Appreciative Inquiry is a generative approach to situations where possibilities for improvement are sought. The word “Appreciative” speaks to the idea of “acknowledging with gratitude” that which works, while “Inquiry” focuses “exploration and discovery” in the search for “new potential” (p. 20, Van Wyk, 2015). I am applying the Appreciative Inquiry (AI) model to a recent change in AHS Calgary Zone Home Care. Home care has implemented an Electronic Care Planning process associated with the RAI assessment, the annual assessment required for all but short term, palliative or pediatric clients within home care.
- Discover – Home care is a distributed care environment with a broad, varied and complex patient population. Home care is part of the continuing care portfolio, and is audited to the Continuing Care Health Service Standards. Review of the CCHSS revealed opportunities for improvement in the care planning process.
- Dream – AI assumes that there is a “positive core” at the center of every organization (Kelm, 2011). Home Care professionals care about their clients and want for them to be well-supported and enjoy maximum health and quality of life – evidence of this positive core. Dreaming about the best possible care planning process resulted in envisioning a process to address clients' health care needs across all domains. Care planning would capture interventions and their efficacy, and connect back to the original patient goals (CCHSS, 2018). All this would be enabled by creating a path of 100% success on compliance with the care planning process through a technology-enabled solution. Assistance for clinicians in caseloads that are beyond a reasonable level would be forwarded to management to request relief support as part of this process.
- Design – The solution envisioned above would need to be designed to include the current electronic health record and a plan for integrating into the pending solution of Connect Care. The design would require inclusion of standard structures, pick lists of goals and interventions, as well as the availability for customization in certain areas. The process would need to follow a prescribed path, however must account for the variation inherent in a complex, heterogeneous patient population. Process and choices within the system must be based on best-practice.
- Deliver – The build of this process is complete and was delivered through partnerships with information technology professionals, RAI specialists, home care educators and front line professionals. The result is promising, though the “dream” piece I included above for workload management is not a reality within this system. Managing this “change” has resulted in some struggles with “transitions”, an issue highlighted by Bridges (n.d.), however the general consensus is that this process has been positive for staff and will improve patient care, continuity and safety.
A “D” I might add to the 4-D’s above is “data” – the change process in healthcare needs to both be informed and evaluated using data at each stage of the process.
There is much excitement over the promise of better informatics management and transparency. To invite the reader into the “dream” process of AI, I have this for you to consider: what is your dream for a comprehensive electronic health record (EHR)? What improvements or achievements will be possible through EHR realization?
References
Continuing Care Health Service Standards (2018). Alberta Health. Government of Alberta. Retrieved from https://open.alberta.ca/publications/9781460138441
Kelm, J. [JBKelm]. (2011, October 4). What is appreciative inquiry [Video file]. Retrieved from https://www.youtube.com/watch?v=ZwGNZ63hj5k&feature=youtu.be
Van Wyk, S. (2015). Change Management: Making use of Appreciative Inquiry. Professional Nursing Today, 19(4), pp 20-23
William Bridges Associates (n.d.). Retrieved from: https://wmbridges.com/videos/