Transitioning a physician practice to a patient-centered medical home (PCMH) is a daunting task for physicians and staff and can create or exacerbate physician burnout symptoms if carried out poorly.
So, looking to head off the stress and turmoil during the change at his 11-provider Indianapolis primary care practice, family physician Jason Everman, DO, turned to an approach called appreciative inquiry. His goal in using the tool was to avoid the negative impact that changes in the work environment can have on morale and communication in the practice during and after the switch in the practice’s daily operations.
He succeeded.
“Because we used appreciative inquiry as we pursued this strategic improvement aim, the atmosphere in our practice has actually become more positive,” he said.
Committed to making physician burnout a thing of the past, the AMA has studied, and is currently addressing issues causing and fueling physician burnout—including time constraints, technology and regulations—to better understand and reduce the challenges physicians face. By focusing on factors causing burnout at the system-level, the AMA assesses an organization’s well-being and offers guidance and targeted solutions to support physician well-being and satisfaction.
The AMA Ed Hub™—your center for personalized learning from sources you trust—offers CME on a broad range of topics, including professional well-being using the STEPS Forward™ open-access platform that offers innovative strategies that allow physicians and their staff to thrive in the new health care environment. These toolkits can help you prevent physician burnout, create the organizational foundation for joy in medicine, create a strong team culture and improve practice efficiency.
The AMA STEPS Forward module, “Appreciative Inquiry: Fostering Positive Culture,” guides physicians through a five-step process to boost resilience and collaboration in the office setting.
Appreciative inquiry, developed at Case Western Reserve University in the 1980s, uses unconditional positive questions to identify what is working in the practice. For example, physicians and others in the practice are asked to think about someone who went beyond the call of duty in the organization and to then think about what happened because of the extra effort. Or, everyone is asked to think about a recent successful team project and to reflect on what made it successful.
Some ways to incorporate this include appreciative “check-ins” at the start of meetings; “shout outs” where team members share something positive that they observed recently about another member’s actions or performance and “positive gossip” where staff members share favorable vignettes or inspiring patient quotes. The team also can turn a barrier into an opportunity and find the value behind a complaint.
Dr. Everman said his practice uses appreciative check-ins when they begin staff meetings, appreciative debriefs when they conclude staff meetings and appreciative interviewing when they conduct strategic planning for the coming year.
During one exercise, some staff members showed a readiness to put the patient first and showed their internal drive to make improvements at the practice. Dr. Everman said the experience has made him appreciate the power of humanism to change the culture at a health care organization and to help effectively implement improvement projects.
“I’ve seen more human touches in our clinic over the last few months than previously, including heartfelt laughter among patients and staff while handling disease and life changes, smiles and kindness even during the most-tense of times,” Dr. Everman said.
He said he has noticed side conversations focused on raising the bar in the practice’s approach to patient care, questions being asked about why the office functions in certain ways and conversations about whether those things can be improved. Dr. Everman also has noticed innovation in clinic-patient communication to raise satisfaction for every patient at every visit.
“I've been truly inspired by my co-workers' focus, motivation and personal commitment during this process,” Dr. Everman said. “Appreciative inquiry gave us the positive atmosphere we needed to move ahead with the changes involved in becoming a PCMH. It helped us grow together and provide even better care to our patients.”
The STEPS Forward module offers more concrete information to help practices learn about the appreciative inquiry process and outlines how they can apply it to their health care setting. The module answers frequently asked questions about the approach and takes doctors through the five steps to build and maintain a positive organizational culture. It explains how to:
- Build a guiding coalition of leaders to shape your organizational culture and work experience.
- Form a “discovery team” to elicit positive stories and themes from your organization.
- Share positive stories to catalyze and spread culture change.
- Incorporate appreciative inquiry into daily work to maintain positivity in your organization.
- Link appreciative inquiry to existing performance improvement initiatives.
Several modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks.
The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.
