Anatomy of an initiative
AI journey for hospital will focus on the positive
Balancing other projects that focus on errors
[Editor’s note: This article begins a series of periodic glimpses into the start and the progress of a quality initiative. We will follow the professionals at Children’s Medical Center Dallas as they implement a new appreciative inquiry (AI) initiative. This first article describes the planning process.]
A combination of management change, rapid growth, and a pending Joint Commission on Accreditation of Healthcare Organization survey together created the impetus for an AI initiative at Children’s Medical Center Dallas, recalls Greg Terrell, MS, CSP, ARM, CPHRM, FASHRM, director of risk management.
"We had had the same leadership here for about 15 to 25 years; then through retirement and attrition, we have had a significant changeover over the past two years," he notes. "That was coupled with a Joint Commission survey scheduled for Dec. 7, 2004, and major growth at the hospital."
The patient population also had become much more educated and were asking many more questions about their care, at the same time that the Joint Commission was putting greater emphasis on sentinel events, he says. All of this was felt in risk management, where of necessity the emphasis is on things that go wrong.
However, Terrell also was in a unique position to put things in perspective. "Since we might be referred 10 cases out of, say, 300,000, I’m also able to grasp all the good we do," he explains.
"Yet when you’re looking at a survey coming up in 12 months and you have to try to find all your warts, there’s a danger of focusing on all the negative things you find. If you do not try to inter-mingle all the things you do right, you can get lost," Terrell notes.
And that’s where AI comes in. It’s an approach to performance improvement based on asking questions to identify occasions of optimal performance and then seeking to repeat and sustain that high level of performance.
Managers create impetus
A discussion began in November 2003 between Terrell and the senior director of education and research, June Marshall.
"One day she was telling me about AI and it was fascinating to me," Terrell recalls. "We had been doing hazard surveillance surveys, tracers — and seen a lot of not’ documentation; you know: This staff did not do this, the staff did not do that.’"
Fascinated by this more positive approach, Terrell and others bought some books and conducted research on the Internet. "I talked to the core group of people I deal with regularly, and their eyes lit up," he says.
Chief nursing officer Sharon Tourville volunteered to open her house, and a group of six or seven individuals on the director level met in March 2004 — including representatives from social work, nursing, clinical education and research, management, staff development, and the vice president of ambulatory care — and formed the core kickoff team.
"It was a very relaxed atmosphere," Terrell says. "I had made three-ring binders to introduce the concept formally. We bounced off each other the benefits of positive interactions." The group agreed they should be careful not to just come up with a "flavor of the week."
"We want to change the culture," he notes. "It also fits well in our journey to achieve Magnet status" — a nursing recognition program that measures organizational outcomes and attributes that exemplify excellence in 14 areas including patient care, organizational leadership, quality of nursing leadership, management style, personnel policies and programs, and community relationships.
AI fits perfectly with this goal, Terrell, explains, "because it’s not so much a top-down approach — and we don’t want a top-down approach. We know that’s not the way to really improve patient care, and our goal is to be the pre-eminent children’s hospital in the U.S."
Follow-up meeting held
As of this writing, the group had just completed a follow-up meeting.
Everyone on the team was given a copy of the Appreciative Inquiry Handbook: The First in a Series of AI Workbooks for Leaders of Change,1 which came with a CD-ROM and a PowerPoint presentation on rollouts.
It also included several worksheets on how to deal with problems. "One of the questions was, What are the three wishes we have for changing the health and vitality of our organization?’" Terrell continues.
"Everyone in the group is to answer this for themselves. Then, when we get back together, we will get everyone’s three wishes, put them together, and then start thinking about getting started on rolling this out organizationwide," he notes.
The group agreed to meet again in two weeks. "This will be set up in concentric circles; we don’t want to all of sudden say to all 4,000 employees, Now we are doing AI,’" Terrell adds.
"We have to live it first. We need to think differently about how to ask questions about situations, how to interact with people in a positive manner, as well as techniques for handling things when you encounter — for example, a person who is potentially spreading rumors or gossip — how to engage them and try to get that negativity out," he adds.
During the next meeting, it was hoped that individuals within the organization would be selected to be team leaders. "You want to have the executive leadership team walk the talk and exhibit this type of attitude and demeanor, then communicate it to the lower level and bring it up through the organization," Terrell explains.
"Maybe not all of the things written about AI fit health care or us," he concedes.
"We may mix in our own elements, but we want to really change the culture of our organization and focus on what we do right — for example, the best practices we do," Terrell explains. "At our directors’ council, instead of rumor control, we’d like to be able to ask if anyone has gone above and beyond expected performance and publicly thank them."
A good organization is like a good marriage, he adds. "Good things do not just happen; you have to work at it."
Reference
1. Cooperrider DL, Stavris JM, Whitney D. Appreciative Inquiry Handbook: The First in a Series of AI Workbooks for Leaders of Change. San Francisco: Berrett-Koehler Publishers Inc.; 2003.
Need More Information?
For more information, contact:
- Greg Terrell, MS, CSP, ARM, CPHRM, FASHRM, Director, Risk Management, Children’s Medical Center Dallas. Phone: (214) 456-2020. Fax: (214) 456-1622. E-mail: [email protected].
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