwell and Sullivan

Discovery—people talk to one another, often via structured interviews, to discover the times when the organization is at its best. These stories are told as richly as possible.

Dream—the dream phase is often run as a large group conference where people are encouraged to envision the organization as if the peak moments discovered in the ‘discovery’ phase were the norm rather than exceptional.

Design—a small team is empowered to go away and design ways of creating the organization dreamed in the meetings.

Destiny—the final phase is to implement the changes.

Background Increase in pressures in healthcare system led to a

negative impact on the current work environment and shortage in personnel Hospital closures Mergers Ageing population Increase in people living with chronic diseases

Persistent employee dissatisfaction need for change in health care environments

Based on the literature review by the authors, AI was chosen as the framework for the transformational change process

Article: Background

Article: Purpose

Purpose To examine the use of Appreciative Inquiry (AI) to

promote the emergence of innovative ideas regarding the reorganization of health care services

Break through old boundaries and promote the emergence of new ideas

Method

Research Strategy Case Study

Participants 52 participants 3 teams

2 health care teams 1 management team

Method cont’d

Procedure Health care teams

AI process (4-D) led to development of an action plan Evaluated for innovativeness using ‘Innovative Ideas Grid’ Action plan was presented to the management team

Evaluation Participant observation

During interviews with health care teams Interviews

With management team gauge responsiveness Direct Observation

During management meetings to observe responsiveness Documentation

of reports to determine if action plans were implemented

Major Findings

Emergence of innovative ideas 13 of the 15 ideas in the action plans were found to be ‘innovative’

therefore: AI promoted emergence and adoption of innovative ideas

Innovative ideas were incremental in nature Initiated by nurses More fully developed by members from all disciplines

Discovery phase: Group discussed the importance of collaboration and teamwork in relationship to staffing, time efficiency, and patient care

Dream phase: Proposition that the organization should create a vision for cancer care

Design Phase: Group took ownership of idea and decided to propose a vision to all members of the interdisciplinary team

Destiny phase: member of team had contacted other disciplines and organized a meeting to present the vision/goals that were developed through the AI process

Ideas rejected then brought back

Major Findings cont’d

Organizational Responsiveness and Idea Implementation Implementation involved action of those who were

part of the AI process Formal meetings held to elicit organizational response

to ideas Management team did not respond to health care teams’

expectation to support the implementation of most ideas External context issues and new emerging pressures took

precedent over discussions of ideas proposed in the action plan

Conclusion

Using a process that builds on positives such as AI may be the first step towards promoting the emergence of innovation in health care but….

The organization must respond and take action to support change Importance of follow through on proposed ideas

AI is a way to create organizational change by building on its most important asset, its people

Limitations and Future Research

Limitations Short post-AI observation period

Future Research Use of multilevel interventions involving middle and

upper management to better understand the factors that influence the implementation of ideas and the key role of management in this process

Discussion Question

Assuming that the development of innovative ideas is not unique to AI, what other change models could have been used to promote the development of innovative ideas and how would these processes differ from the 4D method of AI? Critical Research Model? Traditional Action Research Model?

The Critical Research Model

Traditional Action Research Model

Appendix 1

• A YES answer at item #1 or 2 and a NO answer at item 3 classify the idea as innovative

References

Rothwell, W. J., Sullivan, R. (2005). Practicing Organization Development: A guide for consultants. San Fransisco, CA: Pfeiffer.

Richer, M., Ritchie, J., & Marchionni, C. (2009). ‘If we can’t do more, let’s do it differently!’: Using appreciative inquiry to promote innovative ideas for better health care work environments. Journal of Nursing Management, 17, 947-955.

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