Using Appreciative Inquiry to Make a Real Difference to the Experience of Care

Dr Beca Stilwell

Anna Tee

Dr Bethan Lloyd

Hywel Dda University Health Board

This project tested the principles of Appreciative Inquiry (AI) at the front line of healthcare.

This was a short intervention, at the ward level, using the leadership of a clinical psychologist that explored how AI could be used to develop nurses’ understanding of what enhances compassionate care. AI holds at its core the principle that something works well in every system. Using the 7Cs of caring conversations (Dewar, 2013) as the model, the things that worked, i.e. good practice was observed and reflected on with nursing staff.

What makes this approach different?

Unlike the typical approach of ‘finding the problem and fixing it’, AI offers an alternative where the focus is placed on the things that work well. By creating a better balance, can we improve care?

Our project has shown that this is possible, but also that a lot more work is needed. We see this as the start of a journey, one that includes better balance in feedback that recognises and celebrates the things that we do well and encourages more of the same.

This Project Supports Prudent Healthcare

By improving:

  • Dignity and respect for patients as equal partners in care.

  • The expectation of a positive experience of care.

  • The memory of what happens in hospital.

  • Staff awareness of the impact of how we do what we do, improve the connectivity between tasks and outcome, and consistency for the patient experience.

Early Outcomes

By being involved in this project, staff have developed increased:

  • Awareness of how the small things that they see as part of their normal work make a big and positive difference to patient experience.

  • Opportunity to reflect upon what they can do to enhance and build compassionate behaviour. Understanding in how challenging it can be for qualified staff to reflect and celebrate compassionate care.

Examples of findings using the 7Cs model

Being courageous: courage to ask questions and try things out:

  • Going out of your way to change someone’s meal because they’d ‘lost their appetite’ following their operation.

  • Asking ‘are you ok’ and stopping their task to listen to the response.

Connecting emotionally: noticing how we are feeling:

  • Noticing a lady with dementia was reassured through affectionate touch and making sure that they spent time tucking in her blanket.

  • Stopping and asking other staff how they feel at the start of a shift.

Being curious: suspending certainty and looking for the sense of what is said:

  • Finding out more about a patient and what they used to do when they were working.

  • Admiring a patient’s book selection and sharing their interest.

Collaborating: talking together, looking for the good in others:

  • Asking others for help and expertise in understanding a situation.

  • Checking with each other and helping each other out when we can.

Considering other perspectives: creating space to hear differences:

  • Engaging in banter and humour with patients.

  • Reflecting that beliefs may be different from patients.

Compromising: working hard to suspend judgement and talking together:

  • Delay washing patients until the afternoon after patient asked.

  • Supporting patients to eat their lunch.

  • Celebrating - making a point of noticing what works well.

  • Sharing appreciation to the morning shift for their hard work.

  • Praising others and calling them a ‘superstar’.

  • Giving each other a hug.

Part of Cohort Bevan Exemplars 2015-16