Appreciative Inquiry in Healthcare: Positive Questions to Bring out the Best

appreciative_inquiry_in_healthcare Appreciative Inquiry in Healthcare offers a practical "toolkit" designed to stimulate positive change and engage others in creating the healthcare environment so desperately needed today. It offers an encyclopedia of unconditionally positive questions to encourage dialogue about what is right in health care.

Diana Whitney and Center for Appreciative Practice faculty created this book as the result of dozens of hours of conversation and interviews across the UVA Health System. The Center’s interprofessional team worked with more than 30 groups encompassing all levels and aspects of healthcare, helping to guide them through the process of culture change. This book is the distillation of that work – outlining questions designed to:

 

  • Harness the creative energy and passion of people at all levels
  • Focus the positive energy on the challenges facing your healthcare organization
  • Create a culture of top-quality care
  • Learn about and support the best of caregivers, patients, and families
  • Embrace improvement opportunities with commitment and optimism
  • Build collaboration based on trust and a belief in the best of one another

Although the book is designed to stimulate change in the healthcare arena, the questions are easily adapted to other professional environments. AI in Healthcare is available on Amazon.com or you may purchase a copy directly from the Center (which gets you a free bookmark!).


Choosing Wisdom: Strategies and Inspiration for Growing Through Life-Changing Difficulties

by Margaret Plews-Ogan, Justine E. Owens, and Natalie May

"Every once in awhile a book comes along that alters the landscape of words and thoughts; Choosing Wisdom is one of those rare books. I never heard of 'posttraumatic growth' until I read this book and now it is term that lives hopefully in my soul. As a hospice and palliative care physician for the past 12 years, it was always interesting to watch individuals enter the terminal phases of their life; some spend their last days and weeks filled with anger, bitterness, and regrets while others enter the dying process filled gratitude, love, and hope. Why the difference? In Choosing Wisdom, a team of researchers at UVA, led by Margaret Plews-Ogan, MD, explores how average people respond to adversity, how they change, and what factors help or hinder positive change.

"This is a book about 'hope,' although I don’t think that word came up often. This book gradually but persistently instills into the reader the hope that people–that I–can choose a wise path, one that will turn my sufferings and adverse experiences into something good. By entering the journeys of the patients described in this book, we learn how we can grow, change, and develop wisdom through adversity and how we can help others pick the wise path.

"I strongly and enthusiastically recommend this book to every health care provider, anyone facing their own difficult journey, and every person who wants to help others face life’s difficulties."

-James A. Avery, MD, CMD, FACP, FCCP, FAAHPM
Chief Executive Officer, Hospice of the Piedmont, Charlottesville, VA

“This is a wonderful and very accessible book that gives hope to all who suffer from physical and emotional pain. The participants in this study show how the straw of adversity can be spun into the gold of wisdom. I highly recommend this book to anyone who believes that life is a journey toward psychosocial growth.”

-Monika Ardelt, PhD, Associate Professor of Sociology, University of Florida

Choosing_WisdomChoosing Wisdom is a very human story taking us from breakdowns to breakthroughs in scenarios of unrelenting physical pain and physicians’ serious medical errors. Health care providers of every discipline will benefit from the elegant strategies proposed; wise lessons from ordinary people. Choose this book and appreciate the power of those who can reframe adversity and develop wisdom along the way. We can too.”

-Dorrie K. Fontaine, PhD, RN, FAAN, Dean and Professor, University of Virginia School of Nursing

“Like a plant that grows toward the light, Choosing Wisdom takes the reader on a journey toward enlightenment through the stories of regular people who have faced difficult circumstances and been positively transformed in the process. It is a must-read for medical professionals, patients, and anyone interested in cultivating their own self-awareness and appreciation of our deep connections to the sufferings and joys of our fellow human beings.”

-Richard M. Frankel, PhD, Professor of Medicine and Geriatrics, Indiana University School of Medicine

Ad astra per aspera (a rough road leads to the stars). Read this book as though your life depends on it– it does!”
-Thomas S. Inui, ScM, MD, Senior Investigator and Professor of Medicine, Regenstrief Institute, Inc. and Indiana University School of Medicine

Amazon Review

“Down to earth discussion of what it is like for patient and physician when treatment does not produce the desired outcome, sometimes through error or sometimes through the nature of disease and treatment. We are so accustomed to the now seemingly magical successes of contemporary medicine it is all the more shocking when these quite complex procedures and treatments may not bring the expected results. This book and the CD enter into personal accounts of these experiences from the perspective of the physicians and the patients. A most insightful paradigm is offered for approaching these events and using the experience for increased wisdom and strength for the continuing journey. I purchased this to give to a first year medical student and her parents whom I love and respect and was delighted to find this to share with them.”

-Marita Digney, D.Min., Psychologist, Charlottesville, VA

Wisdom Leadership in Academic Health Science Centers: Leading Positive Change

Wisdom Leadership In Wisdom Leadership in Academic Health Science Centers: Leading Positive Change, editors Margaret Plews-Ogan and Gene Beyt illustrate how academic health science centers can create a culture that closes the gap between what we should be doing for patients and the reality of what occurs, by nurturing the “thread” of humanity that connects healer to patient and teacher to student. Drawing on William Stafford’s poem “The Way It Is”, Plews-Ogan and Beyt argue that healthcare professionals should hold tight to this thread (“You don’t ever let go of the thread”) even as it is being frayed by the divisive debate over the Affordable Care Act, incentivized payment to providers and eroding consumer trust. The thread is wisdom leadership which has the potential to transform healthcare workers and thereby transform the culture of academic health science centers.

Several chapters are written by CAP faculty, including Julie Haizlip, John Schorling, and Plews-Ogan.

The first in a five-volume series on enhancing the professional culture of academic health science centers, Wisdom Leadership inspires readers to become their best selves by reconceputalizing the attributes of leadership to reflect and integrate wisdom. In this framework, wisdom transcends intelligence; is multi-dimensional, spanning knowledge, emotion, and moral behavior; and represents the pinnacle of human development. Drawing on work of business leadership gurus Ikujiro Nonaka and Hirotaka Takeuchi, Plews-Ogan and Beyt propose that wise leaders are those who are both thinkers and doers dedicated to patient-centered care and who focus on details without losing sight of the big picture. In other words, they create space for the exchange of knowledge, concerns, and shared goals. They bring people together and resolve conflicts. They nurture wisdom development in others from boots-on-the-ground workers to high executives, creating an environment of pervasive leadership.[1]

Plews-Ogan and Beyt have carried this notion of wisdom to the healthcare arena and specifically to the culture of academic health science centers (AHSC). They link the same wisdom attributes of successful business leaders to successful leaders in AHSC. Wise leaders encourage healthcare providers to be “their best selves” by adopting affirming techniques such as reflection, increasing one’s tolerance for ambiguity and complexity, and fostering compassion. Transformation of complex healthcare settings is evidenced by effective communication skills, shared goals, shared knowledge, and mutual respect among healthcare teams and across the organization. In short, by actualizing the practices of wisdom, the practitioner becomes a transforming force in shaping a healthcare environment that is more positive, collaborative and patient-centered.

The editors espouse that leaders in AHSCs can harness capacities for wisdom development and demonstrate this by weaving together stories, experiences, and insights from distinguished contributors from fields of medicine, management and leadership, and ethics. Drawing on the humanities, the editors introduce each chapter with a poem, story, or interview to spark moral imagination, elicit meaning, and connect on a human level the concepts explored within. For instance, there is a story about colleagues in Korea who despite the termination of monthly regional meetings continue to show up because of their need to exchange and compare ideas, successes, and failures.  There is another story recounting the leadership actions of one physician who rebuilt her distraught crisis intervention and care team devastated by a nursery-wide medication error that took the lives of several newborns. The reader is also privy to a physician’s lived experience of complexity theory, in which she learns that contrary to a linear model of cause and effect, the complex interaction of interdependent agents—physician-as-patient, unfamiliar clinician, and silent spouse—resulted in the delay of diagnosis and treatment of her pneumonia.

This book is organized into three parts. Part I, the introduction and first chapter, familiarizes the reader to the complexities of leadership and management of complex AHSC and justifies wisdom as a worthy construct for framing an exploration of leadership. Monika Ardelt’s three-dimensional model conceptualizes wisdom as a state of being, accenting both character and behavior. The cognitive dimension seeks truth and meaning; the reflective dimension requires self-examination, insight, and awareness; and the compassionate dimension transcends self-absorption to express empathy and sympathy for others. Leaders in AHSC are charged with modeling and fostering attributes of wisdom as they nurture the formation of wise professionals and create the new fabric of our health care arena.

Part II focuses on the capacities of wisdom leadership: “finding and understanding the deeper meaning of things, reflection, compassion, understanding and applying right action in difficult circumstances, seeking out and fostering the best in ourselves and others, and understanding and embracing complexity”. Each of the seven chapters identifies helpful, practical techniques to operationalize these capacities. Some of these include having people reflect on a hand held object that symbolizes the meaning of their work and sharing that meaning with others in the group; promoting professionalism using physician peer supporters especially following adverse events; and using positivity strategies such as opening meetings with a positive story, assuming people interact with positive intent, and focusing on desired behaviors as opposed to unwanted ones.

Part III, consisting of only two chapters, provides a glimpse into what the journey to wisdom leadership might look like. First, Angel Barron Mc Bride, Indiana University School of Nursing, records this journey by following threads of evidence of wisdom leadership woven across all stages of one’s career. She illustrates how capacities for leadership vary in appearance from early development in which one learns the knowledge and clinical skills of entry level practice. The fledgling analyzes personal strengths and opportunities for growth, becomes socialized in the culture of healthcare, and learns strategies to manage stress. The seasoned practitioner builds a stable infrastructure and creates a vision for the future. She assumes responsibility for program development, challenging new thinking, and coaching her team. In the book’s final chapter, Wiley “Chip” Souba, Geisel School of Medicine, Dartmouth College, explores the phenomenology of wisdom, asserting that a journey of personal change must precede organizational or system transformation. He claims that many of our healthcare challenges stem from our resistance to let go of or revise our “engrained ways of being and acting”. Wise leaders, however, choose to make changes to their “being” that enhance their leadership effectiveness. Not unlike the phrase often attributed to Gandhi, “Be the change you wish to see in the world”, Sousa recommends four ways of exercising wisdom leadership by personifying the changes you wish to see in your institution. He suggests being mindful (awareness of one’s already-always-listening), being your word (having integrity), being a stand (being committed to a position), and being cause in the matter (having authenticity). In other words the wise leader is mindful of negatively distorting contexts through which he hears. He does what he says he will do and lives for a future that surpasses the quality of today. He replaces excuses with renewed responsibility and determination to overcome challenges and conceive a higher quality patient-centered tapestry of care.

"This book speaks especially to readers who will provide care in complex dynamic healthcare settings where relationally coordinated collaboration among care team members is essential for safe, efficient, high-quality patient-centered care. Wisdom Leadership will also engage readers who will potentially receive care—who envision health care that is compassionate and meaningful, and deserve a humanistic medical profession that knows what to do, andhow to act as healers and leaders. This volume blends the theoretical with the practical. It generates positive mental images of benchmarks in progress, and contains practical skills that instill confidence and keep success within reach. These are turbulent times, but as William Stafford implores, while we cannot “stop time’s unfolding/ You don’t ever let go of the thread”. Wisdom Leadership should be required reading for all health care executives who wish to sustain the thread of humanity and weave wise leadership into contemporary healthcare."

-Gordon Mosser, MD, Senior Fellow, School of Public Health, University of Minnesota
Co-author of Understanding Teamwork in Health Care

[1] Ikujiro Nonaka and Hirotaka Takeuchi. The Wise Leader: How CEOs Can Learn Practical Wisdom to Help Them Do What’s Right for their Companies and Society. Harvard Business Review; May 2011.