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RCGP Quick guide: Appreciative Inquiry

Appreciative inquiry is an approach to improvement that shifts the focus from ‘What is wrong with our service and how can we fix it?, to ‘What is going well and how can we build on this?’.
It is an approach that has started to be used in business environments to help groups of people working together to learn more from their success and to build on these to generate further improvements.
The approach has a positive influence on the culture of an organisation and can be especially helpful when working in difficult circumstances in order to improve morale and create a culture that is more conducive to quality improvement.
Download RCGP Quick guide: Appreciative Inquiry
How to
It is your choice whether to use a structured Appreciative Inquiry (Ai) process, or whether to just become more appreciative in general when approaching improvement. For example when reviewing the National GP Survey Results at your practice meeting you could decide to start by highlighting what the patients like best about the practice.
If you chose to use a structured Ai approach then there are 5 stages:

  1. Define the area you want to focus on. This would be best achieved at a whole team practice meeting. Allocate someone to lead the Ai approach. This could be anyone in your team, and it would be best to choose someone who is feeling positive about their work, as they will find it easier to take an appreciative approach.
  1. Discover the positive stories relate to the area of focus. This can be done in a group setting or by one-to-one discussion with GPs, Practice nurses, staff or patients using positively-framed open questions such as ‘What do you like best about…?’ and then taking the inquiry to a deeper level ‘Why does that work well for you?’ The language used in your inquiry is critical to whether the inquiry generates further positive change.
  1. Discover the stories that most reflect the high points, those that seem to be most inspiring and generate a sense of optimism. These moments or experiences are called the ‘Life Giving Forces’. A Life-giving force could be a single event when excellent patient care was delivered, or a wider project that led to positive outcomes. The Ai leader collates the key features in the stories and presents them back to the practice team.
  1. The positive energy generated in Step 3 is then used to imagine a future service, where the highpoints discovered become part of everyday reality. This stage is better achieved if the practice team have enough time to be creative and are prepared to challenge the ‘way things have always been done’, and challenge assumptions and routines.
  1. Design. This final step puts the details on any changes that are decided in order to move the practice towards their ‘dream’. If the approach is to make a sustainable difference then it is important to notice and celebrate successes that are contributing towards achieving the dream.