As health care professionals, we are accustomed to reflecting on those rare occasions when things do not go as well as they should, and rightly so. But we have much to learn from when things go well, as it gives us insight into what we could be doing more of, and better for our patients.

Appreciative Inquiry is a tool that can help us to reframe the picture of care that we have in our mind by consciously acknowledging the routine, high quality care that we provide every day.

I’m talking about all those thousands of acts, small or large, where we get it right. Everything from a simple act of kindness at a difficult moment, to an inspired, innovative clinical intervention.

At our event on Appreciative Inquiry we looked at how, with practice, we can become better at skilfully reflecting on what we are doing well and using it as a powerful force for quality improvement in health care.

We looked at how this works and some beginner approaches for its use in improvement work. Co-presenter Suzanne Quinney set out how reframing our mindset to be psychologically positive is a formative step toward developing an Appreciative Inquiry skills set.

Positive thinking is an analytical skill like any other, and must be exercised, rather like a muscle. It can help us to grow as individuals so that we can learn to create space for appreciative dialogue with colleagues.

Suzanne emphasised that those of us in leadership roles may need to re-educate ourselves in appreciating our own good qualities. We can then model this behaviour for our teams and begin to build positive feedback in our QI reporting.

Using appreciative inquiry as a QI tool

At University Hospitals Plymouth University Trust where I am based, we have been using Appreciative Inquiry as part of our Learning from Excellence programme since 2016. To date, we have gathered around 13,500 examples of positive feedback, about one in five of which is from a patient.

After interrogating this feedback, we were able to establish specific behaviours that consistently contribute to psychological safety for everyone. This data has given us the evidence we need to establish a baseline from which to improve quality of care across our organisation, using feedback directly from our staff, patients and carers.

The next step for us was to understand how we could spread the best of what we were doing across the trust. Adapting this kind of insight into our organisational learning culture is an often messy and iterative process that requires new tools and approaches.

IRIS: a tool for empowering reflection about quality of care

One of the tools helping us to turn feedback into action to improve quality of care is known as IRIS. IRIS stands for ‘Improving Reflecting Inspiring Success’. We hold an IRIS session when a staff member or team is attracting a consistently high number of positive comments and we want to delve into why this is happening. In some ways, an IRIS operates as the reverse of a ‘serious incident requiring investigation’, or SIRI.

It may surprise some of you to read this, but having conversations with staff members about what they do well can be a bit uncomfortable. During a recent IRIS conversation with a staff member, I asked him what he thought he was doing to trigger the high number of positive comments about him. Initially he struggled to respond, and this is not uncommon.

Articulating the positive aspects of our work is culturally unfamiliar for many of us and reinforces Suzanne’s insight that this is a skill set we need time to learn.

It takes practice to be able to fluently describe the actions we take to put the patient’s wellbeing at the centre of our care.

What next for Appreciative Inquiry?

What we are now seeing in our organisation is that when staff are given regular, proportional feedback it generates psychological assets including honesty, creativity, empathy, and openness about mistakes.

In my view, positive feedback is likely to be our most effective QI tool as it gives us the ability to deliver constructive, robust feedback about both positive and unwanted or adverse outcomes. This is because it is feedback that is based on the fact that most of our interactions and interventions go well.

Used effectively, Appreciative Inquiry can move us to a high respect, high feedback culture that is innately safe for all and allows QI to thrive.

For those who are interested, I invite you to join our Special Interest Group on Learning from Excellence where we explore Appreciative Inquiry and many other innovative examples of learning from what goes well.

You can also watch the session with Suzanne Quinney and I by visiting the Q community Youtube channel.