Appreciative Practice:An Overview

Rebecca Bouterie Harmon, PhD, RN, PMHCNS, BC

University of Virginia School of Nursing

What is Practicing “Appreciatively”

…in a nutshell…

Finding what is best in your organization (& you)

Figuring out how to get more of it

Focus on good and good appreciates

Foundational Theorists

Maslow, Hierarchy of Needs, 1943

Rogers, Client Centered Therapy, 1951 (unconditional acceptance)

Peplau, Interpersonal Relations in Nursing, 1952 (communication)

Bandura, Social Learning Theory, 1977 (self-efficacy)

Antonovsky, Health, Stress, & Coping, 1979 (salutogenesis & sense of coherence)

Appreciative Practice combines Self-help Movement

Dale Carnegie, Dr. Joyce Brothers & others

Positive Psychology Research Diener, Subjective Well Being, 1984 Csikszentmihalya, Flow, 1990 Seligman, Learned Optimism, 1991 Fredrickson, Broaden and Build, 2000 Julienne Bower, benefit finder, 2007

Organizational Development Cooperrider & Srivastva, Appreciative Inquiry

in Organizational Life, 1987 Whitney & Trosten-Bloom, The Power of

Appreciative Inquiry: A Practical Guide to Positive Change, 2003

Applies the Appreciative Eye to business models

A Generative or “Anticipatory Theory that has the capacity… to challenge guiding assumptions of culture, to raise fundamental questions regarding

everyday life, to foster reconsideration of that which is

taken for granted, and thereby furnish new alternatives...”

(Influenced by Ken Gergen’s 1982 book,Toward Transformation of Social Knowledge)

Appreciative Inquiry

Cooperrider, D.L., and Whitney D. (2005). Appreciative Inquiry: A Positive Revolution in Change.

Traditional Problem Solving

Focuses on a problem Identifies solutions, action

plans, interventions Break down the problem Fragmented response Slow resolution Change is mandated

The Medical Model

Chief Complaint:Problem focused

Differential Diagnosis:What is the worst thing that could happen?

Interventions:How do I prevent / fix it?

Break it down:Labs, x-rays, procedures

Diagnosis:The Problem

Action Plan:Often includes behavior modification

The Nursing Process

Assess Diagnose Identify outcomes

Plan Implement Evaluate

Cooperrider, D.L., and Whitney D. (2005). Appreciative Inquiry: A Positive Revolution in Change.

The Appreciative Approach

Focus is on the positive Asks, “What is working?”

“What is going well?” Identifies positive core values Builds on creativity &

imagination to co create Expands the vision of a

preferred future

10

The AI Process

Decide what to learn about

DISCOVERY:Find &

Appreciate the Positive Core

DREAM:Imagine what

might be

DESIGN:Determine what

should be

DELIVERY:Create what

will be

Positive Core:(What you

want more of)

Adapted from Whitney, D., and Trosten-Bloom, A. (2003). The Power of Appreciative Inquiry: APractical Guide to Positive Change.

DiscoveryAsking the Question… Unconditional, positive question Asking the question influences the

answer & sets the tone Not: “Who/what is the problem?”

Not: “How do we fix the problem?”

The Appreciative Practitioner asks: “What is working?” “Where is it working?” “How are they doing it?”

identify positive deviance encourage staff to find out provide psychological safety

(Amy Edmondson, 1999)

Example: Appreciative Check-in

“What went well today?” A great presentation on rounds. My patient got all the diagnostic tests

she needed. A patient said “thank you.” A coworker said “thank you.” My son hit a home run

(and I was there to see it !)

Guiding Principles of AI/AP

Constructionist Principle We create our reality Our interactions with others

determine who we areKenneth Gergen, 1994, 1999

Poetic Principle Everything is open to

interpretation We choose what we see

Rollo May, 1994

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See things differently…..

More Guiding Principles

Simultaneity Principle Change begins with the

question (Frankel, 1998; Goldberg, 1998)

Positive PrincipleWe’re more creative & able

to solve problems when we’re happy (Fredrickson, 2000)

Even More Guiding Principles

Wholeness Principle Everyone involved and focused on

higher ground Anticipatory Principle Our image of the future guides

our present actions Pictures &

images are more powerful than words

Anticipatory Principle Quote

“If you want to build a ship, don’t drum up the people to gather the wood, divide the work, and give orders. Instead, teach them to yearn for the vast and endless sea.”

-- Antoine de Saint Exupery

Cooperrider, D. & Whitney, D. (2005). Appreciative Inquiry:

A positive revolution in change.”

Why the positive approach works

Positive, energizing focus Builds the organization you

want to be a part of “Be the change you want to be.”

Builds a future with roots in the present (Doesn’t focus on

changing people)

Hammond, S.A. (1996). The Thin Book of Appreciative Inquiry

Why it works

Creates a shared vision

Statements are grounded in real experience

People know how (& want to) repeat their success

Why it works

Doesn’t ignore problems Uses collective wisdom of

group to move forward Identifies core values and

strengths as a basis for growth

UVA Projects in Process

PICU - Environment of Care Family Medicine - Magic of

Teaching Students SNMA - Success of Minority

Faculty Students Interventional Radiology School of Nursing Inpatient Psychiatric Unit TCV And more

UVA Appreciative Practice Executive Team“Moving as one into the future.”

Dorrie FontaineDean,UVA School of Nursing

Steven DeKosky Vice President and Dean,UVA School of Medicine

Ed HowellVice President and CEO,UVA Medical Center

UVA Appreciative Staff

Julie Haizlip, MDPICU and Pediatric Sedation Services

Peggy Plews-Ogan, MDGeneral Medicine, Geriatric, & Palliative Care

John Schorling, MDGeneral Medicine,Healer’s Art, Mindfulness Center

Anne Williams, MA Natalie May, PhD

Not pictured: Cathy Keefe-Jankowski, MTS

Selected References Cooperrider, D.L., & Whitney, D. (2005). Appreciative Inquiry: A Positive

Revolution in Change. San Francisco: Berrett-Koehler Publishers. Fredrickson, B.L. (2009). Positivity. New York: Crown Publishers. Hammond, S.A. (1996). The Thin Book of Appreciative Inquiry. Bend, Oregon:

Thin Book Publishing Company. Haizlip, J.A., & Plews-Ogan, M.L. (2010). Successful adaptation of

appreciative inquiry for academic medicine. AI Practitioner, 8, 3, 44-49. Kelm, J.B. (2005). Appreciative Living: The Principles of Appreciative Inquiry

in Personal Life. Wake Forest, N.C.: Vener Publishers. Ludema, J.D., Whitney, D., Mohr, B.J., & Griffin, T.J. (2003). The Appreciative

Inquiry Summit. Berrett-Koehler Publishers, Inc. San Francisco. Plews-Ogan, M.L., May, N.B., Schorling, J.B., Becker, D.M., Frankel, R.,

Graham, E., Haizlip, J.A., Hostler, S., Pollart, S., & Howell, R.E. (2007). Feeding the good wolf: Appreciative inquiry and graduate medical education. ACGME Bulletin, 11: 5-8.

Whitney, D., & Trosten-Bloom, A. (2003). The Power of Appreciative Inquiry:A Practical Guide to Positive Change. San Francisco: Berrett-Koehler.

Whitney, D., Trosten-Bloom, A., Cherney, J., & Fry, R. (2004).Appreciative Team Building. New York: iUniverse, Inc.

http://appreciativeinquiry.case.edu http://appreciativepractice.virginia.edu