Leadership: Positive Change Management through AI

AI - Appreciative Inquiry is a philosophy and methodology for promoting positive organizational change through creating meaningful dialogue, inspiring hope, and inviting action – it builds relationships and unleashes learning!

Although the literature speaks to compelling evidence for improving communication and increasing staff member’s involvement in decision-making, there is little guidance on how to implement changes in communication with-in the office environment.

Setting the Stage
What if we set a goal to improve our practice work environment and enhance quality patient care?

What if we had goals like:
1) To improve communication and collaboration between staff
2) To enhance staff involvement in decision-making
3) To enhance awareness of cultural awareness and sensitivity to patients, families and other staff by the day, by the hour, by the minute!

Here is a Project
To discover your practice’s “positive core”
To combine AI – Positive Change Management results with previous results – begin by collecting benchmark data, reporting examples of positive or inspiring performance data and stories at the end of each day within the office, on a practice blog as it may relate to patient’s interest, and at staff meetings 4 times per year. This “positive attitude change” coupled with online CE resources and tools, email contact, etc. brings about powerful positive change, improved staff morale and patient care.

What is different?
Most change management models guide individuals to search for problems and then to identify options to “fixing it”. In contrast, AI is a strength-based approach to change management that guides organizational members to discover what is already working and then design ways to do more of what works as a foundation for change. By focusing on the positive – what already works well in the office, AI supports futuristic thinking. Practices grow in the direction toward which they focus their attention and repeatedly ask questions about.1

“Unconditional positive questions” ignite conversation and action based on peak experiences, best practices, and noble accomplishments.1

According to Stravros et al, “Change requires action, action requires a plan. A plan requires strategy, a strategy requires goals and enabling objectives. Goals and objectives require a mission. A mission is defined by a vision. A vision is set by values. And the AI approach starts by focusing on the strengths of the organization and the stake holders values.” 2

It is a shift from problem analysis to positive core analysis. The old paradigm, “where change begins with a clear definition of the problem” was painfully slow, always asking people to look backward to yesterday’s causes, rarely resulted in a new vision, and was notorious at generating defensiveness.

The Appreciative Inquiry cycle goes in 4-phases.
1- Discovery – What works? What gives life to your practice at its best?
2- Dream, Imagine – What might be?
3- Design (strategize) – Determine what should be.
4- Delivery/Destiny – Create what will be

Discovery Phase
During the Discovery Phase the staff conduct interviews with all involved, and then interview each other about positive stories within the office, eventually summarizing them into what you see as the practice’s “positive core” attributes based on these stories.

They ask questions that are designed to bring light to the practice’s positive attributes in a chosen topic in order to discover what works. They do this through what’s called “powerful flow” questions reflecting first on past experience (backward), then exploring what about the experience worked (inward).

For example,
Backward Question (Anchored in a past experience)
Can you describe the situation when you collaborated with other staff when all parties treated each other with respect, and appreciation and everyone’s expertise was needed to make a difference? Or, can you describe a time that you consider a highpoint experience, a time when you were most engaged and felt alive and valued in the office?

Inward Question (reflect on what worked)
What was your contribution? What was it about you, your co-workers, the office that made it special? What did you most value about the other staff members? Without being modest, tell me what it is that you most value about yourself, your clinical work, and your practice?

Forward Question (built on past, imagine what might be)
What 3 wishes do you have to improve the vitality and effectiveness of communication and collaboration within the office? What is the one thing that if done well, would make the most difference to improve collaboration at this office? What factors give life to your office when it is at its best?

Dream Phase
Strategic Shared Collaborative Vision of the practice:
Take a look at the positive stories gathered form the Discovery Phase. Look at the “positive core” of these stories and say what it would look like if the “positive core” grew 10X more? What would be the practice’s greatest potential for a positive influence and effect in the world?

As these dreams are shared, compelling ideas are put forward, summarized, and then, become the basis for some action.

Design Phase
What does it mean to have staff involved in decisions, what decisions, who is involved here? What all is there for the stakeholders to decide? Here the rubber meets the road –
Articulate values publicly
Invite action + staff enthusiasm for their work
Propose Provocative Propositions and Principles

Delivery/Destiny Phase
Staff focuses on maintaining AI’s positive approach to improvement. The staff make a habit of noticing what is better every day, every hour, minute by minute, every conversation. Staff identify what they are doing right, and what others do well. By building ever widening circles around them, first person to person, then group to group, the destiny phase of AI ever broadens into the community…Good news stories are used as “possibility perspectives” to bridge the best of what is with the collective aspiration of what might be.

Answer the question, “What would our practice look like if it were designed in every way possible to maximize the qualities of the “positive” and enable the accelerated realization of our dreams? Harness the synergy of group cooperation! Realize the dream in alignment with its principles. Create new levels of partnership.


Use of AI by Others
Appreciative Inquiry has been used by the US Navy, US Department of Health and Human Services, MacDonald’s, BP, John Deere, GTE, Save the Children and World Vision among others. AI is just now beginning to be used in Heath Care, for example, in hospitals in New Mexico, Pennsylvania, Kentucky, Indiana, and the UK. This is its first sighting in dentistry.

“I would like to commend you more particularly for your methodology of Appreciative Inquiry and to thank you for introducing it to the United Nations. Without this, it would have been very difficult, perhaps even impossible, to constructively engage so many…” – Kofi Annan UN Global Compact Leadership Summit in 2004

“Morale has improved dramatically, relationships have grown tighter, teamwork has significantly improved – and equally compelling – sales and profitability outpaced the rest of both organizations. A holistic “appreciative approach” has truly become the way of life for this organization.” – Jim Gustafson, VP and General Manager, ELECTRICjob.com

“The Appreciative Inquiry approach unleashes tremendous power, tremendous enthusiasm, and gets people fully engaged in the right way in what we are trying to accomplish. It’s not that we don’t deal with the negative anymore, the value of AI is that, in anything we do, there’s a positive foundation of strength to build on in addressing those problems.” – Jim Staley, CEO of Roadway, 2003

The Structure of the AI Process
The staff interview each other, one-on-one, and define the topic of inquiry (i.e. staff involvement in decision making or optimum patient experience, then find positive stories or patient success stories that illustrated staff involvement at its best).

Collect these stories and share them.

How to use AI
Always begin with what is really going well with regard to the project or goals? Practice the “positive”, appreciate mindfully and practice on a daily basis.

(Pause and notice: What things are already changing again? What are you discovering? Who have you involved? What are you learning?)

Appreciative stories are retold in huddles, blogs, websites, staff meetings and patient email. Morning huddles are accompanied by “positive check-ins”. What can we do more of? What do you want more of? And what can you do better?

This requires follow up and monitoring. Is this a job for ______________, the same person who begins by collecting benchmark data? What data?

Days/months outstanding patient billings*
Daily Cash Report per Pt./day
Days/months outstanding Insurance billings*
Daily/monthly Cash Deposit Reports
Production: $/day/provider
Procedures/hour/provider
New patients/month
Daily/monthly Laboratory Expenses*
Daily/monthly purchase of dental supplies*

* This information is being tracked nationally through the ADA Dental Market Index, the first index of this nature in dentistry.

You have to take measurements to manage!


AI Requires a New Way of Thinking
A New Set of Skills
AI flys in the face of what’s wrong and how to fix it. The AI change management model works on what works or has worked well in the past (recalling excellence) and then identifying what was involved, who was involved, what was done, how it felt, and how they can make this “best practice” happen again. Sadly, getting people to be positive is a challenge.

Adapting AI to Meet Practice Needs
We are now trying to work toward the positive end, not complaining, just trying to look for the positive. We are looking for success and trying to figure out ways to multiply it.

Good Things Are Already Happening
People are using its principles to build morale. Being able to create positive verbal shifts there is more collaboration. Practice it on a daily basis; the image of our future guides our current behavior.

Changes Are Spreading
We can start our staff meeting off with, “Let’s look at what we are doing really well… what are some of our best features?
Who is doing “it” well, and invite that person to show the others.

You May Ask
Why do people get so excited and want to participate in Appreciative Inquiry? Why does participation so readily lead to positive results, such as, innovation, productivity, employee satisfaction, and profitability? What creates the space for people to be their best at work and for personal transformation? And what are the conditions that foster cooperation throughout a whole office?

The Answer:
Freedom to be known in the relationship, all so often people are related to as their role rather than as human beings, i.e. “That’s the front desk, the CDA, the hygienist, etc. who does that kind of thing”.

Freedom to be heard with sincere curiosity, empathy and compassion.

Freedom to dream in community, i.e. unleashing the dreams of all involved

Freedom to choose to contribute, i.e. to volunteer in the community

Freedom to act with support, and break through years of apathy and distrust

Freedom to be positive, its simply not the norm to have fun, be happy, or be positive!

Why?
Because relationships thrive where there is an appreciative eye! – When people see the best in one another, share their dreams and ultimate concerns in affirming ways, and are connected in full voice to create not just new worlds, but better worlds.

Discussion
Appreciative Inquiry offers numerous advantages to the old way of doing things, diagnosing and correcting the problem. AI primary strength is in improving relationships between co-workers. Although AI potential for positive organizational change, its effectiveness within the dental industry remains largely untested.

Summary
AI has potential to unleash and sustain positive organizational change. Bring it on, day by day, hour by hour, minute by minute!

“There are only two ways to live your life. One is a though nothing is a miracle. The other is as though everything is a miracle” - Albert Einstein

“If only the world’s religious leaders could just know each other, the world will be a better place.” – Dalai Lama

Author’s note: This discussion paper for the dental audience was largely a re-edited version of an earlier paper. The original source material was:
Sullivan Havens D. Wood SO. Leeman J. Improving Nursing Practice and Patient Care Building Capacity with Appreciative Inquiry. JONA Volume 35, Number 10, pp 463 - 470 2006










1 Ludema JD, Cooperrider DL, Barrett FJ. Appreciative inquiry: the power of the unconditional positive question. In: Reason P, Bradbury H, eds. Handbook of Action Research. London: Sage Publications; 2000:189-199.
2 Stravos, J. Copperrider, DI., Kelley Di., Strategic inquiry appreciative intent: inspiration to SOAR, a new frame work for strategic planning. AI Practitioner. November 2003: 10 – 17.