Appreciative inquiry

Appreciative Inquiry
Dr. Shweta Goswami
Junior Resident
Deptt. Of Community Medicine
PGIMS, Rohtak

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Appreciate:
valuing;
the art of recognizing the best in
people or the world around us;
affirming past and present
strengths, successes, and
potentials;
to perceive those things that
give life (health, vitality,
excellence) to living systems.
Inquiry:
the act of exploration
and discovery.
to ask questions;
to be open to seeing new
potentials and
possibilities.
Appreciate + Inquiry
“is the study and exploration of
what gives life to human
systems when they function at
their best.

It is an organizational development method that seeks to
engage all levels of an organization (and often its
customers and suppliers) in its renewal, change and
improved performance.
AI implies a particular way of asking questions in the way
for enhancing the capacity for collaboration and change
of people.
It focuses
on strengths,
on good practices
on possibilities instead of problems or risks.

Appreciative Inquiry- organizational
development method
This approach to personal change and
organization change is based on the assumption
that questions and dialogue about strengths,
successes, values, hopes, and dreams are
themselves transformational.

AI- “asset- based” or “strength-based”
approach
Salutogenesis:
salus (=health) and genesis (= origin),
means the origin of health.
The salutogenic approach focuses on resources for
health than on risks for diseases. It is the opposite of
the pathogenic concept where the focus is on the
obstacles and deficits.
Salutogenesis is a way of thinking, being, acting
and meeting people in a health promotion
manner

Comparing- ethos
Problem solving focus Asset or strength focus
Negative event directed Positive research directed
Deficit methods Positivist methods-story sharing
Problem finding Build on successes or experiences
of success
Focused on dysfunction (social or
intra-psychic)
Rebuild relationships, create a
collaborative vision and tap into
passion and generative core

PROBLEM SOLVING VS. ASSET FOCUS
Problem solving
(deficit based change)
“Felt Need”
Identify problem
Conduct root cause analysis
Analyze Possible Solutions
Develop action plan (Treatment)
Basic assumption:
An Organization is a
“problem-to-be solved”
Appreciative inquiry
(strength based
innovation)
“Valuing the best of what is”
Appreciate
Imagine (What might be)
Dialogue and design
(What should be)
Create (What will be)
Basic assumption:
“An organization is a
mystery to be embraced”
Basic
Assumptions
What we focus on
becomes our reality
Reality is created in the
moment, and there are
multiple realities
In every ongoing
team/group/
organisation . . . Some-thing(
s) work
People have
more confidence and comfort
to journey to the future (the
unknown) when they carry
forward parts of the past (the
known)
The mode and
language of inquiry
effects the org. being
observed
Comparing- ethos

Underlying theories & Research
Effects of both positive and negative
thinking on the outcomes of
surgery: patients with Appreciate more + positive
Inquiry
thoughts recovered at a much faster
rate

The Pygmalion Effect (Self-fulfilling
prophecy) - what we expect to
happen will happen when Appreciate we
+ Inquiry
project certain expectations on
another

The Placebo Effect - people
experience what they expect to
experience
Beliefs are powerful factors in
what we can achieve

 Neuroplasticity (brain can be
rewired); intentional work on
feeling optimistic Appreciate strengthens
+ Inquiry
neural connections creating
“muscles of optimism”
 Memory and future thought are
highly interrelated; Our
memories are essential in
helping see ourselves in the
future

Psychoneuroimmunology
How stressors, and the negative
emotions they generate, are
translated into physical changes

Six Aspects of Change and Development of
which to be Aware
Knowledge of the community is critical to determining its
destiny.
The seeds of change are implicit in the first questions we
ask.
A critical resource we have for creating positive change
in our communities is our imagination and the capacity to
free the imagination and the mind of groups.
Our imagination and mind are constrained by bad habits,
limited styles of thinking, underlying assumptions and
traditional rules of organizing.

Six Aspects of Change and Development of
which to be Aware
Our styles of thinking rarely match the increasingly
complex worlds in which we work… We need to discover
more creative and fruitful ways of knowing.
All systems (organizations and communities), as living
constructions, are largely affirmative and respond to
positive thought and positive knowledge.

Understanding
A major assumption of AI is that in every
community something works. Change can
be managed through the identification of
what works, and focus on how to build on
it.

AI- Five Principles
Constructionist Principle
Principle of Simultaneity
Poetic Principle
Anticipatory Principle
Positive Principle

1.Constructionist Principle

Constructionist Principle
Social Constructionism argues that
the language and metaphors we use
don't just describe reality (the
world), they actually create 'our'
reality (the world).
The way we know (think/feel),
influences our attitude and
response
We make meaning out of our lives
and our experiences in
conversation with others. The
language we use to describe things
actually shapes how we see them.
People can go through exactly the same challenging or
negative experience – but use very different language and
tell very different stories about that experience.
Some people focus on being a victim – and this becomes their reality.
Others focus on their stories of survival and
how they overcame the challenge,
creating a very different reality for themselves

In an organisation same thing can happen-organisations
are made up of social constructs
If the stories being told
around the lunch table or
over the coffee breaks are
all about how terrible the
boss is and how
overworked people are,
then those stories will
shape their reality. And
that’s going to be the kind
of place they will build –
an unhappy place that will
probably never reach its
full potential.
But if the stories people
tell are about how good it
is to work there, and the
language they use about
each other and their boss
is mostly positive – then
they are going to see a
different reality. And this
will in turn affect the
kind of workplace it
becomes - a happier and
more productive
environment

IMPLICATIONS
If social reality is shaped by how we talk about it, it
makes sense to talk about what is working, what we
are proud of, what gives life to the organisation, and
what we want.
What changes could you make to what you talk about,
or the way you talk about it, to get the best from your
team, your colleagues, or your boss?
What specific changes will you try out in: the
questions you ask; the stories you tell?

2. Poetic Principle

Poetic Principle
The organization can be seen as an open book—an
incomplete story that is continually being co-authored
by group members over time.
It is open to interpretation, we are free to study
virtually any topic related to the group, its members
and their experiences.
We can look for what is going wrong or what is going
right and the greater gains are made when the means
and ends of inquiry are aligned.
If we seek to increase employee retention
we should inquire into why people stay in our organization
rather than focus on employee turnover.
Appreciative inquiry chooses to focus on
the positive and lifegiving forces

3. Simultaneity principle

The principle of simultaneity
Inquiry and change are not separate. Change
begins with the first questions we ask and the
questions we ask determine what we find. So, the
act of inquiring is a intervention
AI questions do not seek ‘‘right’’ answers, but
rather they generate conversations that seek out
the ‘‘essential goodness’’ of the system as a
platform for creating an even ‘‘better’’ system.

4. Anticipatory Principle

The anticipatory Principle
An anticipatory view of organizational life posits that the image
of the future is a guiding force in organizational life.
Our greatest resource for generating constructive organizational
change is our collective imagination and discourse about the
future.
AI opens up our creative minds to think about new ideas and
ways of thinking about “old topics”. We can look into the future
and see the possibilities because our mind is not focused on
fixing the current problem or the problems of the past. We can
anticipate a different future than we had in the past.

5. The positive principle

The positive principle
Building momentum for change requires hope, inspiration and
sheer joy in creating with one another.
Just as plants turn towards sunlight, human systems tend to turn
towards positive images and those things that give them energy
and nourish their sense of joy and happiness.
The human spirit is lifted when we talk about possibilities,
hopefulness, joy, and positive images of our future. This energy
will allow our minds to create images that we haven’t imaged
before.
The more positive the questions that are asked, the more people
are captivated by the inquiry process and the longer the benefits
are sustained.

Appreciate + Inquiry The 4-D Appreciative Inquiry Cycle

The 4-D Appreciative Inquiry Cycle

DISCOVERY STAGE
The task in this phase is to inquire into and discover the positive
capacity of the organization or community through carefully
crafted appreciative questions.
the questions are designed to engage participants in the telling
of stories to one another about what gives energy and vitality to
the system.
people seek to explore their strengths, assets, peak experiences,
‘‘What’s and successes going and right
to understand the unique conditions that
and made how their do moments we get of more excellence of it?’’
possible.
In contrast to methods which search for the root causes of
problems, it is a method that searches for the root causes of
success.

Creativity starts with
an'appreciative' eye.
DISCOVERY STAGE
The point of the appreciative protocol is not to
dismiss problems
but
to offer a broader lens through which people can cast
an Appreciative eye on their system.

Formulating the Discovery Questions
Frame questions in an affirmative way that implies
respect for group members;
Ask open-ended questions that invite stories and
embellishments rather than yes/no responses;
Build affinity among participants by framing questions
such as “tell us a story about a time when members of
this group played an important role helping you to
realize a dream or overcome a challenge”;
Add additional questions to determine the necessary
details (the who, what, when, where and how of the
event); and
Seek stories of personal experiences from participants
rather than accounts of others.

Project of a two-and-a-half-year partnership between Canada’s International
Institute for Sustainable Development (IISD) and MYRADA, a south Indian
development organization. Funding was provided by the United Kingdom’s
Department for International Development.

The goal of the IISD/ MYRADA appreciative inquiry
project was to advance sustainable development and
facilitate sustainable livelihoods by providing
governmental and non-governmental organizations in
India with a better method of designing and delivering
programs—one that identified and reinforced a
community’s strengths, achievements and vision, rather
than focusing on its problems, deficiencies and needs.

Addressed two interrelated and complementary
factors
GROUP CAPACITY BUILDING
COMMUNITY DEVELOPMENT

GROUP CAPACITY BUILDING
Consider periods when the group was working at its
best
Stories will relate to internal processes such as
decisionmaking, leadership, financial management
and reporting; and core values such as
transparency, participation and equity.
The visions and action plans that emerge will
address how those internal processes could be
strengthened.

COMMUNITY DEVELOPMENT
Stories might relate to building a road, reducing
illiteracy in the family or eliminating gambling in
the village.
The visions that follow will address the group’s
role within the large community. They might
relate to immunizing local children, undertaking
a watershed development project, empowering
women through literacy training or starting new
self-help groups.

Story Analysis
The facilitator helps the group draw common
themes from the stories and to understand more
completely the conditions that made the peak
experiences possible.
What are the strengths that made the
achievement possible?
What individual and group values are reflected in
the story?
What external conditions existed that contributed
to the peak experience?

EVALUATION OF THE DISCOVERY STAGE
Stories were factual
Stories were inspiring and energizing
Affinity among participants was enhanced
Stories and enabling factors were
adequately documented
New strengths were revealed
There was an adequate understanding of
Discovery process

themes and patterns
emerge that inspire
hope and possibility.
‘‘What is the world
calling us to
become?’’
Dream Stage
a time for
passionate
thinking
‘‘What might we become
if our exceptional moments
were the norm?’
It is a time to
imagine
an ideal future
-Because it is a dream that is grounded in people’s
The objective of the Dream Stage is to enable participants
to evolve real quality experiences visions based it is on more their believable strengths and and
values.
more achievable.

In the Dream Stage, local people discuss how they can
build on their strengths to better their group and their
community.
What would the group
be in five years?
What would be its
greatest achievement?
What role would the group
members play in the
development of their village?
Three women discussing their vision of the future

Recording the output – Provocative Propositions
“A provocative proposition is a statement that
stretch the system from where it is to where it wants
to be”
It is provocative- stretches and challenges the
group
It is grounded.
It is desired.
It is highly participative.
It stimulates organizational learning.
It addresses multiple aspects of the group’s structure and
activities-leadership,
societal purpose, communication, staff,
structures, practices, community relations, etc.
It balances existing activities with future goals

Characteristics Of Good Visions
Holistic
Challenging
Achievable/ Realistic
Shared
Documented and institutionalized
Evolving
Internalized
Reinforces existing strengths
Not heavily dependent on outside agencies:

Design Stage
The Design Stage is intended to bring together
participants in a dialogue about creating their
desired future
The objective of this phase is to create /design
principles that will inform the system’s structures
and policies that can move them toward the
realization of their dream.

Design Stage Exercises
Setting short term & long term goals
Prioritizing the dreams- Group Discussion
Which of the goals is most important to the group?
What would you like to start working on right
away?
Which aspects of the group would you like to
strengthen first?
Developing action plans
Planning can be seen as analogous to architecture
in which the various systems within a building
complement each other to produce a structure with
certain characteristics.

Delivery/ Destiny Stage
The system moves to fulfill its destiny.
People begin to read the organization or community
in a new way—a way that invites possibility, forges
new networks of relationships, acquire new skills
and ultimately effects the direction and meaning of
one’s actions.
time for unleashing the creative energy of the system
to undertake individual and collective action.

Effective Delivery emphasizes:
Innovation
Continuous learning
Nurturing an appreciative eye
Institutionalizing the appreciative inquiry
process
Self-reliance
Monitoring
Participation
Transparency

Appreciative inquiry should be seen as part of a
larger development strategy
establishing an inspiring group vision
articulating shared values
developing strategies
Can be a useful feedback tool
Appreciative inquiry creates a sense of ownership in
new initiatives

Appreciate + Inquiry Examples of AI Application

Creating Sustainable Change in the
Interprofessional Academic Primary Care
Setting: An Appreciative Inquiry Approach
Intervention- Appreciative Inquiry (AI)
approach to advance teamwork in
one family health team in Ontario
Aim- the aim was to understand when,
how, and why interprofessional
communication and collaboration
were facilitated or impeded in
practice.

Findings-
Improved patient-centredness
Formalized interprofessional meetings
Bi- monthly interfrofessional case
conference
Clinic huddle- first five minutes of both
morning and afternoon clinics

The patient voice: Appreciative inquiry into
participants’ stories about living well with
diabetes
Research question: to learn from the patient’s
experience of diabetes self management
Sample: A convenience sample of 13
participants Diabetic or being at risk.
Method: Thematic analysis was used to examine
the positive stories elicited. Interviews were
coded, themes were identified and reflective
documents were produced for each interview.

Interpersonal
Results: Participants who self report living well with diabetes
Support
simultaneously embrace their condition and embrace life. They
do so through the complex interaction of experiential
knowledge, interpersonal support, and personal qualities
e.g. family, friends,
diabetes peers,
colleagues and
healthcare team
Experiential
Knowledge
e.g. understanding and
managing individualized
responses to food, exercise
and stress
Simultaneously
Embracing
Diabetes and
Embracing Life
Personal
Qualities
e.g. balance, compassion,
confidence, honesty, hope,
humour, optimism,
persistence, respect

Recommendations
Consider use of an appreciative inquiry
design in asset focused investigations of
patient experiential knowledge of self
management.
Assess how consideration of patient
experiential knowledge, interpersonal
support and personal qualities is
integrated into patient centered care

Appreciative inquiry

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