Systematic review and narrative synthesis of the impact of Appreciative Inquiry in healthcare

Abstract

BackgroundAppreciative Inquiry is a motivational, organisational change intervention, which can be used to improve the quality and safety of healthcare. It encourages organisations to focus on the positive and investigate the best of ‘what is’ before thinking of ‘what might be’, deciding ‘what should be’ and experiencing ‘what can be’. Its effects in healthcare are poorly understood. This review seeks to evaluate whether Appreciative Inquiry can improve healthcare.MethodsMajor electronic databases and grey literature were searched. Two authors identified reports of Appreciative Inquiry in clinical settings by screening study titles, abstracts and full texts. Data extraction, in duplicate, grouped outcomes into an adapted Kirkpatrick model: participant reaction, attitudes, knowledge/skills, behaviour change, organisational change and patient outcomes.ResultsWe included 33 studies. One randomised controlled trial, 9 controlled observational studies, 4 qualitative studies and 19 non-controlled observational reports. Study quality was generally poor, with most having significant risk of bias. Studies report that Appreciative Inquiry impacts outcomes at all Kirkpatrick levels. Participant reaction was positive in the 16 studies reporting it. Attitudes changed in the seventeen studies that reported them. Knowledge/skills changed in the 14 studies that reported it, although in one it was not universal. Behaviour change occurred in 12 of the 13 studies reporting it. Organisational change occurred in all 23 studies that reported it. Patient outcomes were reported in eight studies, six of which reported positive changes and two of which showed no change.ConclusionThere is minimal empirical evidence to support the effectiveness of Appreciative Inquiry in improving healthcare. However, the qualitative and observational evidence suggests that Appreciative Inquiry may have a positive impact on clinical care, leading to improved patient and organisational outcomes. It is, therefore, worthy of consideration when trying to deliver improvements in care. However, high-quality studies are needed to prove its effects.PROSPERO registration numberCRD42015014485.

Identifying Holistic Nursing Research Priorities for 2023–2026

“…Appreciative Inquiry was chosen to guide the initial activities as it allows for the engagement of the hearts, souls, and minds of people engaged in creating change using four stages: (1) discovery, (2) dream, (3) design, and (4) destiny (Copperfield & Whitney, 2005;Cowling, 2001Cowling, , 2004Cowling, , 2023Cowling & Repede, 2010;Merriel et al, 2022;Verheijen et al, 2020). In the first stage (discovery), the topic selection is based on related concerns or issues, what the group wants to discover, and a deep dive into the literature.…”

“…Appreciative Inquiry is used in both nursing and organizational research to frame quantitative and qualitative studies (Cowling, 2004; Merriel et al, 2022). Using appreciative inquiry in a qualitative study of women in despair, Cowling (2004) described the process he used to provide a listening space for their stories to be told.…”

What factors in the workplace enable success in antimicrobial stewardship in paediatric intensive care? An exploration of antimicrobial stewardship excellence through thematic analysis of appreciative inquiry interviews with healthcare staff

“…This approach is complementary to the prevailing approach to improvement which tends to focus on understanding failure. A recent systematic review identified a lack of high-quality empirical evidence to support the effectiveness of AI to inform positive change in the quality and safety of healthcare, 10 so we intend the results of this study to build on the research in this area.…”

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“…A potential method to create this culture is appreciative inquiry which is becoming increasingly embedded within healthcare and more specifically around learning to improve the quality and safety of healthcare (Beaumont, 2017; Crust, 2023; Merriel et al, 2022). It can effect positive change in complex, human-based systems.…”