A role for Appreciative Inquiry methods for staff management in the UK National Health Service.

University Degree Business and Administrative studies

A role for Appreciative Inquiry methods for staff management in the UK National Health Service.

The staff of Mountbatten Ward, King’s College Hospital NHS Trust & Alastair Baker.

Introduction

One major obstruction to NHS modernisation is the poor connection between strategic and operational levels (1). They function according to different agendas, using different languages representing different mental models, in effect experiencing different realities, resistant to imputed hierarchical authority from each other. One mental model they have in common, however, is a deficit-based approach or ‘problem solving’, a legacy of the rationalist traditions of management and medicine. They both look for what is bad and try to fix it, usually with the application of resources. However, problem solving is unsuited to situations of complexity with uncertain cause and effect, and is inherently critical of the present in order to find the problems to solve toward a better future. Managerial problem solving struggles to influence professionals especially within clinical microsystems (the individuals including patients, their relationships and interpersonal interactions that co-create patient care) or to shift the operational focus from task-finish, itself a form of problem solving. When it is used to manage behaviour the problem tends to be identified with individual(s) risking scapegoating.

Appreciative Inquiry (Ai) is a social constructionist alternative to problem solving. It contends that asking questions about the future can create that future first by use of language to envision it together, then by collective actions. The first question determines the direction in which the vision will develop. A personal and collective vision of the future with its foundations firmly grounded on what is known to work well including profoundly valued personal achievements and beliefs removes much of the anxiety that is a major obstruction to change. Reflection on successes leads them to become new benchmarks (2,3). Since Ai is derived from story-telling, a human interaction familiar to all societies and cultures, no special skills or technical language are necessary to take part. Ai builds inclusion and positive personal relationships, encourages democracy and self-organisation and promotes the ‘positive core’ of competencies, values, inspirations and wisdom that is any organisation’s most potent renewable source of energy for change. (4).

Although, like the NHS modernisation agenda, the focus of Ai is on change and the future, Ai has had only limited application in the NHS to date. We postulated that Ai could link strategic and operational levels and performed the following preliminary project to assess if it might have a role in motivation toward quality at the clinical microsystem level. The aims were to:

List the positive characteristics of the staff’s perception of their successes in high quality healthcare.
Assess the acceptability of Ai interviews to staff by immediate feedback.
Establish the medium term effects on nurse sickness, leavers and vacancy rates as surrogates for staff morale.
Establish evidence of prolonged effects.

research interviews 1 hour each by AB

Methods and Subjects

Interviews lasted 1 hour performed by AB, a paediatric consultant who was a member of the ward management team but moved to manage another part of the service after completion of the project. An explanatory paragraph was read describing Ai and the interview (Appendix A (3)). Four stories based on the intention to develop quality in interpersonal interactions were sought:

1. When you saw healthcare delivered at its best.

2. When a patient, parent or family received healthcare at its best.

3. When you made the difference to what happened.

4. What or who inspired you to become a (professional).

The stories were received with minimum interruption. Active listening prompts focused on detail and led from events to communication to emotions to the significance for the respondent. Immediately after completion, a reflection was written with the respondent recalling ‘quotable quotes’ from the stories. Following reflection on the process, feedback was written and the respondent read and sanctioned the record. Confidentiality, collective ownership of the data and intention to publish were restated. Availability of counselling in the Trust Occupational Health department was pointed out. Even though it was undertaken as an organisational and personal development project, the Trust research ethics committee was consulted informally at the outset when the chairman decided that it fell outside the committee’s remit. The project was reviewed and accepted again by a different chairman during preparation for publication.

Themes were counted by first giving descriptive titles to the quotes according to the essence of the respondent’s meaning in context. The titles were grouped under empiric headings as themes. This open coding method is based on Grounded Theory (5). The records were then counted if they had each theme. The same process was applied to the feedback. The grouping was repeated by an independent reviewer with experience in qualitative research showing good agreement with concurrence on all themes and feedback responses supplied by more than 50% of respondents. Considerable efforts were made to avoid the obstacles of thematic analysis; projection, sampling bias and mood as described by Boyatzis (6).

Thirty-two ward staff of a National Paediatric Liver Service took part, while two repeatedly delayed interview, recognised as passive refusal. The 34 included all nursing staff on the Liver Ward (M) when the project started (nursing complement 41 whole time equivalents (WTE), vacancy rate 20-27% during the project), and 1 pharmacist, 1 dietitian and 1 play therapist associated with M. During 16 months to complete 5 staff left and 6 joined. Of these, 3 were approached and interviewed. In March 2004 in order to assess if the interviews had left any lasting effect on respondents those still working in the Trust were contacted with two questions in writing as follows: “What do you remember about the Appreciative Inquiry interview we undertook 2 years ago?” and “What difference do you think the interview has made to you since then?”

Recruitment, resignation and vacancy data and sickness absence rate (SAR) were obtained from the Trust STARS database from March 2000 to July 2003, 25 months before the project to 8 months after, and compared with data from a general paediatric ward (15 beds, 31 WTE staff, Ward B) and a paediatric surgical ward (12 beds,16 WTE staff, Ward P). SAR was not held on STARS until November 2000, month 8. SAR was also noted in March 2004. Project data were collected on a Microsoft Excel spreadsheet (Microsoft Seattle USA) and processed using NCSS software (NCSS, Kaysville, Utah USA). Statistical significance was calculated by analysis of variance (ANOVA) and p<0.05 was considered significant.

Results

Rich and defining stories describing the professionals’ roles showed remarkable consistency with many supporting parents and patients through distress including bereavement, or making other professionals act to prevent a disaster. More experienced nurses tended towards the former structure while less experienced preferred the latter. Many described patients’ and parents’ needs at the centre of best healthcare. One interview was irretrievably interrupted before feedback, 5 respondents found the process sad or painful but none sought counselling. All except 1 and the interrupted interview had at least one positive response. All complex feedback (n=27 respondents) involved reflection on what respondents ...

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Results

Vacancy rates (%) fell significantly on B and M wards in the period after the project but not on P. M; before (median and standard error) 22.7, 1.9; during 22.6,1.7; after 16.2,1.8: B; before 14.1,4.5; during 16.0, 3.9; after –1.4,4.2: P; before 10.3, 3.7; during –1.6,3.2; after 6.7,3.4: There was a trend to an increase in leavers from B and P but not M during the project; M, 5 (0.76 leavers/month/100 WTE) during, with 11 (0.78 leavers/month/100 WTE) outside the project versus 11 (1.47 leavers/month/100 WTE) and 14 (0.87 leavers/month/100 WTE) from B and P (p=0.11) respectively. SAR showed a significant reduction on M during the project but rose again to previous levels on completion. (Fig 2 here approx).

Fourteen individuals of 23 who were interviewed and could be located still working in the Trust replied to the two questions to provide follow up over 2 years later. Responding to the question ‘What do you remember about the Appreciative Inquiry interview we undertook 2 years ago?’ all 14 remembered the interview with varied degrees of detail, 2 recalled it as emotional, 2 felt good about it, 2 felt it useful/helpful, 1 recalled it as interesting. Detailed responses to the question “What difference do you think the interview has made to you since then?” are shown in Figure 3. (Fig 3 here). At that time SAR for M was 4.9%, for B was 3.5% and for P was 0.0%.

Discussion

The qualitative data describe the collective values of healthcare at its best held by the ward staff of a UK National Children’s Liver service. Widely endorsed themes – empathy including trusting, caring, efficiency and use of time, expertise, enjoyment and teamwork reflect aspects of the 6 facets of quality of healthcare: patient-centredness, effectiveness, efficiency, safety, equitablility, and timeliness (7). Respondents considered equitability and timeliness in immediate personal needs, and efficiency and safety in avoiding errors and inappropriate care and treatments, while almost all stories in response to questions1, 2 & 3 had features of patient-centredness. It is reassuring that when exploring values to motivate best care, professionals have a good idea what quality is in practice.

Replies were inevitably constrained by the interviewer who may have been seen as an insider, connected to the management, personally powerful and with his own agenda. It was unlikely that a story of success could have included conflict with managers or senior doctors, for example. While 23 respondents described positive feedback or appreciation, only 9 described feeling respected or valued by the institution, despite its progressive HR policies and being an “Investor in People” (IIP). Perhaps they were not fed back information on their value or were detached from the opinions of their managers who changed frequently, so that such feedback was not heard, or do not see their own value as part of good healthcare. Ai may be a better means for such feedback than providing it as a solution to a problem.

Despite being emotional, the interviews were often enjoyed with no adverse consequences. Refusal rate was very low (6%). Staff quickly learned the interviews were occasionally associated with tearfulness but worthwhile, and some were impatient for their turn. Although in feedback only 3 expressed pleasure that someone was interested it seemed that this was an important motivating factor. It is reassuring that even when uncomfortable levels of emotion developed no harm derived from the Ai process. When recalled over 2 years later the process had affected many profoundly. It had precipitated or contributed to life-changing decisions. Improved communication with enhanced feelings of belonging to a team and improved relationships with colleagues and patients mentioned by 6 were all positive contributions to clinical microsystems. Greater confidence and a feeling of being valued were mentioned by 5. It served as an introduction to, or reminder of, reflection as a tool particularly for dealing with stress and strong emotions through developing insight. One-to-one Ai interviews can therefore have powerful long-term positive effects permeating the entire environment where they were undertaken.

There were no significant effects on staffing numbers as the fall in vacancy rate was also seen on B. Effects from the project depend on willingness of nurses to join M based on factors such as its reputation and morale. Although 4 other studies could not show SAR responding to interviews (8), we have shown that very high SAR can be managed by Ai interviews. The average SAR in 299 NHS trusts was 4.5%; ancillary staff, and nursing including midwifery staff had the highest rates (6.0% & 5.4%), while medical and administrative staff had the lowest (1.3 % & 2.3 %) (9). Thus SAR on M was very high and greater than B or P, possibly due to the intensity of work, M being designated high dependency, having the highest vacancy rate and frequent changes of nursing leadership. In favour of improved morale on M being associated with lower SAR during the project, we received unsolicited feedback of a more positive atmosphere from 3 independent sources, and a ward newsletter was started. Assuming Ai caused the mean reduction in SAR of 1.3%, 15.6 hours per week were saved at the expense of less than one hour each of staff and interviewer time. Thus even without the additional cognitive benefits the process was cost effective.

It is possible that the transient improvement in SAR was due to a Hawthorne effect of observation, although no particular scrutiny or discussion of sickness or absence was undertaken at any point and the outcome measures were not revealed until the final analysis. “Instead of referring to the ambiguous and disputable Hawthorne effect ….. researchers should introduce specific psychological and social variables that may have affected the outcome under study but were not monitored, along with the possible effect on the observed results” (10). The wide swings in SAR seen during the entire period were possibly echoed on B where vacancies also fell, but not on P suggesting common perhaps cyclical factors fortuitously amplified by Ai to lower SAR. There were 3 different nurse ward managers with periods of vacancy between resignations and appointments between months 1 and 50 with one leaving at month 28 during the project. In their absence, the interviews may have acted as a form of managerial supervision, motivating staff to change sickness behaviour through a sense of individual scrutiny, even though the intervention was designed to avoid scrutiny or judgment. AB left M at month 42, possibly reducing any effect, which might have been maintained by a rolling programme of interviews including with a different interviewer or stories. There is a current debate among Ai practitioners whether Ai is a tool or a philosophy. We showed change on M while Ai was used as a tool but did not show any sustained change in the underlying behaviour once Ai conversations dissipated, although individuals still retained effects within themselves. This is in keeping with a social constructivist explanation that social structure and behaviour are created by the language being used, suggesting that the closer Ai can become to a philosophy, the more pervasively it will affect language and behaviour.

In a meta-analysis of 45 studies of management interventions related to stress at work (8) with outcome variables based on ‘cause for concern’ including SAR and retention rates, 17 showed positive effect, 11 of them major. Employees improve quality of life at work, psychological resources and complaints most from short interventions of cognitive design when they have high degree of decision latitude to use new skills. At least 12 weeks are necessary to detect benefits (11). This project fulfilled the above criteria well except that no direct assessment of change in work satisfaction was made.

From the form of words in the feedback there was evidence of second loop learning (e.g. “makes you think..” “didn’t realize...”), shifting the meaning of work towards congruence with respondents’ values and skills giving potential for self-actualisation in work (12,13). These effects were still evident two years later. Despite discovering relative conformity in ward values, the Ai process may promote autonomy and personal values giving the confidence for individuals to stand out against the group when appropriate. For example religious values are not part of the culture of M but motivate a significant minority of staff. Ai may be a means to ensure personal values are not over-run by group culture, avoiding situations such as the Bristol scandal, when senior figures in an hierarchical system performing paediatric cardiac surgery with very poor results refused to hear the appropriate concerns of team members and punished them for dissenting.

Appraisal can contribute to lower hospital mortality (14), but is mostly used in the NHS without 360degree feedback, as a combination of appraisal, assessment, and performance management (15,16). Even if the relationship between the parties is good the process may be threatening. A problem-solving approach may identify the appraisee as the source of problems risking negative feedback, with deterioration of the relationship and worsening performance. Using appropriately designed Ai, a two way synthesis may be achieved with appraisees identifying personal goals aligned with strategic intentions, linking strategy with the micro-systemic level. Meanwhile the simultaneous emphasis of their own achievements may empower them to lead the relationship in favour of their own values and capabilities, engaging themselves with their work. Ai should therefore form the primary structure of appraisal in staff development leaving deficit based solutions for situations with certain cause and effect (2).

Ai may also have the potential to facilitate the development of positive social interactions as bridges between groups with differences in goals and mental models. Poor interactions between such groups are currently spoken of as the ‘silo culture’ in the NHS. Many respondents identified with parents’ experiences, followed by learning about their professional identity, actions and meaning in a ‘community of practice’ at work to which parents and children also belonged (17). They recognised that families became members of a group with the same aims, practices and ideas as themselves. This is encouraging in terms of the primary intention to find an effective link between strategy and operation. It implies the link may be found in relationships between people mutually seen as ‘different to us’. For example, Ai is an ideal strategy for managers outside clinical microsystems to exert a positive influence on professionals within them, and staff from different silos could be invited to recount stories about, and reflect on when their interactions together were successful, co-creating new, shared possibilities made into actions by continued Ai conversations. A simple but very robust format that we have used for initiating Ai stakeholder group work including patients is illustrated in appendix B (18). Perhaps the successful future of the NHS lies in recognising what we, including patients, do well together, talking about it and doing more of it.

References:

1. Maddock S. Modernisation Work-New narratives, change strategies and people management in the public sector. I J of Public Sector Management. 2002. 15(1):13-44.

2. Magruder Watkins J & Mohr BJ. Appreciative Inquiry. 2001. New York. John Wiley and sons.

3. Annis Hammond S. The thin book of Appreciative Inquiry. 2nd Ed. Nov 1998. The thin book publishing Co. Edinburgh.

4. Mantel MJ and Ludema JD. From local conversations to global change: Experiencing the worldwide web effect of Appreciative Inquiry. Organizational Development Journal. 2000 Summer; 18(2):42-53.

5.Glaser B. & Strauss A. The discovery of grounded theory; strategies for qualitative research. 1967.Aldine, Chicago, USA.

6.Boyatzis RE. Transforming qualitative information. 1998. Sage Publications, Thousand Oaks USA.

7.Crossing the Quality Chasm A New Health System for the 21st Century. Institute of Medicine (USA) 2001. National Academy Press.

8. Klink JJ, Blonk RW, Schene AH, van Dijk FJ. The benefits of interventions for work-related stress. Am J Public Health. 2001 Feb;91(2):270-6.

9. Sickness absence in local government. 2001-2002. employers.gov.uk/documents/recruitment_careers/workforce_surveys

10. Wickstrom G, Bendix T. The "Hawthorne effect"--what did the original Hawthorne studies actually show? Scand J Work Environ Health. 2000 Aug;26(4):363-7.

11. Barkum M and Shapiro DA. Brief psychotherapeutic interventions for job related distress: A pilot study of prescriptive and exploratory therapy. Counselling Psychol Q. 1990; 2:133-147.

12. Argyris C and Schon D. Organisational learning: a theory of action perspective. 1978. Reading Mass. Addison Wesley.

13.Seligman MEP and Czikszentmihalyi M. Positive psychology: American Psychologist. 2000. 55:5-14.

14. West MA, Borrill CS, Dawson JF, Scully J, Carter M, Anelay S, et al. The link between the management of employees and patient mortality in acute hospitals. Int J Human Resource Management 2002. 13: 8: 1299-1310.

15. Conlon M, Appraisal: the catalyst of personal development

BMJ 2003;327:389-391.

16.Antonioni, D. Designing an effective 360-degree appraisal feedback process. Organisational Dynamics. 1996 Autumn 24-38.

17. Wenger E. Communities of practice: Learning, meaning and identity. 1998. Cambridge University press.

18. A Baker and M Wright. Using Ai to initiate stakeholder interactions in healthcare. AI Practitioner May 2004 30-31.

Acknowledgements

We acknowledge the help of Dr. Paul Cheeseman with the statistical analysis, Mrs. Jeanette Singer who reviewed the data independently for story themes and feedback responses, Mr. Martin Fischer of the King’s fund who introduced the idea of Ai to us, and Prof. Patrick Besson of ESCP-EAP management school, Paris for his comments on the text.

Correspondence to: Alastair Baker, Consultant in Children’s Liver Disease, Paediatric Liver Dept. The Variety Club Children’s Hospital, King’s College Hospital, Denmark Hill, London SE5 9RS.

Conflicting interests: None

Funding: None

Table and figures

Table 1.

Legend to table 1.

Themes from stories and feedback responses are shown with presence of independent confirmation by a second reviewer in the second column and numbers of respondents giving quotes that were classified under each theme by the first reviewer in the third column. Themes appearing in more than 5 responses and more than 1 feedback response are shown.

Figure 1:

Story quotes

•‘Little things/decisions make a big difference for parents’ (3 respondents)

•‘spending quality time’ ‘not just dishing out medicines’ ‘Time is a resource’

•‘What would it feel like to be that patient?’ ‘Feelings about people’s feelings are right - parents tell you that’

• ‘You can change people by listening’ •It’s about making partnerships properly with patients’ •‘Maintaining empathy is rewarding but draining’

•‘Every family has their own story’ ‘human to human’ ‘It’s nice when they can be honest with you’ •‘happy for the family - I enjoyed their progress’ ‘good to see him happy’ •‘After all that, she came back and she looked great’

•My judgment about what was right proved right’ • ‘I was a good nurse that day’

•‘Having a bit of fun - that’s what it’s all about’

•‘They were terrible experiences but they made me a better, caring and sensitive person’ •‘I used my fundamental beliefs to know what to do’

Feedback quotes

negative

‘difficult to talk about emotions’
‘ sad when people aren’t going to make it’
‘difficult to think about families’ side’

ambiguous

•mystified’ •‘feel like I’ve been to a counselling session’

positive

‘has been useful’ ‘good’ ‘excellent’
‘I feel very reflective’ ‘reflecting is always positive’
‘I needed it so much’ ‘I felt I needed to....’
‘makes you think why you are doing what you are doing’ ‘made me think how I feel about families’ ‘makes you appreciate what you do’ ‘nice to think about it’ ‘job is worth doing’ ‘feel better about my job’
‘It gave me a lot more confidence’
‘didn’t think I would open up’ ‘didn’t realise how much I get involved with parents’
‘makes me realise I’m not different from parents’ ‘helps you take a reality check’ ‘brought together a lot of things for me’ ‘looking back on how you coped gives you a clearer insight into how you and parents would like things done’

Legend to figure 1.

Representative quotes from Ai interviews. Quotes are given verbatim to illustrate the form in which they were recorded. Although context cannot be determined much of the meaning for the respondent is evident.

Figure 2.

Legend to figure 2. Nurse sickness absence rates of current complement are shown on the vertical axis for wards M (black line), B (green dot and dash line) and P (red dash line) per month on horizontal axis. AI interviews per month are shown as black bars with the project period between vertical lines. Sickness absence on M was significantly less during the project period than either before or after the project (p<0.05). There was no such difference on B or P wards.

Figure 3.

Answers to the question “What difference do you think the interview has made to you since then?”.

Bullets designate responses of the 14 different respondents.

I would not now be so happy to speak about & express anything I definitely feel - the scales have been lifted from my eyes.
Reflection is always good but I don’t think it had any effect on me since then.
I have known for some time that I need to leave the Health Service. Maybe the things we talked about served to highlight the reasons (or some of) why I need to leave. If my plans carry on to my timescale I should be leaving Kings by September at the latest.
It was a very positive experience. We have so few opportunities and so little time for structured reflection and yet it is a very useful tool. It left me feeling positive about being a skilled, experienced nurse, and valued as such. I also felt it was a 2 way process and I had opened the eyes of the interviewer and given him insight into the detailed work of nurses, things that do not happen on the ward or are not seen by the medical team.
Has highlighted that it is human nature to feel upset/sad even when you have given good care. Has helped me to accept that some situations cannot be controlled by medicine & medical intervention. I am still nursing and have since embarked on a change in career direction into PICU nursing. Assisted my decision to move out of managerial levels of nursing to focus on patient/family care.
Especially recently, it has reminded me what and why I enjoy nursing. Helped a little with reminding me what I am good at and believing in myself.
Having an appreciative inquiry interview made me feel my views and feelings about a situation were important and valued. I do now try to have both formal and informal discussions with other staff particularly my mentees regarding stressful situations we may have encountered. I feel this helps to move on from events and forge new ways of working and dealing with emotive events.
Positive outcomes as far as development is concerned. – improved relationships with colleagues and patients – had a definite positive effect on building confidence in dealing with colleagues and patient issues – positive outlook on the unit as a whole as I have gained more knowledge and experience in the last 3 years – has changed the way people (colleagues) treated me as they appreciate me more than before.
I think the effects since then made me a good listener. Not judging anyone before I know anything about them. Being approachable and being able to approach other work colleagues or the public without feeling I’ve got no confidence in myself to do so, and being part of a team working towards the same goal.
I am not sure if it was due to the talk but I have since realised that I must not get too involved in different situations. I need to be more objective in my approach.
It was useful and helpful to reflect on practice & think about what could have been done better, what we did well. It was good to take time out and discuss the effect our care/work has on us, i.e. how it can be stressful, rewarding, emotional. It would be good support/useful to practice if we had more time for reflection and clinical supervision.
Remembering certain events therefore being more confident in making decisions. Does seem a long time ago.
It has allowed me to reflect on my practice and how I can improve on certain aspects of my day-to-day nursing of sick children. It has made me empathise more for the family of a sick child.
I think there has been a big improvement in communication between nurses and doctors and also doctors to patients with regard to ongoing patient treatment and procedures.

Abstract

Strategic and operational levels of the NHS are separated by major differences of conception, practice and goals. Solutions tend to be found at both levels through problem solving, but this method is unsuited to connecting the levels. Appreciative Inquiry (Ai) is an alternative management approach focusing on developing current successes into the future through reflection at individual and group level. To obtain preliminary data on the value of Ai we undertook individual 1 hour interviews with nursing staff on a National Paediatric Liver in-patient ward. They were asked to recount stories based on their experiences of successful delivery of healthcare, with active listening, followed by reflection on the process. Thirty-two staff members took part with only 2 refusals. Data were written and analysed by an open coding method.

Staff described quality in interpersonal interactions, preventing errors and engaging their personal values in their work. The process was emotional but well received. No improvement in recruitment or retention was shown but a high level of sickness absence fell significantly during the period of the project. Two years later, significant positive effects were recalled and attributed to the interviews by many respondents. AI appears a cost-effective way of connecting professionals’ motivation toward quality in their work with strategic intentions.

Summary points

Strategic and operational levels of the NHS are separated by major differences of conception, practice and goals.
Appreciative Inquiry (AI) is an alternative management approach than problem-solving focusing on developing current successes.
Individual interviews based on story telling of experiences of success gave a consistent picture of staff’s values in quality of their work with a high level of acceptability.
Staff sickness absence fell significantly during the period of the interviews contemporaneous with using Ai language.
Two years later respondents recalled the continuing positive effects of the interviews.
AI may be an approach to NHS management with wide application including in appraisal and connecting strategic with micro-operational levels.

Appendix A

Introductory paragraph.(ref 3).

“’*Before we start I would like to explain what we are going to do, because it may be a bit different to what you are used to. This is going to be an ‘Appreciative Interview’. I am going to ask you questions about what happens where you work when things are at their best. Often we ask questions about the things that aren’t working well - the problems - so that we can fix them. In this case we ask about when things are at their best - the successes - so that we can find out what works, and find ways to infuse more of it into the organisation’s performances. It’s also like what we do with children and athletes when we affirm their smallest successes and triumphs, so that they will hold a positive image of themselves and go on to envision even greater possibilities. The end result of the interview will help give me a picture of those life-giving forces that provide vitality and distinctive competence to our organisation. Have you any questions?

Appendix B

An introduction to Ai group work.

The process and data collected during a 2 hour workshop creating a vision for critical care and including a feedback form that is an essential part of the process is shown in powerpoint slides. The topics were chosen as intuitively appropriate but could be canvassed from participants before the meeting. Slides 2 & 3 are taken from ref 2. (Insert powerpoint file AiappendixB here)

A role for Appreciative Inquiry methods for staff management in the UK National Health Service.