Summary of the article 'If we can't do more, let's do it differently!': using appreciative inquiry to promote innovative ideas for better health care work environments. As seen in the Journal of Nursing Management, 2009 Richer MC, Ritchie J, Marchionni C

1. Journal Article Review
Andrea Dvorak
‘If we can’t do more, let’s do it differently!’: Using
appreciative inquiry to promote innovative ideas
for better health care work environments .
-Richer, M., Ritchie, J. & Marchionni, C. (2009)

2. Class Readings: What is Appreciative Inquiry
 Scherer and Alban  Rothwell and Sullivan
 Uses interviewing and storytelling to  Requires a paradigm shift from focusing
explore the past while looking at the on what is going wrong to what is going
positive aspects of ‘what is working’ right and then trying to leverage what is
in the organization as a basis to ‘what going right into new, higher level visions
of a positive future
might be’
 A way of being, a model, a conceptual
 Combines data collection with a framework, and a process to guide change
large-group meeting where the
stories gathered are used as building  Search for the best in people, their
blocks to design new initiatives for organizations, and the world around
the future them
 Aim is to generate new knowledge  Focuses on what is going right, what is
that expands the realm of the motivating, what is energizing, and what
possible and helps members of an are the key strengths of a setting
organization to envision together a
desired future  The most exciting development in
thinking about change in recent years

3. Class Readings: The 4-D Model of Appreciative Inquiry
Rothwell and Sullivan
 Discovery—people talk to one another,
often via structured interviews, to discover
the times when the organization is at its
best. These stories are told as richly as
possible.
 Dream—the dream phase is often run as a
large group conference where people are
encouraged to envision the organization as
if the peak moments discovered in the
‘discovery’ phase were the norm rather
than exceptional.
 Design—a small team is empowered to go
away and design ways of creating the
organization dreamed in the meetings.
 Destiny—the final phase is to implement
the changes.

4. Article: Background
 Background
 Increase in pressures in healthcare system led to a negative
impact on the current work environment and shortage in
personnel
 Hospital closures
 Mergers
 Ageing population
 Increase in people living with chronic diseases
 Persistent employee dissatisfaction  need for change in
health care environments
 Based on the literature review by the authors, AI was chosen
as the framework for the transformational change process

5. Article: Purpose
 Purpose
 To examine the use of Appreciative Inquiry (AI) to promote
the emergence of innovative ideas regarding the reorganization
of health care services
 Break through old boundaries and promote the emergence of
new ideas

6. Method
 Research Strategy
 Case Study
 Participants
 52 participants
 3 teams
 2 health care teams
 1 management team

7. Method cont’d
 Procedure
 Health care teams
 AI process (4-D) led to development of an action plan
 Evaluated for innovativeness using ‘Innovative Ideas Grid’
 Action plan was presented to the management team
 Evaluation
 Participant observation
 During interviews with health care teams
 Interviews
 With management team gauge responsiveness
 Direct Observation
 During management meetings to observe responsiveness
 Documentation
 of reports to determine if action plans were implemented

8. Major Findings
 Emergence of innovative ideas
 13 of the 15 ideas in the action plans were found to be ‘innovative’ therefore:
 AI promoted emergence and adoption of innovative ideas
 Innovative ideas were incremental in nature
 Initiated by nurses
 More fully developed by members from all disciplines
 Discovery phase: Group discussed the importance of collaboration and
teamwork in relationship to staffing, time efficiency, and patient care
 Dream phase: Proposition that the organization should create a vision
for cancer care
 Design Phase: Group took ownership of idea and decided to propose a
vision to all members of the interdisciplinary team
 Destiny phase: member of team had contacted other disciplines and
organized a meeting to present the vision/goals that were developed
through the AI process
 Ideas rejected then brought back

9. Major Findings cont’d
 Organizational Responsiveness and Idea Implementation
 Implementation involved action of those who were part of the
AI process
 Formal meetings held to elicit organizational response to ideas
 Management team did not respond to health care teams’
expectation to support the implementation of most ideas
 External context issues and new emerging pressures took
precedent over discussions of ideas proposed in the action plan

10. Conclusion
 Using a process that builds on positives such as AI
may be the first step towards promoting the
emergence of innovation in health care but….
 The organization must respond and take action to
support change
 Importance of follow through on proposed ideas
 AI is a way to create organizational change by
building on its most important asset, its people

11. Limitations and Future Research
 Limitations
 Short post-AI observation period
 Future Research
 Use of multilevel interventions involving middle and upper
management to better understand the factors that influence
the implementation of ideas and the key role of management
in this process

12. Discussion Question
 Assuming that the development of innovative ideas
is not unique to AI, what other change models could
have been used to promote the development of
innovative ideas and how would these processes
differ from the 4D method of AI?
 Critical Research Model?
 Traditional Action Research Model?

13. The Critical Research Model

14. Traditional Action Research Model

15. Appendix 1
• A YES answer
at item #1 or 2
and a NO
answer at item
3 classify the
idea as
innovative

16. References
 Rothwell, W. J., Sullivan, R. (2005). Practicing
Organization Development: A guide for consultants. San
Fransisco, CA: Pfeiffer.
 Richer, M., Ritchie, J., & Marchionni, C. (2009). ‘If we can’t
do more, let’s do it differently!’: Using appreciative inquiry
to promote innovative ideas for better health care work
environments. Journal of Nursing Management, 17, 947-
955.

17. Article Rating