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Creating Positive Change in Healthcare Through Appreciative Questions

By Susan Wessel, RN, MS, MBA, NEA-BC, Consultant, Creative Health Care Management

Appreciative questions are a simple and effective way to inspire people and reinforce desired behavior. They can put a positive spin on huddles, staff meetings or during casual rounds with staff. They can be used during interviews or performance dialogues to draw out stories that will give you insight about the person. An example of an appreciative question is asking someone to tell you about his/her most fulfilling patient interaction in the last few days instead of asking about what challenges or obstacles they’ve faced. 

Amplify Positive Behaviors

The underlying principle behind the practice of asking appreciative questions is that you get more of what you choose to focus on. If you focus on problems and what is wrong, those things seem to fill everyone’s attention (and drag everyone down). If you discover and lift up what is going right, this creates positive energy and it also encourages those good practices to be done more intentionally. Appreciative questions are created to discover examples of things going well. The mere asking of them amplifies the positive behaviors you seek. 

The simple practice of appreciative questions is based on the philosophy of appreciative inquiry, developed by David Cooperrider and his colleagues (Cooperrider, D; Whitney, D; and Stavros, J. (2003). Appreciative Inquiry Handbook. San Francisco, CA: Berrett-Keohler). Appreciative inquiry is a multi-step method for leading change, with appreciative questions being only one part, a part that can be used easily in our daily lives. As leaders, part of our role is to find what’s right, acknowledge it with gratitude, and build on it. 

Appreciative Inquiries Focus on the Positive

An appreciative question is worded in such a way that it asks for examples of something positive. It conveys to others what is important to us, and the answers we receive provide a great opportunity to recognize and affirm the successes of others. We can create these questions specifically around things that we want to see happen more often. For example, if you want staff members to collaborate more effectively with physicians, you can create an appreciative question around that. Or you may want staff members to welcome and mentor new employees or to find out from patients and families what is most important to them. For any behavior that you want to affirm and encourage, you simply need to ask regularly for examples of staff having success with that desired behavior.  

Examples of Appreciative Questions

Over the last six years I have collected examples of appreciative questions written by participants in our course on leading Relationship-Based Care. These are some of my favorites: 

  • Share a story of when your caring relationship with a patient made a difference for them.
  • Describe a time when your collaboration with a physician resulted in a positive outcome.
  • (Interview) Tell me about a time you made a difference for a patient or family that they especially appreciated.
  • Describe a situation when your clinical knowledge and critical thinking had a positive impact on a patient outcome.
  • In what ways have you been able to make a float person feel really welcome to your unit?
  • Who would you like to appreciate on your team today, and why?
  • Share an example of how bedside shift report improved your communication with patients.
  • What have you done this week that really helped a co-worker?
  • Share about a time when you incorporated a patient into the planning of his or her care.
  • Describe an example of how you exhibited patient advocacy.
  • What have you discovered about your patient’s main priority for this shift?
  • Describe a time when caring for a patient taught you something or positively changed how you provide care to other patients.
  • What went well with your patient care today?  

As you regularly use one or two of these, staff get used to them and have more answers readily available.  You may want to begin every huddle or every staff meeting with an appreciative question, so that everyone can hear several positive examples (teamwork, patient care that goes above and beyond, or whatever your question is about). 

Spreading Positive Energy

I often find myself making rounds on units in hospitals that are new to me. I always begin with an appreciative question to the manager, and it sets the stage for a relaxed and positive experience. For those situations, I like to ask, “What are you most proud of having accomplished on this unit?” It’s a great way to spread positive energy. 

As a consultant at Creative Health Care Management, Susan partners with hospitals to improve patient care through the design and implementation of Relationship-Based Care. She develops leadership teams to build trust, collaboration, and personal accountability. She also specializes in creating an engaged workforce and building professional practice environments consistent with Magnet® Recognition criteria. Contact Susan at swessel@chcm.com

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