When undertaking organizational change, focusing only on what is wrong in your practice can create a negative atmosphere. But taking the time to recognize what is positive in your practice can help your care team see more clearly what gives life, vitality and joy to their daily work—and make sure those aspects remain.

“Appreciative inquiry”—developed at Case Western University in the 1980s—is an approach to change that identifies and builds on what is already working well in an organization to move a practice toward positive change. It uses unconditional positive questions to identify what is best in an organization, such as:

  • “Think of a recent successful team project. What made the team so successful?”
  • “Have you noticed a colleague go beyond the call of duty recently? What happened?”
  • “What is something that went well for you today?”
  • “What is a recent positive experience in your work or personal life?”

While you’re making changes around what is not working well, these types of questions can help your team stay focused on what they are already doing well as those changes are put into place.

A new module from the AMA’s STEPS Forward™ collection of practice improvement strategies shows you how to change your organizational culture using appreciative inquiry. The module can help your practice use this technique in daily huddles, staff meetings, leadership meetings, performance evaluations and interactions with patients and family members.

How it’s working in Indy

At Rockville Plaza Family Practice in Indianapolis, appreciative inquiry became a significant part of their transition to becoming a patient-centered medical home.

“The stress and turmoil of this change could have had a negative effect on morale and communication,” said Jason Everman, DO, a family physician at Rockville Plaza Family Practice. “In my role as a physician leader, I’ve seen just the opposite.”

“Because we used appreciative inquiry as we pursued this strategic improvement aim, the atmosphere in our practice has actually become more positive,” he said.

Dr. Everman’s practice uses appreciative check-ins when they begin staff meetings, appreciative debriefs when those meetings conclude and appreciative interviewing as they conduct their strategic planning for the year.

“The changes in the practice have been noticeable,” Dr. Everman said. “I’ve seen more human touches in our clinic over the last few months than previously,” including:

  • Real laughter among patients and staff while handling disease and life changes
  • Smiles and kindness even during the most tense moments of the day
  • Side conversations focused on raising the bar for the approach to patient care
  • Questions of why the practice functions in certain ways and if it can be improved
  • Innovation in clinic-patient communication to raise satisfaction for patients

During one of the practice’s appreciative inquiry exercises, Dr. Everman said it became apparent that some of the staff already had an internal drive for improvement, and that can often be more powerful than external incentives.

“Staff members displayed a readiness to put the patient first,” he said. “Since that exercise, I have come to really appreciate the power of humanism to change the culture of a health care organization—and to help us effectively implement improvement projects … It helped us grow together and provide even better care to our patients.”

There are seven new modules now available from the AMA’s STEPS Forward collection, bringing the total number of practice improvement strategies to 42; several thanks to a grant from and collaboration with the Transforming Clinical Practices Initiative.

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