"The best way to predict the future is to create it.” - Peter Drucker
Please read Part I of this blog series, which provides the context for this post.
- Interdisciplinary group (IDG) members are encouraged to let their imagination and creativity run loose and give voice to their highest vision of the coordinated interdisciplinary delivery of care;
- Each IDG meeting is an energized and passionate experience with innovation, collaborative thinking, and anticipatory planning focused on achieving the patient and family goals of care; and
- The documentation of clinical information reflects a multidimensional, integrated and cohesive picture of the dynamic nature of the patient’s terminal illness, related conditions and the palliation of total pain.
For those of you who have already achieved this, congratulations! Please share with us your pathway(s) to success! For the rest of you, please read on…
Appreciative Inquiry (AI), is a transformational process that seeks not to identify problems and construct solutions, but to embrace the understanding that organizational change is rooted in, and energized by, the innate strengths and capabilities that have carried it thus far -- its positive core. AI is built upon the premise that the process of asking positive questions shapes the creative conversations that generate a shared vision of the future and the design. Years of experience and research have demonstrated that “…people learn, and organizations change most readily when they focus on, study, and engage in dialogue about strengths, patterns of success and who they are at their best.[i]” Research has demonstrated that AI lends itself to a variety of scales of involvement from small groups (e.g., teams) to whole organizations to large gatherings known as AI summits.
What led to this new way of thinking about organizational change and the move from deficit thinking to the exploration of innate strengths as a springboard to possibility? Sue Annis Hammond outlines the 8 Assumptions of Appreciative Inquiry [ii]
- “In every society, organization, or group -- something works.
- What we focus on becomes our reality.
- Reality is created in the moment, and there are multiple realities.
- The act of asking questions of an organization or group influences the group in some way.
- People have more confidence and comfort to journey into the future (the unknown) when they carry forward parts of the past (the known).
- If we carry parts of the past forward, they should be what is best about the past.
- It is important to value differences.
- The language we use creates our reality.”
This is not “pie in the sky” thinking or a process that denies the existence of problems. It is a reorientation of how an organization chooses to approach its development. Rather than looking for what is broken, the focus is on finding what is working and using that as a foundation for creating more of the same. Sound familiar? Remember Dame Cicely Saunders’ famous quote about hoping to “help the dying to live until they die, and their families to live on”? Looks to me like hospice and AI already swim in the same pool!
I. The Affirmative Topic Choice
The process begins with the selection of the topic choice. From the beginning of any meeting or process, the premise is informed by the framing of the topic. For example, rather than trying to solve the problem “inconsistent and incomplete documentation,” in the AI process, the affirmative topic for inquiry could be framed as “deliberate descriptive documentation.” The topic of choice becomes the focal point for inquiry and the 4-D cycle begins.
II. The 4-D Cycle
Each of the 4 phases of the AI cycle can be summarized by the following affirmative questions:
- Discovery: “What gives life?”
- Dream: “What might be?”
- Design: “What should be?”
- Destiny: “What will be?”
“The best of what is” – Appreciating
This stage aims to uncover past and present strengths and successes of the group through asking positive questions. What gives life to the system? Stories emerge illuminating experiences of which both individuals and the group can be proud. There is validation of the inherent “best” that already exists.
Questions are constructed to encourage storytelling, such as:
- Describe a time when you felt most engaged with the IDG and proud to be a member of the team.
- What were the circumstances that made you proud? What effect did that have on your work? On the next team meeting?
- What is at the heart of the IDG -- that thing that most defines who you are as a team, and without which the team could not survive?
- Tell us about an example of successful collaboration with another team member that you experienced recently. What did you do to contribute to this collaboration? How did this make you feel? What did you learn from this experience?
What emerges from this stage is the positive core – the strength, resiliency and successes that is the team’s shared history. These are the qualities, competencies and practices that will remain, even as change occurs. Recalling these experiences, team members are energized as they move into the next phase.
“What might be?” – Envisioning
Through attention to the stories that emerged in the discovery of the “best of what is,” and through the use of imagination, in this phase, team members explore their hopes for the future. The process of affirmative inquiry continues:
It is 2018 and your team has been voted the “ideal IDG” – a best practice model of interdisciplinary coordination, collaboration and communication.
- Describe in as much detail as you can what makes this 2018 team exceptional. As you walk into IDG:
- How is the room arranged?
- What is the structure of the meeting?
- What kinds of conversations are transpiring? Between whom?
- What do you recognize that is present in your IDG today?
- What is different?
- If you could have 3 wishes that would increase the vitality of the IDG, what would they be?
- You have the opportunity to work with an information technology (IT) expert to build an electronic medical record. What would be most important to you? Why?
This is a time for unbridled dreaming with creative thinking encouraged through the use of conversation, writing, drawing and drama.
What emerges from this stage is a collective vision of the future -- a shared dream.
Energized by the positive core and dreaming of what might be, the group is ready to move into the next phases in the co-creative process. Design and Destiny, found in Part III of this blog series.
Posted by: Suzanne Karefa-Johnson, MD, Senior Physician Consultant, Weatherbee Resources, Inc.
[i] Appreciative Inquiry, The Corporation for Positive Change, accessed November 8, 2014. http://positivechange.org/how-we-work/appreciative-inquiry-ai/
[ii] Sue Annis Hammond, The Thin Book of Appreciative Inquiry, 1998, p 20-21