Appreciating People is an organisation in the United Kingdom whose key goal is to “make positive change happen” at local, national and international levels. Since 2014 they have partnered with Aqua and Health Innovation West Midlands to introduce health and social care staff to the theory and application of Appreciative Inquiry (AI). It is from these healthcare staff that resources and examples within the book are drawn. This book expands our understanding of AI in the demonstration of AI in action within the healthcare sector.
Debbie Ryder, Ph.D., is a leader and senior lecturer within the Master of Education programme at Te Rito Maioha: ECNZ. She teaches Appreciative Inquiry and Research Methods courses, and supervises master’s thesis students working with a broad range of methodologies, including Appreciative Inquiry.
AI, and what it looks like in action within the healthcare sector
The authors start by taking us back to the basics to remind us of the initial work of David Cooperider and his ground-breaking approach to acknowledging the “life-giving forces” that are present within teams or organisations. Whilst AI does not come from a problem-focused perspective, it also doesn’t discount that problems exist. It is in focusing on problems from a strengths-based, participatory perspective that positive action can occur.
There is no more a pressing issue or problem in healthcare than patient safety, but surely AI can’t be applied to safety – or can it? The authors discuss how most research performed in patient safety focuses on unsafe system operation (referred to as Safety-I). Interestingly, whilst “what could go wrong” almost never does in reality, “what doesn’t go wrong” gets very little attention. This is where the notion of Safety-II takes a more positive approach and defines safety as “the ability to succeed under varying conditions”. AI and the Safety-II definition can be seen to overlap, especially in Sydney Dekker’s notion of “Safety Differently” which involves patients, families and staff as part of the solution.
The authors provide a summary of examples of AI in action, and it is from those case studies that key themes are drawn. Whilst not all themes can be highlighted, a few of the key ones caught the eye of the reviewer. For example, “the importance of relationships” in two case studies, one where AI had been incorporated to create a relationship-centred approach to stroke care, and another within a clinical rehabilitation team.
Another theme of interest was that of “wellbeing and culture” where, again, AI approaches were used within the area of prevention of mental health problems, and in re-energising leadership within an NHS network. Having just spent some time in Accident & Emergency (A&E), the reviewer’s attention was caught by the “person-centred care” theme which focused on an A&E department. How exciting to see AI being used in an environment that is so often influenced by stress and, at times, negativity!
Examples of AI principles
The examples of the AI principles are excellently provided. Starting with the Simultaneity principle, one example illustrates when a nurse experienced inquiry and change happening simultaneously in an interview with a group of women. The Anticipatory principle was demonstrated by a participant who imagined a better work–life future, realising that this was not only what she wanted but that it was within her power to do something about it. Just as the Constructionist principle focuses on the power of words creating worlds, a participant demonstrated the generative power of words when she decided to turn around how she viewed her practice.
The Positive principle reminds us of the influence our “best of” stories and how in this case, when anonymised, helped shape the constantly evolving identity of one aspect of the healthcare sector. Finally, the Poetic principle influenced the research that underpinned this book when deciding on what would be “focused on to grow” within the study. As a key focus of the study was participant wellbeing, choosing an AI approach that looks for the best and amplifies strengths was an appropriate research method of choice.
An evaluative summary of the book
By taking us back to the basics, the authors set the scene for how AI within the healthcare sector creates opportunities for relationship-based culture, where voice are heard, dreams are shared, contribution is acknowledged, and positive and generative approach to change is encouraged.
In the section on the role of AI to shift perspective on patient safety, the authors clearly introduce how AI, when used as an approach to nurture whole systems, can shift the existing Safety-I lens to one of “Safety Differently” and Safety-II, and as such can be incorporated to enhance patient safety.
From a general AI perspective, the authors clearly provided practical examples for even the novice AI inquirer to understand. As a researcher, it was of particular interest for the reviewer to see the authors’ use of the Poetic principle as a framework to choose the topic and method for the research that underpins this book. Therefore, if, like this reviewer, you are constantly seeking more perspectives on the AI principles, you will find this section to be very enlightening.
If you are in the healthcare sector you will find the examples a great practical way of understanding the AI principles. It was also good to see discussion on the five emergent principles (Whitney and Trosten-Bloom, 2010). Whilst not offering examples of what the emergent principles could look like in healthcare practice, some very interesting insights and key ideas were offered.
Whilst all themes discussed in the “AI in action” section were of keen interest to the reader, the ones of most pertinent interest were the last three around patient safety, which, so excellently, reminded the reader of the use of AI to move from Safety-I lens to “Safety Differently” and Safety-II. Of interest across several of the case studies, was the use of SOAR (Stavros & Hinrichs, 2009) as an analysis tool. Whilst this is commonplace in AI analysis, it was excellent again to see such practical application of it.
Appreciating Health and Care is not only a practical guide for the use of AI for people working in the health and care sectors, it also offers generous resources and activities to expand the knowledge of anybody with a growing interest in AI.
REFERENCES AND FURTHER READING
Stavros, J. & Hinrichs, G. (2009) The Thin Book of Soar: Building Strengths-Based Strategy. Thin Book Publishing.
Whitney, D. & Trosten-Bloom, A. (2010) The Power of Appreciative Inquiry: A practical guide to positive change. Berrett-Koehler.
Although the software and apps are changing and adapting at the speed of light, it is useful to have a snapshot of what is possible now. The authors of some of the articles in this issue have listed their “go-to” Artificial Intelligence apps: the ones they’ve found that help them be more productive as Appreciative Inquiry practitioners.
Artificial Intelligence tools and apps
Contributed by
Name of app/tool
Brief description
What do I use it for?
Tony Silbert
https://fireflies.ai/
Chat GPT 4
Transcribes and summarizes meeting notes
4th gen AI
Virtual meeting note taking, 1-1 AI interviews, etc.
Now includes images, audio, video and text
Bernard Tollec
Chat GPT 4
Heygen
Notta.ai
Midjourney
Perplexity
AI video platform
AI transcription service
AI photo generator
Search engine powered by Artificial Intelligence
Creation of avatars, videos
Transcription of conversation
Creation of pictures
Engine search on internet
Sherri Sutton
Google Gemini
Gemini, formerly Bard, is Google’s generative AI tool that creates human-like text, aids in translation and supports content creation using advanced machine learning models.
Generating human-like text, translating languages and assisting with content creation by leveraging advanced machine learning models to provide accurate a
Microsoft Teams – CoPilot
Copilot in Microsoft Teams is an AI tool that assists with tasks like summarizing meetings, generating text, and providing relevant information using advanced AI models.
It helps enhance productivity and streamline communication within Teams.
Synthesia
Synthesia is an AI video creation platform that generates realistic videos with virtual presenters.
It helps create engaging content by turning text into video, simplifying the video production process.
Visla
Visla is a visual storytelling platform that creates engaging multimedia content by combining video, text and graphics.
It helps simplify the creation of interactive and visually appealing stories for various purposes.
Scribe AI
Scribe AI is an AI-powered transcription tool that converts audio and video into accurate text.
It assists with transcribing meetings, interviews, and other audio content, making it easier to capture and use spoken information.
Ideogram
Ideogram is an AI-driven tool that generates and enhances visual content such as diagrams, infographics, and illustrations.
It helps simplify the creation of detailed and visually appealing graphics for various applications.
Pictory
Pictory is an AI-powered video creation tool that transforms text into engaging videos.
It helps create and edit video content easily by using advanced AI to add visuals, voiceovers and music.
Sherri Sutton
Drawify
Drawify is an online platform that provides hand-drawn illustrations to enhance presentations and content.
It helps create engaging visuals by offering a library of customizable drawings.
Craiyon
Craiyon is an AI-powered image generation tool that creates images from text prompts.
It helps visualize concepts and ideas by generating unique images based on user input.
Otter
Otter is an AI-powered transcription tool that converts spoken conversations into text.
It helps capture and organize meeting notes, interviews, and lectures by providing accurate, real-time transcriptions.
Fathom
Fathom is an AI tool that automatically generates meeting summaries.
It helps save time by providing concise, actionable notes from meetings, making
DeepL
An AI-powered translation tool known for its high accuracy and natural-sounding translations.
It helps translate text between multiple languages, making it useful for communication and content localization.
Copy.ai
An AI writing assistant that generates marketing copy, blog posts and other written content.
It helps create engaging and persuasive text quickly, streamlining content creation for marketing and communication.
Jasper (formerly Jarvis)
An AI content creation tool that helps generate blog posts, social media content, and other types of written content.
It assists in producing high-quality written material efficiently, enhancing productivity for content creators.
Lumen5
An AI video creation platform that transforms articles and blog posts into engaging videos.
It helps turn written content into visually appealing videos, making it easier to share and promote
A selection of relevant articles
Brynjolfsson, E. & McAfee, A. (2017) The Business of Artificial Intelligence. Harvard Business Review. https://hbsp.harvard.edu/product/H03QXY-PDF-ENG This article examines the strategic implications of AI for businesses and provides practical advice for leveraging AI technologies.
Sharma, P. (2021) How AI is Transforming the World of Finance. Forbes India. https://www.forbesindia.com/blog/technology/how-ai-is-transforming-the-world-of-finance/ This article explores how AI promises to usher in a new world of frictionless and seamless payments
McKinsey & Company. (2021) Implementing AI in Your Business: A Guide. McKinsey Themes. https://www.mckinsey.com/featured-insights/themes/your-guide-to-deploying-ai-at-scale This guide provides practical steps and considerations for businesses looking to integrate AI into their operations.
Young, C. (2023) Build a Winning AI Strategy for Your Business. Harvard Business Review. https://hbr.org/2023/07/build-a-winning-ai-strategy-for-your-business This article discusses the potential of Artificial Intelligence, arguing that we cannot yet fully envision its potential or appreciate contexts.
Alexandra Arnold (she/her) Arnold MSPsy, MSHR/OD, ACC, is a personal development and climate coach with a certificate in Positive Organization Development from Champlain College, USA. She is the host of The Quiet Activists online community, where she uses positive psychology and Appreciative Inquiry to help introverted and highly sensitive people shift from climate anxiety to inspired action. She is the Program Director at The Taos Institute and recently joined Community Harvest of Central Vermont, a gleaning program reducing food waste and providing neighbors in need with fresh & nutritious food.
About two months ago, I received an email from a graduate student of the Penn State World Campus Master’s in Organization Development and Change. One of the required courses in this program is Appreciative Inquiry (AI), which “provides a foundation in the theories, principles, and techniques of Appreciative Inquiry”. One of the assignments for this course is to complete an interview with an AI practitioner to consider such questions as:
What is a peak experience in your AI practice?
What strengths and skills underpin your effectiveness as an AI practitioner?
What strikes you about the idea of “being versus doing AI”?
Little did we (my interviewerJason Hoskins and I) know that our conversation about Appreciative Inquiry would become a conversation about Appreciative Improv.
Like so many conversations among those who practice or learn about AI, the energy was immediate and palpable. We quickly discovered that we were speaking the same language – except I had learned it in the AI context, while Jason learned it in the improv context. Jason shared that when he learned about AI in his Master’s program, he thought it was “a breath of fresh air… and very similar to my experiences in doing improv comedy”.
He pointed out that we were improvising right then and there during our interview:
He acknowledged me as the interviewee & I acknowledged him as the interviewer – referred to as the “initiation” in an improv act
We were following the number one rule of improv which is “yes, and”: one person talks, the other acknowledges what his/her partner offers and builds upon that, all in a very positive way
Our conversation took a turn into the intersection between Appreciative Inquiry and Improvisational Comedy.
What is improv?
The Covert Theatre website says: “Improv is an art form where the performers make up the theater, usually comedy, on the spot […] It is the wonderful vehicle for leadership development, whether it’s self-leadership or leadership of others, as it imparts crucial life skills that every person needs.”
Making room for fun
In my opinion, using AI is like getting permission to do things differently, to play, to have fun. It is particularly encouraging because there is over 20 years of research that shows how it works to reassure those who are hesitant to move away from traditional management styles.
Jason was very gracious when I responded to his first question with one of my own: How can we approach this differently and still get to where we need to go?
I explained that the reason I was suggesting this was to invite us both to jump right into “being AI” instead of going through the interview in the linear way the assignment was designed. My interviewer was immediately on board with this more playful, creative, and challenging approach: “I like it to be more of a give and take rather than just a straight interview”.
Whether we were doing comedy is debatable, but there was plenty of joy and laughter in our conversation. According to comedian Tina Fey (known for her work on Saturday Night Live), in an appearance in Alan Alda’s Clear+Vivid podcast called The Transformative Power of Improv, improv is not about being funny, it’s about relating.
If you’re still not sure you’re up for playing in this way, check out performer and corporate facilitator Gary Ware’s Ted Talk on how play saved his life. His mission: “to infuse improv with positive psychology so that his students leave with a renewed sense of life.”
A connective tissue
It was hard to answer Jason’s question about a peak experience using AI because what is most memorable to me is how I learned to pay attention to the words I use and the questions I ask, and to notice the different outcomes.
From the beginning of his class, Jason also had the feeling that AI is not something that you do, but that it’s a way of life, a “connective tissue” between the many roles we play in life. Just like improv, AI offers a new perspective on your whole world. Both help you get through the tough times in life.
His work with Human Resources, implementing HCM systems, is data-driven and linear. Improv concepts have seeped through his way of being with clients: he helps them shift from resistance to being more comfortable and engaged with the changes.
Powerful and immediate
Discussing the power of words, Jason shared that he has a sticky note on his desk that reads “try not to lose patience” to help him soften emails when needed. This was a great opportunity for a positive reframe – dropping what he doesn’t want, stating what he does want and embodying it by using the present tense. Sure enough, he now has a new post-it that reads “I have an abundance of patience” and a new, inspiring ideal vision of himself as he deals with annoying emails. In his words, the shift was “powerful and immediate”.
The point of improv is that nothing is prepared or rehearsed, and the effect is instantaneous. Your partner responds to your offer without missing a beat and in a good performance, the audience responds right away, typically with laughter, a powerful tool for life.
Jason is inspired by his three-year-old daughter: she doesn’t judge, she is not on a schedule, she isn’t trying to get something done, yet she does get a lot of things done, she learns, and she’s happy.
In AI, just like in improv, we are inspired by children’s curiosity, creativity, playfulness, and ability to be in the moment. Both remind us that adults can play too!
A multiplicity of voices
In AI, co-creation comes from including as many voices as possible in the conversation and from giving the same weight to every person regardless of their titles.
On stage, when a suggestion (or prompt) comes at the start of an improv act, it is assumed that whatever character is going to appear is going to have the full respect from his/her partner. There is no power differential, only pure teamwork.
A misconception about performing is that it is reserved for confident, outgoing and extroverted folks. In fact, it is the opposite. Many actors, including Tina Fey, are introverts. Many find a certain freedom on stage, it’s a way to find their voice. Improv is particularly appealing (compared to stand-up comedy for example), because you are engaged in an intense one-on-one dialogue with your partner, and at that moment, everything else disappears, even the audience. Don’t take my word for it: in an appearance on Paul Vaillancourt’s Improv Tip YouTube channel, Ali Reza Farahnakian, founder of The Pit (New York City), says “take the cotton balls out of your ears and put them in your mouth”.
To be able to respond to your partner on stage, you have no choice but to listen intently. You have to pay attention and forget everything else but the present moment. Deep listening is not a practice unique to AI, yet when we become more intentional with the words we use, we naturally develop a new way of listening to others.
No failure
AI calls it “prototyping”. We don’t wait until it’s perfect, we try something new as early as possible and learn as we adjust and try again. Keli Semelsberger is a corporate team building facilitator, a Medicine Woman, an improviser, and the founder of the Charlotte Comedy Theater in North Carolina. In an interview with Jimmy Carrane for the Improv Nerd podcast, she says “there is no failure in improv, only something to create more on.”
Saying yes to whatever comes
“Life is one big improvisational sketch.” Episode 3 of the Unpolished Therapy Podcast with Rachel Silver Cohen and Dr. Lori Fineman makes a good case for the benefits of relinquishing control. Life is unrehearsed. Rather than trying to plan for everything and getting upset when things don’t turn out as expected, we would be better off to “roll with the punches” and to laugh more. In AI terms, retraining our negativity bias to noticing the positive core of every person and situation is much more generative.
It comes from the heart
Whether introducing a strengths-based approach to an organization or standing in front of an audience in an improv act, it only works if you are sincere. It is not about selling an idea, proving that it works, or forced family fun. It’s about a genuine belief in what you do and showing up as who you are. Again quoting Tina Fey, improv is a way to break social protocols: It takes vulnerability, and being ok with being embarrassed. Keli Semelsberger adds, “it’s not about fame or success, it’s about being authentic, true to your core values, and being of service.”
Not knowing where you’ll end up
It goes without saying that when you improvise in a performance, you don’t know where you’ll end up. When Jason reached out to me for an interview to complete his assignment, we had no idea that we would end up a few weeks later having a live conversation about improv in the context of climate change in my online community, The Quiet Activists. Or that after a few more weeks, this article would come to life.
Jason has been doing improv for 14 years. Discovering AI in the course of his graduate studies in organization development made him wonder how he could bring his hobby of improv into any kind of work environment where he is helping people change their whole frame of thinking. “That would be really, really interesting to me.”
He wouldn’t be the first to bring improv into the workplace. At the Alan Alda Center for Communicating Science, improv has been a key part of training over 12,000 scientists to communicate clearly with lay people. As we know, change happens the moment we ask a question, so who knows in what context Jason will be performing next.
Alexandra Arnold MSPsy, MSHR/OD, ACC, is an ICF-accredited personal development coach with a certificate in Positive Organization Development from Champlain College, USA. She uses positive psychology and Appreciative Inquiry to coach her clients, especially those with High Sensory Sensitivity, through transitions and out of overwhelm. She is the Program Director at the Taos Institute.
Ok. I haven’t left my house in a few weeks because of the smoke from the wildfires.
How tragic. Here, hundreds of people were stranded on the highway for over 24 hours because of the blizzard.
Awful.
Yeah … the weather really has changed over the last few years.
If you live in a culture where greetings start with small talk about the weather, you are likely to have such encounters frequently.
How are you after such an exchange? Is it time to reshape these greetings so they lift us up instead of bringing us down? Do we have the tools to do so? According to Dr. Stowe, co‑director of the Harvard Project on Climate Agreements and executive director of the Harvard Environmental Economics Program, the most important impact individuals can have on climate change is by increasing “climate conversations”. So – let’s talk. But let’s choose our words carefully since, as we know from the Constructionist principle of Appreciative Inquiry, “words create worlds”.
To help, here are just a few of the resources on climate change that I’ve gleaned in the past few months – resources that can move us forward, not leave us stuck. My hope in compiling them into this “gift basket for the planet” is to spark different kinds of dialogues about “how we are”.
Starting with hope
“Hope is what enables us to keep going in the face of adversity. It is what we desire to happen, but we must be prepared to work hard to make it so. Like hoping this will be a good book. But it won’t be if we don’t bloody work at it.” Jane Goodall, The Book of Hope
My journey started last autumn with an email announcement for the Activating Hope Summit celebrating Jane Goodall and her new book, The Book of Hope. The four-day online event aimed at “sparking lasting change by illuminating and celebrating hope around the globe” through a diverse collection of workshops given by celebrities, wellness leaders, musicians, activists and more.
Attending these webinars was overwhelming at first, but then, it really did give me hope. I was struck by the lack of alarmist, guilting and shaming messages. Instead, it was an invitation to soothe the soul. I felt validated. My experience was normalized. I learned techniques to manage stress – and a whole new way to speak about the topic of climate change.
Words, indeed
Sadly, a whole new vocabulary has emerged in the last decade: Climate-anxiety is defined as “a chronic fear of environmental doom” (APA and ecoAmerica, 2017) or “anxiety or worry about climate change and its effects” (www.apa.org/news/podcasts/speaking-of-psychology/eco-anxiety, 2021). Solastalgia is “the distress that is produced by environmental change impacting on people while they are directly connected to their home environment” (Albrecht et al., 2007). Ecological grief is “the mourning of the loss of ecosystems, landscapes, species and ways of life” (Comtesse, Ertl, Hengst, Rosner & Smid, 2021).
There is also something empowering about having these new phrases to use in conversation, especially since most of them are recognized by the American Psychological Association (APA). These complex emotions are not rare diagnoses (to be clear, they are not diagnoses at all). They are more widespread than we think. Now that there are words to talk about them, we can do something about them.
And people…
Indeed, once I started using these terms, I discovered new fields of study and practice that address the range of human experiences triggered by global warming. Ecopsychology, for instance (Division 34 of the APA), explores “humans’ psychological interdependence with the rest of nature and the implications for identity, health and well-being”. The Climate Psychology Alliance, Climate Psychology International and the Climate Psychiatry Alliance all raise awareness of the impact of the climate crisis on mental and physical health.
In one of my “climate conversations”, I learned about climate coaching. As an emerging coach, and someone who experiences climate grief and often wonders “what can I do?”, I was thrilled to find a meaningful way for me to contribute. Since then, I have joined an inspiring community of coaches at the Climate Coaching Alliance (CCA), given a presentation at their Coaching in the Great Awakening global festival on the topic of Climate Anxiety meets Appreciative Inquiry, and started an International Coaching Federation (ICF)-accredited course hosted by Climate Change Coaches. Amazing what one conversation can do!
Put your own oxygen mask on first
Anxiety, fear, grief, despair, hopelessness, powerlessness … no one denies that these are part of the journey. And there is hope. Here are a few more resources to support and nourish ourselves as we take on these critical conversations.
BookClimate Courage: How Americans Are Bridging the Political Divide and Tackling Climate Change – A Bipartisan Citizens Guide by Andreas Karelas. While US-centric, this book can only leave you with a big dose of hope and optimism, no matter where you are in the world. Did you know that solar installer and wind technician will be two of the fastest-growing jobs in the next decade according to the Bureau of Labor Statistics (2021)?
BookThe Nature Fix: Why Nature Makes Us Happier, Healthier, and More Creative by Florence Williams. The author’s scientific approach will help fight off any nay-sayer as “she uncovers the powers of the natural world to improve health, promote reflection and innovation, and ultimately strengthen our relationships”.
Podcast– Climate Change and Happiness. As the name of Episode 2 implies, this podcast is for Holding Space. Launched in January 2022 with this provocative title, it is already getting five stars, making listeners feel heard, validated, resilient and hopeful.
PodcastThe Jane Goodall Hopecast. Even intrepid world traveler Jane Goodall was slowed down by the pandemic. To our delight, her message is now captured in a podcast series launched in December 2020 where she “reinvented herself as Virtual Jane, and without ever leaving her childhood home in Bournemouth, England, recorded intimate conversations with humans who have dedicated their lives to helping people, animals, and the planet.”
Virtual meeting Climate Café. A safe space with no guest speakers, no lectures and no advice. Free and available once a month.
Virtual meetingGood Grief Network. A ten-step program to personal resilience and empowerment in a chaotic climate. In less than four years, this new program has reached 1000 participants all over the world.
Taking ActionCitizens’ Climate International. If action is what you need, CCI “empowers citizen volunteers to exercise personal and political power in the shaping of effective climate policy”.
Taking Action TreeSisters. Still overwhelmed or unsure of what to do next? Plant a tree. Reforestation plays a major role in fighting climate change. TreeSisters is a UK-based charity “in support of humanity’s identity shift from a consumer species to a restorer species. [Their] approach is the balance of inner and outer, spiritual and practical, behavioural and ecological pathways towards that shift.”
There is so much more already happening that can lift us up, give us life, make us smile, and help us do the work required to keep going, with hope.
As we know from AI’s Simultaneity principle, change begins the moment we ask a question. Imagine what would happen if, in our next small talk about the weather, all of us also asked “have you heard of this great [book/podcast/organization/news…]?!” How much can we collectively add to this gift basket for the planet?
Systems thinking perspective requires curiosity, clarity, compassion, choice, and courage. This approach includes the willingness to see a situation more fully, to recognize that we are interrelated, to acknowledge that there are often multiple interventions to a problem, and to champion interventions that may not be popular. Michael Goodman in Systems Thinking: What, why, when, where, and how?
Alexandra Arnold MSPsy, MSHR/OD, ACC, is an ICF-accredited personal development coach with a certificate in Positive Organization Development from Champlain College, USA. She uses positive psychology and Appreciative Inquiry to coach her clients, especially those with High Sensory Sensitivity, through transitions and out of overwhelm. She is the Program Director at the Taos Institute.
Thesystemsthinker.com is an archive of published articles aimed at “catalyzing effective change by expanding the use of systems approaches”. The website was launched in the early 1980s thanks to Daniel Kim, organizational consultant, facilitator, teacher, public speaker and contributor to almost 100 articles on the site, and to Colleen Lannon, co-founder of the original publisher, Pegasus Communications. In 2013, The Systems Thinker was acquired by Ebay founder and philanthropist Pierre Omidyar’s The Omidyar Group.
The site is a repository of hundreds of free articles, case studies, how-to guides, pocket guides, tools (causal loop diagrams, archetypes, management flight simulator, the iceberg framework and more) and videos/webinars. These can be searched by topic (archetypes, fundamentals, leadership, management, managing conflict, organizational learning, personal mastery, public policy, scenario planning, strategy, sustainability and system dynamics almost all show over 100 results); by sector (business, education, government, healthcare and social change); by type; or by author.
Among contributors are internationally acclaimed organizational learning and complex system change gurus like David Peter Stroh, Peter Senge, Gene Bellinger and Michael Goodman. Dozens more authors are listed with handy short bios. Contact information or links to their other work would be a plus.
From technical to inspirational
The content can be technical, like A pocket guide to using the archetypes, by Daniel Kim and Colleen Lannon or inspirational – How can we solve our toughest problems peacefully, by Adam Kahane – and addresses what feel like current, relevant topics. None of the articles are dated. The articles are presented on a clean, modern, advertisement-free platform that makes it appealing to browse and easy to share with quick links to social media, print and email on each page, as well as the option to bookmark articles of interest.
This review was hard for me to write. For a long time, I couldn’t figure out why. I wanted to do justice to the depth and breadth of the topic, the articles and the authors that make up thesystemsthinker.com. Yet I felt ill-equipped to tackle this big task. There was something else, some deeper block that prevented me from capturing the essence of it. Finally, in a conversation with my coach, it became clear, in unexpected ways, and with unexpected tears.
All along, I was trying to find a way to explain that systems thinking is a better approach to problem-solving than linear thinking. I wanted the reader to understand that this methodology and mindset could be used on topics ranging from service quality excellence, to mindfulness, to climate change or conflicts like the one between Israeli and Palestinian.
A miracle solution?
In other words, I wanted to provide a miracle solution to some of the world’s toughest issues. Not surprisingly, it was overwhelming. That’s when the tears came. I became aware of my own discomfort and fears when faced with the proposition that most problems don’t have a simple solution, that no matter how much we wish to believe in simple laws of cause and effect, it is not the most effective way to make progress.
The unexpected consequences of linear thinking
In fact, systems thinking suggests that such a linear view can be harmful. In their article Acting and Thinking Systematically, David Peter Stroh and Kathleen Zurcher give the example of starvation and call our attention to the unintended long term impact of food donations as they drive local food prices down and indirectly hinder local agricultural development. They offer four key areas in which a systemic approach surpasses a linear one:
●There are more than symptoms and direct causes. One must look at the interdependencies between the elements of a system, at the relationships that are circular, indirect and non-obvious.
●Without such analysis, quick fixes only create problems in the long term.
●Well-intentioned but isolated groups contribute to the very problem they are trying to solve unless they work together, like distributing food aid without collaborating with local food producers.
●Aristotle said “the whole is greater than the sum of its parts”, and indeed, improving the relationship between parts, or local initiatives, or people, yields a greater positive impact on the system as a whole than improving each of these separately.
Systems thinking and AI: Stakeholders, diversity and interconnectedness
Systems thinking mirrors the Wholeness principle of Appreciative Inquiry in that it invites many stakeholders into the conversation, it finds value in diversity of views, it reminds us that we are interconnected, and it shows that embracing the system generates creativity, capacity and generativity where everyone flourishes.
“Nothing good in the world happens until people get together, talk, understand one another’s perspectives and assumptions, and work together toward a compelling goal or a vision,” says David Berdish in Learning and leading through the badlands.
All in all, this resource is valuable because its content and contributors share a common mission: they call for curiosity, for asking new types of questions to unveil diverse perspectives; they recognize that there is not one perfect solution but many stories embedded in our teams, organizations, societies and global networks; they remind us that it is ultimately about people and relationships.
So rather than offering an answer, I hope that thesystemsthinker.com can, as it did for me, give you more courage to look complexity in the eye, nurture compassion for your sense of being overwhelmed, and fuel your hope with the belief that our small, individual actions do indeed make the whole system shift, just like an invisible breeze moves a baby’s mobile above the crib in sometimes significant and beautiful ways.
This November 2021 issue is about AI and technology. “Resources” when the journal started meant primarily books and journal articles, hence the title Book Appreciation. Neena Verma, who has supported AI Practitioner in so many ways, took on the role of editor of the column of the journal in May, 2018. She wrote thoughtful, in-depth reviews about books she perceived to be especially relevant for AI practitioners until February 2021. We’d like to thank her for the rich diversity of treasures she shared.
“Resources” more than ten years after the column started means something quite different: not only books and journals, but blogs, videos, podcasts … and all the other technologies that will develop to connect people with the information they are looking for. So it is fitting that we change the name of the column to “Appreciative Resources”. Alexandra Arnold has agreed to take on the role of editor of the column. It will be exciting to see where the resources take us in future.
Alexandra Arnold MSPsy, MSHR/OD, ACC, is an ICF-accredited personal development coach with a certificate in Positive Organization Development from Champlain College, USA. She uses positive psychology and Appreciative Inquiry to coach her clients, especially those with High Sensory Sensitivity, through transitions and out of overwhelm. She is the Program Director at the Taos Institute.
From Physical Place to Virtual Space:
How to Design and Host Transformative Spaces Online
Gwen Stirling-Wilkie
BMI Publishing, 2021
ISBN 978-1-7771846-2-9
A brand-new book, From Physical Place to Virtual Space, has just been published, in the spring of 2021, by BMI Publishing, a branch of the Bushe-Marshak Institute for Dialogic Organization Development. The author, Gwen Stirling-Wilkie, has over 20 years of consulting experience in OD. This little green book is an account of her personal experience, written in the moment, without jargon, as she had to transition to virtual interventions when the Covid-19 pandemic shook the world in the spring of 2020. She admits that she didn’t believe it was possible, but because she was just starting a big project involving 600+ stakeholders with a new client – like many of us – she jumped right in.
Her intention is to share her own experience while answering three questions:
●How do we design virtual interventions?
●How does one host online gatherings to create connection and safety that increase contribution?
●How do we facilitate relational dynamics that create “transformative moments that matter?”
The term is key here: transformative, as in spontaneous and open, as opposed to transformational, or planned. One of the book’s appeals is that it takes the view that the expertise of DOD (dialogic organization development) professionals lies in “creating generative conversations that enable or unlock the transformative potential” of teams and organizations (p.11). This book is not for experts giving webinars, presentations, courses, training sessions or calling regular meetings. It is for consultants and leaders involved in workshops or large group events who are willing to embrace the idea that there is no right way, who work with what is unfolding, live in the moment, and recognize that “solutions” are socially constructed within conversations.
A reminder of how much we’ve learned
For those of us in the field, much of the content may be second nature. Those who will benefit most are new practitioners, managers and leaders, or those just entering the virtual space. A year before publication, this book would have been a lifesaver for many who had to swiftly reinvent their ways of working due to the pandemic. Today, it is a reminder of just how much we have learned and how much is possible to achieve online – especially if we plan and execute as carefully as the author has done.
Seasoned facilitators are likely to pick up a few new, practical tips out of the many the author shares (for example, use the “slides as background” feature in Zoom to avoid sharing your screen and keep the group together in gallery view). Or, perhaps they will understand what is behind the best practices they have naturally embraced over time: the specific elements that impact psychological safety, group dynamics or presence.
The book is structured in two parts, one about preparing virtual spaces, with chapters on participation, design, technology (offering options for both low- and high-tech organizations), and presence. This section is particularly valuable as it invites practitioners to reconsider the time dimension of their work. For reasons beyond “Zoom fatigue”, the author emphasizes the importance of the invitation, preparation and follow-up phases, as well as the “in-between” spaces (checking-in, checking-out, breaking, reconvening, etc.). Also a stretch for those who might underestimate the complexity of virtual gatherings is the break-down of design principles, design options and organization maturity levels to be considered.
Mastering virtual consulting
The second section, mastering virtual consulting, introduces facilitation skills, from understanding group processes to reading the room, tuning into or using your body, how/when to intervene (and there is much more to it than you might think). A succinct chapter on common dialogic approaches suggests that Open Space Technology, World Café, and Appreciative Inquiry can be adapted to the virtual space – not enough details are given for practitioners unfamiliar with these approaches, though. On the other hand, another chapter recounts in detail the decision points, approaches and lessons learned from the author’s client engagement at the time.
Overall, this book fits perfectly within the theme of this AI Practitioner issue: Technology and the Wholeness Principle. Tips on how to use online platforms may be basic for some, but the dialogic (vs diagnostic) OD focus is where the real value is: a real-life story showing that for generative change, the whole system needs to be in the room. Virtual OD, according to Stirling-Wilkie, increases our chances to have an impact. These platforms “democratize contributions by removing hierarchy, power dynamics, and strong presences” (p. 80) when we each inhabit the same-sized square displayed in random order. In 135 pages, this short read raises some very big questions. One is whether virtual organization development interventions, when done skillfully and thoughtfully, are in fact more effective, or even essential, to today’s diversity, equity, and inclusion agendas. Another prompt is for readers to consider that, sooner than we think, OD facilitators might have to trade flip charts and sticky notes for avatars, holograms and 3-D virtual reality platforms.
Thriving Women Thriving World:
An Invitation to Dialogue, Healing, and Inspired Actions
Diana Whitney, Jessica Cocciolone, Caroline Adams Miller, Haesun Moon, Kathryn Britton, Alejandra León De La Barra, Angela Koh, Tanya Cruz Teller and Marlene Ogawa
TAOS Institute Publications, 2019
ISBN (e-book) 978-1-938552-72-4
ISBN (paperback) 978-1-938552-68-8
Thriving Women Thriving World is less a book for reading than it is a book for doing. The text is designed guide us through the challenges of the #MeToo movement and the variety of struggles gender bias and discrimination have created more broadly, applying the approaches of Appreciative Inquiry to co-create a future where all women can thrive.
A mix of stories, poetry – and questions
The content is a mixture of personal stories, poetry – and most importantly questions to guide constructive dialogue, focussing on what works in supporting women to thrive, improving difficult situations, and creating a better future more systemically.
The authors offer ways to use the text in a range of applications, from personal reflection and journaling through women’s retreats to corporate organizations. Working in a large global organization myself, I can easily see that using the discussion guides could facilitate workshops as part of our diversity, equity and inclusion initiatives, or within business resource/affinity groups.
I’ve seen many “listening sessions” where women share stories of bias and discrimination they’ve experienced in the workplace, including sexual harassment and microaggressions. While it’s essential to be aware of what people are experiencing, these sessions can be very draining when not coupled with a path towards solutions, to what has worked in addressing these issues successfully. The topics “women supporting women” and “men supporting women” would be excellent additions to these sorts of listening sessions.
In taking on discussions of “allies we know and love,” “supporting and celebrating women,” or “allies calling out injustice,” imagine the power of not only calling out existing injustices but also calling out when an ally has stood up against them or when changes have been made in policies to address them.
AI in difficult spaces
Appreciative dialogues are powerful in these difficult spaces. I have known many men who want to be allies to women or women who want to better support other women, but who don’t always know how or what that looks like in action. By gathering and sharing stories of what allyship looks like in every day and what we’ve seen work well in other parts of our lives or organizations, we can rally around solutions and actions while spending less time focusing on what isn’t working.
Some topics covered are more comfortable than others, such as “leveraging financial savvy” or “living life as a work of art.” For uncomfortable topics such as “claiming ownership of our bodies” and “healing from relational abuse” some might feel that, due to their gravely serious nature, the tone of Appreciative Inquiry feels less natural. However, while I found these sections of the book made me uneasy, I also found them rewarding. My initial concerns were the discussion of what thriving women do when faced with situations like physical or sexual abuse. Would there be too much onus on the individual women and how they handled the situation versus the systemic factors that contribute to such abuses in the first place?
A balance of focus
But there was a balance in focusing on actions within an individual woman’s control, how women (and men) can support each other to be safe or to heal from abuses and, critically, an exploration of sustainable solutions to change behavior among men, the law, governments, and culture to support women and keep them from harm.
These sections of the book, while difficult, are essential. And while it can feel almost dismissive at first glance to approach, the authors do a nice job at balancing the delicate conversation around such painful topics in a constructive light, with a focus on solutions for both healing past harms and preventing harms in the future.
As mentioned in the beginning, this is not a book for reading but for doing. Full benefits will only be achieved by taking time to pick sections that resonate with you and sit with them, writing, reflecting and taking action to do more of what works in our lives and in our communities. To spread those benefits even further, engaging with others in dialogue, storytelling and workshops around such important topics will help enable us to start moving towards more of what we need in the world to foster an environment where all women and girls can thrive with ease.
Sharing stories is a practice as old as time. From ghost stories around a campfire to the most recent viral news on your phone-screen, storytelling has always been an essential part of human communication and connection.
Throughout my two years interning with the David L. Cooperrider Center for Appreciative Inquiry, I have had the privilege of hearing individuals’, communities’, and organizations’ stories through interviews, which I then turn into bite-sized videos to share their stories with the world for the AI World Inquiry Project (AIWI).
AIWI emphasizes the human-interest component in a way that can embrace people outside of the AI community. This vital element can often get lost in more formal scholarly resources. Creating connections of the heart keeps AI on one’s mind and hopefully encourages further exploration of the topic as it did for me.
Having truly been shaken to the core by many of the accounts, I have witnessed the power of sharing stories of impact first-hand and believe in AI’s potential to change the world. I could have never imagined how deeply or profoundly I would be affected by my time with the Cooperrider Center and the AIWI project. AI has become a part of my own mindset, really honing in on the strength-based focus and principle of wholeness. As a budding young professional, I am excited to take this mindset with me throughout my career and personal life, illuminating the value of Appreciative Inquiry for all.
AIWI videos can be found in a variety of locations, with the main hub of videos on YouTube. The videos consist of group and individual interviews conducted by Sallie Lee, Ada Jo Mann and the Cooperrider Center. The interviewees include AI practitioners from across the globe and from a variety of AI backgrounds and experiences. The multiplicity of contributors to the project aligns with the overall goal of AIWI to highlight stories of impact amongst the AI community in order to project the value of AI for everyone in a new inclusive light. While the videos depict stories from vastly different scenarios (ie: individual, organizational, corporate, community), there are three common themes throughout the project:
The power of inclusivity
The power of inquiry
The power of a conversation
The power of inclusivity, inquiry, and generative conversations are at the core of Appreciative Inquiry and positive change. AIWI might not directly teach the five principles or the 4D cycle of AI; however, it gives the audience a fundamental understanding of Appreciative Inquiry and the versatility of its application and impact. From hospital protocols to children on the streets of Africa, AIWI covers a spectrum of inspiring Appreciative Inquiry stories that would be of value to anyone and everyone with a beating heart.
Brianna is a Communication major with a specialization in Public Relations and a minor in Event Management at Champlain College in Burlington, Vermont, USA. The two years interning with the David L. Cooperrider Center for Appreciative Inquiry has greatly benefited her thinking process in all aspects of life. As a budding young professional, she strives to embody this mindset throughout her career, focusing on how we can best lift up each other and our communities.
Delirium is common amongst older people in hospital, but up to a third of new cases may be prevented by introducing simple preventative protocols. Addressing these preventable risk factors can seem like stating the obvious to staff: ‘But aren’t we doing that already?’ An AI approach provided a way to encourage staff to reflect and identify changes themselves. In a small-scale demonstration project, the AI process led to a significant improvement in awareness amongst the staff.
Delirium is a common and serious illness amongst older people in hospital, but it is be able to be prevented in many cases. An Appreciative Inquiry approach offered us a way to respectfully find out what was working well and how this could inform and inspire improvements in delirium prevention.
The context
Delirium is sudden confusion which develops over hours to days. People with a delirium have trouble thinking clearly, focusing their thoughts and paying attention. This tends to fluctuate across the course of the day. It is different from dementia, which is a progressive cognitive decline that develops and progresses over time. Delirium is under-recognised but surprisingly common, particularly among older people who are hospitalised. Delirium can have lasting and grave consequences for a patient’s recovery, with an increased risk of staying in hospital longer, having more complications, being discharged to long-term care, and dying. (National Institute for Health and Clinical Excellence, 2010).
The potential
A considerable proportion of delirium affecting older people in hospital develops after admission. These are the cases that we can often prevent with better care.
Anything that impacts on the brain can increase the risk of delirium. Conversely, anything that can be done to reduce a cause or risk factor could help prevent delirium. The focus is to target the triggers that can occur during the episode of care. There is considerable consensus about these preventable risk factors to guide prevention protocols. International evidence shows that new cases of delirium developing during admissions can be reduced by a third or more using interventions that target and reduce identified risk factors (Martinez, Tobar and Hill, 2015; Hshieh et al., 2015). Indeed there is more evidence to support the effectiveness of making changes to prevent delirium than there is to support making changes to better treat or manage delirium once it occurs (Francis, 2014).
The barrier
The components of these interventions are simple but the key is consistency. Despite the knowledge that delirium can be reduced, hospitals are indeed in a persistent “know-do” gap:
… as the evidence grows, the state of implementation is not keeping up … Why, then, are these protocols not more widely implemented? … there may be an assumption held by many physicians and hospital leaders along the lines of “aren’t we doing all this stuff already?” Perhaps because most of the interventions to reduce delirium are protocol-based and nursing-driven, it may be easy to assume that such measures are already in place and running in the background at many hospitals. Numerous components of these interventions may simply seem too simple to question that they are not being done already. (Greyson, 2015, p. 521).
In previous studies, the push to change practice to a more preventative approach was supported by a considerable investment of resources in the form of a designated position and/ or a team of volunteers. In the absence of these types of resources, the gap between the potential and actual practice remains.
The AI fit
It seemed to us that an AI approach offered a powerful way to overcome the “but aren’t we doing that already” hurdle, to encourage staff to reflect and identify changes themselves. AI shares many of the values of nursing and allied health professions, and provides an approach that is supportive and respectful (Reed, 2010). Rather than raising defensiveness by a problem-focused or didactic approach, AI recognises the health professionals involved as experts in their own experience who have much to offer, with specialised skills and knowledge that we can access and utilise (Reed, 2010).
Reflective practice is a key skill for nursing and allied health professionals. Natius Oelofsen (2012) discusses how reflective practice starts with curiosity about a puzzling situation and hopefully concludes with a sense of clarity and understanding. This is achieved through a process of looking closer and finding new ways of answering the questions that were raised. AI can be seen as scaffolding health professionals’ self-reflection and providing a way to focus on how best practice can be maintained and further developed (Bellinger & Elliot, 2011; Stefaniak, 2007). The group nature of AI enables conversations that help health professionals to focus on and strengthen their skills and positive experiences, but also to imagine possibilities together that may go beyond what any one individual might create themselves (Wasserman and Namee, 2010).
The project
The participants were recruited through invitations at Older Person’s Health Specialist Service education days and learning networks. The fifteen volunteers were spread amongst various wards and outpatient teams and twelve nurses, a social worker, an occupational therapist and a physiotherapist.
A key feature of an AI approach is that the methods of inquiry are themselves part of the intervention. Inquiry and change are simultaneous and, by stimulating reflection, inquiry can lead to different ways of thinking (Reed 2007, 2010). To document this we introduced a repeated measures design: a baseline individual interview, a guided AI group discussion, and then a follow-up individual interview.
While an AI discovery phase often begins with the participants interviewing each other, we began with a separate one-to-one interview with a member of the research team. This interview began the appreciative discovery process by framing the conversation with positive questions, but also provided a baseline measure of awareness of the status of risk factors in day-to-day practice. The interviewer asked participants to think about the last older patient in their case load that they interacted with. The preventable risk factors were simplified by a PINCHES ME Kindly mnemonic: Pain, Infection, Nutrition and Constipation, Hydration, Exercise, Sleep, Medication, Environment and person-centred care (kindly). The discussion went through each of the risk factors in turn, for example “Was Mr X in pain? How did you know?” We also asked participants to talk about what was working well to help to prevent, identify or manage each risk.
We gathered the participants together into small groups for a guided AI discussion or “brainstorming session” with the research team. The brain storm was semi-structured to lead the discussion through an iteration of the AI cycle, but remain flexible and fluid (Reed, 2007). The core questions that guided the discussion (see Table 1) opened with sharing what participants were proud of, and flowed on to how things could be even better, and the steps that could be taken to get there. Again, we used the PINCHES ME Kindly mnemonic to help collate the tips and ideas during the discussion about what people were proud of and the magic wand question, with a large sheet of paper for each risk factor alongside broader environmental factors.
Follow-up interviews a month later allowed us to gauge how much had changed since the first interview and what the participants thought of the process. Staff were again asked to talk individually about a specific case to provide a post-intervention measure of awareness of risk factors.
To document the impact of the reflective process on the individuals involved, the awareness of risk factors from each interviews was categorised as 1: cursory, 2: moderate, or 3: thorough by each of the three researchers. The coding was then compared and any discrepancies resolved by consensus, with evolving coding notes to clarify future decisions.
To help embed and sustain change, specific projects that emerged from the discussion were dovetailed into the work stream of the existing Dementia and Delirium group. A link group was set up to enable participants and other interested staff to remain involved.
Phase
Key questions / activities
Discovery
Sharing the positive
One-to-one interviews: What is working well…?
Group, opening question: You’ve all had the opportunity to reflect about what’s happening with delirium prevention for you currently, and we’d like to start by gathering together some ideas about what is being successful. Thinking back about your interviews – what parts made you feel proud to talk to share. What’s working well for you for delirium prevention?
Dream
Sharing a vision
Group, magic wand question: … We’ve gathered together some of the good things that you are doing that really work for delirium prevention. How might we make it better? If you could transform the way you work so that you are more focused on delirium prevention, what would it look like, what would it take to happen? Imagine that you can wave your magic wand and anything is possible – for you, your team, your environment. You’ve got three wishes for delirium prevention in your own work setting – what are they going to be?
Design
Sharing what we think should be
Group, developing provocative propositions (Bridging dream and design): We are going to come up with some statements – our vision, our goal for what we are going to look like in a couple of years when we “think delirium” in our work setting. They are going to be positive. And they going to be bold: “if you are good we want better, if you are great we want outstanding…”
Group: Identifying specific “projects” for the service that would make a difference
Delivery
Sharing a commitment to change
Group, personal goals: Now our last thing is that we want you to think about your own goals in the short term. We’ve got a sheet here for you to fill in three goals – what are you are to aim to do when you walk out that door?
One-to-one follow-up interview
Action planning and implementation: Specific projects were followed through with the support of delirium groups and the participants could remain involved through a link group
Six-month survey
The actions
Part of the Appreciative Inquiry process is to take the ideas that have been generated about what is working and visions for the future, and to turn them into concrete actions about what could be done differently. The AI process was an effective kick-starter for sparking a number of further specific projects.
The vision for a service that “thinks delirium prevention” that emerged had three overarching themes: committed, consistent and a great care environment. We used the simple PINCHES ME Kindly mnemonic to summarise risk factors during the project. The participants strongly embraced this and wanted it to be the core of the ongoing actions.
A committed environment included being proactive about delirium prevention with PINCHES ME Kindly ingrained throughout the service. Identified actions included education, reminders and resources to encourage this.
Collating the Discovery and Dream phase questions can be seen as forming the basis of a good practice guide (Bellinger and Elliott, 2011). A user-friendly fun booklet was created to share the tips and possibilities from participants to inspire other staff (Gee, Bergman, Hawkes & Croucher, 2016). This well-received book provides a useful bridge between abstract international guidelines and how they can be operationalised in daily practice.
A poster/handout summary version of PINCHES ME Kindly was created for publicity and education.
The THINKdelirium resources are being used by CDHB nurses in orientation and in-house education, and there are moves to spread this, given that delirium prevention requires a multidisciplinary approach. A multidisciplinary working group has been set up to integrate the THINKdelirium booklet into an online education package.
An annual “Spring Into Delirium” day has been initiated to raise awareness of the THINKdelirium messages and resources and where to locate them.
The consistent theme focused on consistently and comprehensively assessing and addressing the risk factors. Identified actions included having documentation resources available to accurately monitor relevant risk factors.
A THINKdelirium webpage has been created on the staff intranet. This provides an interactive summary of PINCHES ME Kindly, with links to download the THINKdelirium and associated documentation resources.
A summary of the PINCHES ME Kindly message has been added to the routine documentation for hospital aids when they are providing close observation.
Staff are considering how the PINCHES ME Kindly message can be included in records and discharge documentation.
A great care environment focused on providing person-centred care. Identified actions included more resources for activities, and a prevention-focused brochure for care-partners.
The staff were keen to be supported to encourage meaningful activity for older people on the wards. A follow-up project is trialling the introduction of “activity trolleys” with activity resources and tips alongside a staff-education package.
Staff wanted ways to engage care partners to help prevent older people getting delirium. Based on international exemplars, a prevention-focused brochure for those supporting older people in hospital has been developed.
The impact for participants
The AI approach was effective in engaging staff and overcoming the “aren’t we doing that already” hurdle. A nonparametric Wilcoxon signed-rank test was used to test the difference between the sum pre-test and post-test scores, and an effect size was calculated (Field, 2009). There was a significant improvement in the awareness of the status of the target risk factors for older people in their care when the follow-up interviews were compared with the baseline interviews (z = 3.21, p. <.001,) with a moderate effect size of .59. This change is illustrated in Figure 1 which shows the increase in the proportion of the participants being given the highest rating of awareness for each of the risk factors.
All of the participants gave positive qualitative feedback about being involved in the project during the follow-up interviews, with the predominant themes being that they “enjoyed the process”, and “learned a lot”. A six-month follow-up survey was completed by fourteen of the fifteen participants, and again all were positive about the project. In particular, all the participants agreed that the project inspired them to do more to pro-actively prevent delirium, and that it was worthwhile taking part in the project. Twelve of the respondents identified specific changes in their personal practice and thirteen identified activities or changes that they were inspired to champion in their workplace.
Examples of feedback included
Everyone on our ward has thought the booklet is fantastic. We have found it really useful for our nursing students also. We also love the brochure for families … What a fantastic project to be involved in! It challenged my thinking and made me think about my practice.
My awareness of delirium [now] makes me ask more specific questions regarding risk factors in my assessments. I also provide information/education to clients/families where appropriate. I have provided an in-service session to my immediate team … and [plan to] discuss with the team to include [delirium tool] in our initial assessment tools. I very much appreciated being able to participate in the project.
The discussion
There are well-established guidelines for delirium prevention (e.g., National Institute for Health and Clinical Excellence, 2010), with good evidence of the benefits when they are followed (Martinez, Tobar and Hill, 2015; Hshieh et al., 2015). However, while guidelines are commonly produced as a tool to promote best practice, it has been recognised that on their own they often have little impact on behaviour (Greyson, 2015) and that strength of evidence is not a good predictor of the likelihood of adherence (Ricart et al., 2003). AI was a very effective tool to help to bridge the gap between the abstract guidelines (but aren’t we doing that already?) and what that could look like in the real world. AI gave a way of basing our projects and resources on listening, which has helped to increase engagement and ownership. While we have not yet achieved our ideal vision for the organisation we are excited about the collaborative steps we are taking toward it.
We were drawn to the AI approach for this project because of our positive experiences using an AI approach with our adult students, and our recognition of the synergy between an AI approach and reflective professional practice. Appreciative Inquiry holds that at its best, change is a process of inquiry grounded in affirmation and appreciation (Whitney and Trosten-Bloom, 2010). The AI approach was a chance to provide recognition of the staff and help them work from their strengths (Whitney and Trosten-Bloom, 2010). The staff were respected as experienced professionals, and their contributions were recognised and valued as a resource to be shared. The approach encouraged the participants to recognise the importance of what they do and their potential to make a difference. The AI approach was about asking questions, not providing solutions.
Reflective practice itself can be seen as a process of inquiry: the process of asking questions helps us to look at what we are doing and reflect on how we can do things even better. The use of positive questions and constructing positive images of the future in the AI process helped to inspire positive change. The AI process worked so well because it was both visionary and pragmatic. It helped to inspire a larger vision of an ideal environment while also exploring the small practical steps that could be taken (Loveday, 2011). The AI process was not just a constructive process for generating actions for the teams, but also a positive and effective learning experience for the individual participants.
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The authors start by taking us back to the basics to remind us of the initial work of David Cooperider and his ground-breaking approach to acknowledging the “life-giving forces” that are present within teams or organisations. Whilst AI does not come from a problem-focused perspective, it also doesn’t discount that problems exist. It is in focusing on problems from a strengths-based, participatory perspective that positive action can occur. 
Alexandra Arnold (she/her) Arnold MSPsy, MSHR/OD, ACC, is a personal development and climate coach with a certificate in Positive Organization Development from Champlain College, USA. She is the host of 
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