Ronald E. Fry

An appreciative inquiry approach to practice improvement and transformative change in health care settings.

Amid tremendous changes and widespread dissatisfaction with the current health care system, many approaches tbo improve practice have emerged; however, their effects on quality of care have been disappointing. This article describes the application of a new approach to promote organizational improvement and transformation that is built upon collective goals and personal motivations, invites participation at all levels of the organization and connected community, and taps into latent creativity and energy. The essential elements of the appreciative inquiry (AI) process include identification of an appreciative topic and acting on this theme through 4 steps: Discovery, Dream, Design, and Destiny. We describe each step in detail and provide a case study example, drawn from a composite of practices, to highlight opportunities and challenges that may be encountered in applying AI. AI is a unique process that offers practice members an opportunity to reflect on the existing strengths within the practice, leads them to discover what is important, and builds a collective vision of the preferred future. New approaches such as AI have the potential to transform practices, improve patient care, and enhance individual and group motivation by changing the way participants think about, approach, and envision the future.

FORGIVENESS FROM THE PERSPECTIVES OF THREE RESPONSE MODES: BEGRUDGEMENT, PRAGMATISM, AND TRANSCENDENCE

This article explores constructions of forgiveness by studying responses to perceived offensive experiences in which ones own negativity toward the event is increased, displaced or dissolved. Forgiveness is rarely considered in management research, yet it has particular relevance to the health and function of interpersonal connections that allow organizations to thrive. There are two schools of thought about the meaning of forgiveness. The dominant school accepts that forgiveness occurs when ones negativity toward perceived offenders is neutralized. The second school considers that forgiveness must include a transformation of negativity to positivity. Forgiveness is closely identified with Positive Psychology and Positive Organizational Scholarship, which focus on the dimensions of human strength and resilience. Yet, because the neutralization school is dominant, research has not developed an understanding of forgiveness as an especially positive influence or practice. The article presents a grounded theoretical framework for considering forgiveness, not only as reparation, but also as strength. Data from interviews conducted in a unionized trucking company suggest three responses to offense: the begrudging mode, in which forgiveness is an illusion; the pragmatic mode, where forgiveness is a necessity; and the transcendent mode, in which forgiveness is a life choice. The transcendent mode especially adds a substantive set of ideas that extend an understanding of forgiveness as an elevating, positive dynamic in organizations.

Appreciative Inquiry for quality improvement in primary care practices.

Purpose: To test the effect of an Appreciative Inquiry (AI) quality improvement strategy on clinical quality management and practice development outcomes. Appreciative inquiry enables the discovery of shared motivations, envisioning a transformed future, and learning around the implementation of a change process. Methods: Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical-record review assessed change in PSD rates. Ethnographic field notes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. Results: The PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives, and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited 1 or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. Conclusions: An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective.

Improving the coordination of care: a program for health team development.

This workbook of task-oriented activities is aimed at helping any group of health workers and/or administrators responsible for the delivery of health care to do its job in the most effective way possible. The program focuses on specifically defining tasks and procedures for doing them. It requires 7 3-hour periods to complete and requires no outside consultants facilitators or specially trained helpers. This book contains an introduction guidelines for administrators regarding its use; guidelines for users and 7 recommended task-oriented modules. Topics include: defining and clarifying goals; setting measurable performance objectives; defining and allocating responsibilities; negotiating day-to-day conflicts; making more efficient and effective decisions and referral procedures; and increasing results for time spent in meetings and case conferences. Each module is designed around a common format which specifies desired outcomes expected from a session and the pre-meeting preparation required. Each gives an overview of major activities provides an introduction to the module an outline of the team meeting and a series of summary comments. 6 optional modules cover specific work issues: 1) bringing a new member into the team; 2) running a better meeting; 3) improving leadership and team interaction; 4) identifying and eliminating behavioral habits that hinder the teams work; 5) improving interaction with the rest of the organization; and 6) obtaining feedback from patients.

Boundary spanning and health: invitation to a learning community

Boundaries, which are essential for the healthy functioning of individuals and organisations, can become problematic when they limit creative thought and action. In this article, we present a framework for promoting health across boundaries and summarise preliminary insights from experience, conversations and reflection on how the process of boundary spanning may affect health. Boundary spanning requires specific individual qualities and skills. It can be facilitated or thwarted by organisational context. Boundary spanning often involves risk, but may reap abundant rewards. Boundary spanning is necessary to optimise health and health care. Exploring the process, the landscape and resources that enable boundary spanning may yield new opportunities for advancing health. We invite boundary spanners to join in a learning community to advance understanding and health.

Introduction: Building Ethical, Virtuous Organizations

Since its inception nearly 50 years ago, the Journal of Applied Behavioral Science has consistently sought contributions that address questions of organizational effectiveness and humane organizing. Indeed, the Journal of Applied Behavioral Science has always maintained a general interest in expanding our theory-in-use about how to enact or lead socially responsible, effective organizations. The recent decade has sharpened the importance of such issues, particularly as society considers how to respond to the emergence of the Great Recession and the excesses that preceded it. Thus, this special issue seeks to explore research that builds social theory and informs application of theory to support the creation of positive, sustained ethical action in and by human systems.

THE GENERATIVE POTENTIAL OF CYNICAL CONVERSATIONS

Abstract A common concern raised in opposition to Appreciative Inquiry (AI) is that a focus on life-giving images in organizations tends to suppress negative voices. It is supposed that AI sees little value in skeptical, cynical, or negative perspectives. However, when AI is properly understood, all voices – both positive and negative – are seen as essential to the life of organization. The challenge is to create an atmosphere in which the cynical voice, rather than perpetuating dysfunction, can be tapped to build generativity. This chapter describes how to accomplish this objective through the use of analogic inquiry, thus exploring the focus on generativity that is central to AI.

From coordinators to expediters to owners: A study of cross functional teams as integrating mechanisms

Abstract This study looks at the “fit” between distinctively different customer environments and the internal process of cross functional product development teams interfacing with these environments. Earlier research has suggested as the environment becomes turbulent, teams must be more adaptable, multidisciplinary, and empowered. From interviews and observations of team meetings three team patterns, Coordinators, Expediters, and Owners, emerged supporting the contingency perspective. Similarities and differences in their leadership, meeting dynamics, and boundary management are analyzed and discussed. A general model is proposed to help managers and team members in designing and developing teams as integrating mechanisms.

Chapter 8 Developing Space for Diversity: An Appreciative Stance

Relational space refers to the state and configuration of interpersonal connections within a social system and to the conditions that facilitate these connections. Where connections are strong or of high quality (Dutton & Heaphy, 2003), the relational space is vibrant and full of life. When the number of connections is numerous, and where their configuration is extensive and expansive, the relational space is robust and resilient (Baker, Cross, & Wooten, 2003). Generative capacity is increased by the extent to which people connect to think expansively through dialogue in vibrant, healthful relational spaces.

Workshop: improving worker coordination in health care delivery.

Patient management teams are able to diagnose and begin to solve their own problems with the help of a self-instructional health team development (HTD) program. In this case, the focus is on those task-related issues which limit team effectiveness.