Appreciative Inquiry for Quality Improvement in Primary Care Practices

Abstract

Purpose To test the effect of an Appreciative Inquiry (AI) quality improvement strategy, on clinical quality management and practice development outcomes. AI enables discovery of shared motivations, envisioning a transformed future, and learning around implementation of a change process. Methods Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical record review assessed change in PSD rates. Ethnographic fieldnotes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. Results PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited one or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. Conclusions An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective.

Appreciative Inquiry as an intervention to change nursing practice in in-patient settings: An integrative review

“…The difference with Appreciative Inquiry is that the starting point is an emphasis not on deficits but on what is working well (Cooperrider et al 2008). However, it is the transformative and energising potential of Appreciative Inquiry that makes it distinct from other change management strategies and may explain why healthcare researchers are drawn to using it (Ruhe et al 2011). The drive to transform healthcare is panoramic.…”

“…Recent proliferation of negative accounts of nursing has become the catalyst for seeking change and alternative frameworks for care. Appreciative Inquiry offers potential as a new intervention approach to tap into core motivations, strengths and values that inspire and provide an impetus for change (Ruhe et al 2011). …”

Engagement of Groups in Family Medicine Board Maintenance of Certification

“…Employing the PES was particularly helpful in fostering individualization of QI projects that were personally meaningful. Tying change efforts to personal meaning has been shown to be important to motivating engagement of busy primary care physicians in QI, 14 and a locally-tailored approach is an essential characteristic of successful practice change facilitation 15,1416 …”

Using Appreciative Inquiry During Care Transitions

“…16 Appreciative inquiry was used by health care professionals for adapting and improving professional practice environments. [17][18][19] No reports were found, however, that used AI as strategy to enhance patients' health. Building on our previous work, AI coaching seemed a natural fit to build positive behaviors postdischarge.…”