In Early 1996, Washingtonõs Group Health Cooperative Found Itself in What May Seem Like

Key-Managing Change in Healthcare Page 1

The following chapter appears in: Managing Change in Healthcare: Innovative Solutions for People-Based Organizations, Key, M.K., McGraw-Hill: 1999, pp. 113-128.

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APPRECIATIVE INQUIRY: THE PATH TO POSITIVE CHANGE

Amanda Trosten-Bloom Diana Whitney, Ph.D.

Health Care Trends and Challenges

In early 1996, Group Health Cooperative in the state of Washington found itself in what may seem like a familiar situation. Intense competition and a period of poor financial performance had led to downsizing and restructuring. Even as they were closing one of their hospitals, they were affiliating with another. Professional and geographic groups within the system were becoming increasingly disconnected from one another, as were leaders, employees and patients. Employee morale was low, and service (as measured by a series of internal performance indica- tors) was beginning to slip.

This picture is all too familiar to today’s health care leaders and professionals. Managed care and other pressures lead more and more health care organizations down paths of cost-cutting and efficiency. The delicate balance between patient care and profits has enhanced the popularity of continuous quality improvement and other recipes for improving productivity and eliminating waste.

But these tools rely heavily on the good intentions and interpersonal relationships among caregivers and administrators who are experiencing unprecedented workloads and pressures. All too often, well intended improvement efforts create stress and tension which in turn builds resentment and shortens “fuses.” It’s hard to work harder, smarter, and more collaboratively when you’re hanging on by a thread.

As Cheryl Scott (now President of Group Health) said of their situation, “We needed to create a reason to stay here - not just for ourselves, but for our entire staff and our patients. There were pockets of greatness around the Co-op, where productivity and morale were high. We fervently believed that Group Health had the capacity to be a rewarding place to work and a more successful organization. We wanted to identify the ways to achieve that vision, and to nurture its development.”

Group Health’s search for possible solutions led them to a new approach to organization change called Appreciative Inquiry. By applying core Appreciative Inquiry methodologies, they

Trosten-Bloom & Whitney 4/30/18 Key-Managing Change in Healthcare Page 2 enhanced relationships and communication while building enthusiasm, ownership, commitment, and a sense of purpose which was shared both within and outside their organization..

Appreciative Inquiry is a new way of working . . . a new approach for building loyalty, commitment, contentment, and positive change within a health care setting. Health Care providers, like those at Group Health, are faced with unprecedented challenges which call them to consider new approaches to leadership and organization . . . approaches that significantly increase organizational effectiveness, enhance people’s capacities to change, and instill a sense of joy and wonder in the workplace. Appreciative Inquiry is one such approach.

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(A) What is “Appreciative Inquiry?”

“AI,” as it has come to be called, is an organization development philosophy and methodology that enhances organizations’ capacities for positive change and ongoing adaptabili- ty (Whitney & Schau, 1998). AI was developed in the mid 1980’s by David Cooperrider, PhD and Suresh Srivastva, PhD of the Weatherhead School of Management at Case Western Reserve University (Cooperrider & Srivastva, 1984). It provides a philosophy and tools for leaders to understand and build upon the best of what has been and might yet be within their organizations through inquiry into their “positive core” (Whitney & Cooperrider, 1998). An organization’s positive core is described as the collective wisdom, knowledge, and capabilities - often undis- cussed - of the organization at its best.

Consider the individual words “appreciate” and “inquire.” Webster’s Dictionary defines the word “appreciate” as follows: 1a: to value or admire highly b: to judge with heightened understanding c: to recognize with gratitude 2 : to increase in value

“To inquire” means: 1 : to search into 2 : to seek for information by questioning

Hence, Appreciative Inquiry guides us to ask questions with gratitude and a sense of “valuing” . . . in order to increase understanding and enhance value. AI is the study of what gives life to a human system, when it is at its best.

(A) What’s Different About Appreciative Inquiry?

Appreciative Inquiry is a highly participative process which builds relationships across functions, business units, and levels within and outside an organization - without overt communi- cations training or facilitation. At Group Health, for example, 500 people (including providers, clinical staff, administrative staff, consumers, labor leaders, insurance brokers, and local employ- ers) worked side-by side and collaboratively to enhance the delivery system through such areas as: population-based care, customer service, teams, leadership structure, communication, and development of “great ideas.” Their internal consultants, Scott Caldwell and Diane Robbins, described a time in the intervention where participants worked in small groups to hash out work plans for six priority initiatives: “At the end of the day, each small group presented to the whole group. Each small group was a microcosm of the whole system, including consumers (some of whom had belonged to the Coop since early in its history), insurance brokers, nurses, doctors, union leaders, janitors, and organizational leaders. Some of these folks had been at war with each other for 50 years or so. And there they all were, presenting their work together. It was awesome. We’re always struck with how important it is to heal the healthcare system, and this was a clearly healing experience.”

As a participant in the process said, “There were no barriers. We were all really listen- ing, hearing, and being heard.” In an Appreciative Inquiry process, the choicefully affirmative orientation enables relationships to be established, renewed, and healed as diverse groups of people work on organizationally essential tasks.

Appreciative Inquiry changes the internal dialogue of an organization from problem-oriented, deficit discourse to possibility-oriented, appreciative discourse. In so doing, it accelerates learning and stimulates creativity. In the words of Tom White, President of GTE Telephone Op- erations (White, 1996): “Appreciative Inquiry can get you much better results than seeking out and solv- ing problems. . . . If we dissect what we do right and apply the lessons to what we do wrong, we can solve our problems and reenergize the organization at the same time. In the long run, what is likely to be more useful? Demoralizing a successful workforce by concentrating on their failures, or helping them over their last few hurdles by building a bridge with their successes?

Don’t get me wrong. I’m not advocating mindless happy talk. Appreciative In- quiry is a complex science designed to make things better. We can’t ignore problems - we just need to approach them from the other side.”

Appreciative Inquiry creates a wide platform for discovery, dream and design on the part of people at all levels of the organization, and in so doing it enlists and engages the organization’s informal leadership. Through mass mobilization of interviews and high participation in large group meetings known as AI Summits (to be discussed later in this chapter), informal leaders are given opportunities to contribute and act on behalf of their colleagues and the organization. For example, a manufacturing company in Broomfield, CO reported that: “AI has literally inverted the traditionally hierarchical structure of this organization. Line employees are making decisions previously made one or two levels above them. They are coaching their supervisors when the supervisors slip and fall back into the older, more familiar patterns of communication.”

Last but certainly not least, Appreciative Inquiry enhances people’s capacity for change. To change, we must be curious and open to new possibilities - personally and organizationally. Indeed, change requires a dislodgement of certainty. Older models of change focus on “unfreez- ing” a system in order to open it to the possibilities of change. Most of these approaches activate high levels of resistance, which is one way that participants have of saying ‘this process is not resonant with my truth, with what I believe will help things around here.’ Exclusive attention to problems - even as the target for change - creates a sense of fear and a tendency to blame.

During AI processes participants are inspired by possibilities, rather than resistant to problems. Their curiosity and desire to understand and honor differences increases. They become more appreciative of the ever-changing nature of organizational life. In short, their sense of possibility expands - and with it, their capacity for change.

Appreciative Inquiry offers an alternative way - and affirmative way - to dislodge certainty and promote change. It has been quantitatively demonstrated to increase employee engage- ment and commitment, and has been recommended by employees as a powerful way of facilitat- ing large-scale organizational change (Chandler, 1998).

Meg Leach, an organization development consultant with Fairview Health System in Minneapolis, describes how she uses AI to enhance her organization’s capacity for change: “I use AI to introduce an impending change by asking the group to inquire into its history of positive change. I also use AI to celebrate the successes of change efforts on significant anniversaries or markers, and to support integrating groups in the process of blending. Appreciative Inquiry processes give people a sense of pride in all they have done and how well they have done it. It gives them a sense of their ability to make change, be ahead of change, and be flexible.”

Sandra Janoff, co-developer of the “Future Search” process for large-system social and organizational change, shared her observations about AI as and its influence on the Group Health organization: “This group entered their ‘Futures’ conference with a different energy than some of the other groups I’ve observed in similar settings. The appreciative interviews which had taken place during the months before the conference had nurtured a sense of community, optimism, and hope that I believe served the group over the course of their three-day conference.

“Large-scale organizational change is a very complex, very sensitive process. In organizations - as in life - there are things that work, and there are things that don’t work . . . things that give life, and things that diminish life. Unless organizations can collectively dream and hold hope for positive, constructive change, it simply won’t happen. To me, the capacity to nurture (and in some cases restore) organizational hope is the beauty of Appreciative Inquiry.” Foundational Princi- ples

Based on research in health care, athletics, and education (Cooperrider, 1990), Apprecia- tive Inquiry theory states that organizations change in the direction of people’s collective images of their future. Positive images of the future yield positive changes; negative images of the future yield the opposite. Over the past decade, David Cooperrider and colleagues at Case Western Reserve University, along with members of The Taos Institute, have worked with over 75 organizations around the world using Appreciative Inquiry. Their experience suggests that the more affirmative and life giving an organization’s images, the more positive and enduring the effects of change efforts.

Many of us have experienced or observed a basic human quality: that as people, we all act in ways that are consistent with our images of the future. All of us are profoundly affected by our prophecies, hopes, and aspirations. When we believe the future holds good things for us, we are courageous and more willing to take risks. When we believe the future is dark, we are more conservative, more guarded, more protective of what we have.

AI theory also states that people and organizations collectively create their images of the future, their realities, and their social order through language, communication, and relationships. The stories that they tell about themselves, their organizations, and the relationships among people in their organizations constitute the organizational images, and inform day-to-day actions - both today and in the future.

For this reason, organizational discourse (conversations, dialogues and stories) which is imbalanced in a positive direction contributes to the development of positive action and high performance. Discourse that is skewed in the direction of the negative has the opposite effect. In fact, the more positive the stories told in and about an organization, the more likely its success. Appreciative Inquiry positively influences an organization’s anticipatory images - the images of the future believed and repeatedly told by organization members and stakeholders.

(A) From “Discovery” to “Delivery”: The 4-D Model of Organization Development

Unlike with some organizational change models, every AI intervention is unique. Inter- ventions will vary significantly based upon the organization’s goals and size, the length of time it devotes to the effort, and participation in the process. Some organizations will choose to use AI systematically, over a period of months or years, while others will move immediately to a two- to four-day “Summit” (involving groups as small as 50 and as many as several thousand people).

However the intervention has been structure, the “4-D model” (see Figure 1) is the prima- ry process by which AI realizes positive change. Based on the assumption that change occurs through thoughtful inquiry into and dialogue about affirmative life-giving forces, the four phases of the process are: Discovery, Dream, Design, and Delivery.

The “4-D” Cycle

Discovery Appreciate “What is”

Delivery Dream Create AFFIRMATIVE Imagine “What will be” TOPIC CHOICE “What might be”

Design Determine “What should be”

(B) Discovery: Appreciating What Gives Life

The Discovery phase is a quest to identify positive stories and spread them throughout the organization. It brings into focus those things which give life and energy to people, their work, and their organization. It assumes that the life-giving forces are indeed present in every situation, but that our habits of organizing and talking often over- look the positive in favor of analyzing obstacles, resistance, and deficits. The Discovery phase shifts the balance of organizational attention from what isn’t working to what is, and to what may possibly work in the future.

Discovery begins with the introduction of AI theory and practice to the organization (see Figure 2). The purpose of the effort is clarified, and a “core team” is selected to both guide the effort and select topics for the inquiry. Topics are affirmative, and are stated in affirmative language.

Figure 2: Establish Context Discovery

Select Core Team

Select Affirmative Topics

Conduct Appreciative Interviews

Reflect on Stories

Report on Results For example, an organization wishing to reduce turnover might study “employee retention.” Another wishing to reduce conflict might study “collaboration.” In the selection of affirmative topics, organization members are asked to focus on the things they want more of in their organization - the things they want to grow. (“What would make this organization more the place you want to work?”)

“Appreciative interviews,” the core technology of Appreciative Inquiry, are at the heart of the Discovery phase, and are often woven into later phases of the process as well. Generally conducted as a mutual interview among diverse stakeholder groups, they may also be conducted as a focus group process. Interview questions are crafted around the affirmative topics, and an interview guide is created, exploring: a) people’s beginnings

with the organization; b) what they value most about themselves, their work and the organization; c) their appreciative stories related to the topics being studied; and d) their hopes and dreams for the organization and its future. Discovery involves interviewing many - if not all - members of an organization, and often includes interviews with exter- nal stakeholders (i.e., patients, suppliers, and community members).

(B) Dream: Imagining What Might Be

The Dream phase is a time for groups of people to engage in thinking big, thinking out of the box, and thinking out of the boundaries of what has been in the past. It is a time for people to describe their wishes and dreams for their work, their working relationships, and their organization.

The activities of this phase, which can take place in a large group meeting of 50 to over 1000 people, encourage participants to consider what their organization (department, business unit, or entire company) is being “called” to do. This connects the work of all members of the organization to a greater purpose and vision.

Working together in small groups of eight, participants share and discuss the data and stories collected in the Discovery phase. Even as these discussions ground them in the most positive aspects of their organization’s past, they inspire them to imagine possibilities - what “might be” for themselves and their organization in relation to the world.

Small group conversations have been preceded by one-on-one appreciative interviews, and small groups have been given guidelines for self-management. Participants have been encouraged to “check their titles at the door,” and listen for the “lone small voice” - the one with a different idea or a different way of looking at things. This focus on relationship and dialogue builds safety and trust, which in turn inspires lively, en- livening, participative, and highly creative conversations. In fairly short order, divergent groups of people begin to converge towards and focus on the things that bind them together, as opposed the things that pull them apart.

Often, small group conversations are followed by high-energy, creative presenta- tions to the larger group - which in turn inspire even greater ease and creativity. Skits, murals, songs, poems, and commercials are all possible modes of expression for drama- tizing the positive possibilities envisioned for the organization and its future.

(B) Design: Determining What Will Be

In the Design phase, organization members and stakeholders (including customers and suppliers) recreate the “social and technical architecture” of the organization, so that everything about organizing reflects and is responsive to the organization’s most positive past and highest potential.

Whereas the Discovery and Dream phases generate and expand the organization’s images of itself, the Design and Delivery phases ask members to make choices for the organization. Stakeholders draw on interviews and dreams to select high-impact design el- ements, and then craft “Provocative Propositions” (or Design Statements) which incorpo- rate the positive core into high-impact processes, systems, and programs.

True to the principles of Appreciative Inquiry, Design Statements are written in the present tense. They recreate the organization’s image of itself by presenting clear, compelling pictures of how things will be when the organization’s positive core is boldly alive in all of its strategies, processes, systems, decisions, and collaborations. In this way, Design Statements redirect daily actions and create future possibilities for the organization and its members.

For example, Hunter Douglas Window Fashions Division was committed to at- tracting and retaining quality employees through a professionally and personally satisfy- ing work environment. Feeling the consequences of chronic overwork and extended periods of mandatory overtime, they resolved to balance workloads and schedules through the following Design Statement (on a topic called “Guilt-Free Workforce”):

Figure 3 Sample Design Statement

Hunter Douglas has a work environment in which personnel produce high quality products, thrive on creative and innovative products, and exceed market demands for a quick turnaround - while averaging a 40-hour work week. We maintain a trained, on-call supplemental workforce to help during peak periods, consisting of outsiders and HD personnel who voluntarily switch between these two groups as they choose.

We maintain our market leadership position by rejuvenating the workforce through an in-house training program.

We go the extra distance by providing a dedicated team of community volunteers, consisting of employees who alternate responsibilities as part of their normal work day.

(B) Delivery: Creating What Will Be

Change occurs in all phases of an appreciative inquiry, as AI provides an open forum for employees to contribute and step forward in the service of the organization. The Delivery process, however, focuses specifically on personal and organizational commitments and “paths forward.”

During Delivery sessions, commitments are made to ensure that the Design State- ments are realized. Individuals commit to applications and action plans, small groups work on areas that require collaboration, and teams may be established for new initiatives. Alignment on actions to be taken is high, as a result of the extensive involvement of large numbers of people in the Discovery, Dream and Design phases. By having mo- bilized massive numbers of interviews and interviewers, and by holding large group meetings that include many stakeholders in discovery, dreaming, and critical decision making, process participants get a sense of what the organization is really about - and of how they can contribute to the future, through their personal actions.

(A) The Organizational Summit: A Whole System Application of the 4-D Model

Among the most exciting applications of Appreciative Inquiry is the AI Summit (Whitney & Cooperrider, 1998.) An AI Summit differs from other large-scale meeting processes in that it is fully affirmative. It focuses on discovering and developing the organization’s positive core and converting it into strategic business processes such as patient care, marketing, and human resources. Its goal is to launch the whole organization in new directions.

Participation in a Summit is, by design, diverse and inclusive of all the organization’s stakeholders - employees, customers, suppliers, and community members. It is a generally a three- to four-day meeting, and can involve anywhere from 50 to 2000 or more participants. Ideally, all members of an organization and a selection of outside stakeholders attend the Summit.

Although each Summit has its own design, successful summits share common themes. Each gathering flows through the Appreciative Inquiry 4-D cycle of Discovery, Dream, Design and Delivery. Each involves a combination of one-on-one interviews, small group, and large processes. And each focuses on the affirmative, positive core of the organization - and the potential to build upon the positive core capacities, competen- cies, best practices, hopes and dreams - as the organization moves forward.

Incredible work has been accomplished by large groups of people participating in AI summits. The AI Summit builds and renews relationships across - and outside of - the organization. It creates confidence and commitment in the organization by liberating the ideas and opinions of all participants. It is a high-participation process that makes a positive difference in terms of both business results and the elevation of the human spirit.

(A) Appreciative Inquiry in Action . . . Successes in the World of Health Care

(B) Cleveland Clinic – Harnessing The Power of the Inquiry

Various levels of insight and understanding about this revolutionary practice and its potential for organizational change have emerged since its inception in the early 1980’s. One of the first and most provocative appreciative “interventions,” at the Cleveland Clinic in Ohio, showed us that strategically positive inquiry profoundly affects an organization’s values, culture, and daily actions.

Early in 1980, David Cooperrider, Frank Barrett, and Suresh Srivastva (of the Weather- head School of Management of Case Western Reserve University) were presented with an opportunity to do an organization-wide analysis of this private, non-profit, tertiary care center lo- cated in Northeastern Ohio. Following is a summary of their landmark project (Cooperrider, Barrett, & Srivastva, 1995).

Early on in the study, they found themselves focusing their energy and research on “participation potential” within the Clinic’s 400-member physician group practice, which already en- joyed a reputation as an extremely non-traditional, non-hierarchical, consensus-based organization. This condition, which they later called “the ideal membership situation,” became the pri- mary affirmative topic of their study.

In addition to conducting research into participation potential within this particular group, they were asked to conduct an overall “organizational diagnosis” of the Clinic. This they pro- posed to complete according to what was then a revolutionary model - one which was health- centered (i.e., “appreciative”) rather than disease-centered (i.e., “diagnostic”): “Obviously, in medical terminology, the word ‘diagnosis’ has a long tradition and is very much linked with a disease orientation. . . . So we made a counterpropos- al, which essentially argued that health was not merely the absence of disease - and that what we were interested in was [health]. Following this logic, we pro- posed a process of co-inquiry into the factors and catalytic forces of organizing that served to create, save, and transform the institution in the direction of its highest potential.”

As they proceeded with their work, they assumed that:  The topic they were studying already existed in the system.  “Grounded” theories, based upon examples, stories, and conversations, would have greater potential to positively influence the organization than any other method. Perhaps most important, they decided to focus selectively on “positive deviations in the data” - times when people, functions, and the organization as a whole had been at their very best. This, they believed, would “help ignite the theoretical imagination and mind” - which in turn would result in more frequent occurrence of such experiences in the future.

In short, they determined to help foster conversation about the life-giving, healthy things that are normally “taken for granted,” in order to generate compelling options and possibilities for continued organizational transformation. In their words:

“The inquiry was designed around the idea that organizations are made and imagined, and can be remade and reimagined. Our hope was to contribute to [the organization’s] . . . context-revising freedom on a collective, organization-wide basis – and to help increase the system’s capacity to translate shared ideals into both experienced practices and responsive structures.”

They developed purposefully positive interview questions, as they said, “in order to shape the contours of the conversation.” For example, one of the questions read: “Please describe a moment in your career at CCF when you felt most alive, most effective, or most engaged.”

The results of the inquiry were surprising, even to the researchers. First, they found that the interviews seemed to encourage people to reinforce - and in some cases create - an “interpre- tive repertoire” of stories about the organization at its participatory best.

Second, they discovered that news of the inquiry spread quickly to others, and began to influence and infiltrate the physicians’ everyday conversations. People began to discuss and de- bate organizational strengths and high points . . . to notice, attend to, and learn from everyday in- cidents of participation and overall egalitarian values.

Third, and perhaps most important, they discovered that the inquiry itself resulted in quantifiable increases in people’s attention to and valuing of the behaviors which they had origi- nally set out to explore. As they described, “In all, there were more than 50 structural, behavioral, and relational-attitudinal changes reported by the group, and each of these were supported by survey data that showed significant increases in such things as face-to-face interaction, consensus decision making, unity of purpose, opportunity for involvement, and others.”

They concluded, as a result of their findings, that: “. . . the enlightenment effect of all inquiry is a brute fact . . . . By establishing perceptual cues and frames, by providing presumptions of logic, by transmitting subtle values, by creating new language, and by extending compelling images and constraints, perhaps in all these ways, organizational theory becomes a constructive means whereby norms, beliefs, and cultural practices may be altered.”

(A) Fairview Health System – Appreciative Inquiry as a Foundation for Positive Change

The body of learning about Appreciative Inquiry and its merits continues to grow daily, as leaders and consultants continually expand its applications in their daily work. At Fairview Health System, for example, members of the Organization Resource Group use AI to drive a va- riety of organizational change activities, with ongoing positive results.

Fairview Health System is the second-largest health care provider in the state of Minne- sota, employing approximately 20,000 employees and serving 1.5 million patients throughout the state. Susan Clark and Meg Leach, consultants in the Organization Resource Group, provide organization development and training for the entire Fairview system. They have used AI to drive

Trosten-Bloom & Whitney 4/30/18 Key-Managing Change in Healthcare Page 13 strategic planning and mergers (of both departments and new companies), as well as more traditional organization development activities such as team building and mission/values clarification.

When asked to reflect on why AI is so powerful for planning in such a setting, Clark re- sponded that: “In our System, everyone wants to be part of every decision. Using AI and the interview process, we really can hear from all employees in a department and build their interests and priorities into the work plan. The outcome obviously reflects everyone’s input, which causes them to feel valued and represented in the plan and ensuing decisions.”

Clark illustrates the broad impact of AI when she describes a recent experience using AI to conduct 30 focus groups throughout the system, to determine if organizational values still rep- resent organizational “bests”: “We learned so much about each location, in addition to obtaining the information we needed about values. We learned what makes us a preferred employer, in the eyes of the employee. We didn’t even know we were going after that information, but it sure showed up. We were also able to pick up on those issues and questions that are vitally important to employees at the specific sites. That information was forwarded to specific leadership teams and they continue to act on the insights. I keep thinking we need to save all the answers to all the questions, since the information is so rich it can be used in more than one setting.”

Leach built on these comments, adding that: “. . . even the most cynical participants quickly get into the activities of Apprecia- tive Inquiry. The outcomes are concrete - not soft, as I expected at the outset. It is sustained over time … people talk about Appreciative Inquiry a long time after the activities are finished, and it becomes part of the culture. Appreciative In- quiry is not a strategy. It is a way of life, a mindset, a philosophy.”

(A) Summary: Why AI Works

As described above, Appreciative Inquiry is a powerful tool for organizational change. It is particularly powerful in a health care setting, for some of the following reasons:

 It is relationally and values-driven. “When we allow our employees to be true to the very reasons they came into this field,” reflects Clark of Fairview Health System, “they provide us with a clear picture of where we need to go as a System to best meet and exceed the needs of those we serve.” Dr. John Nimlos, Clinic Chief for Occupational Medicine at Eastside Hos- pital in Bellevue, WA shares a similar sentiment: “No matter what the technology or the information, if we don’t treat ourselves with respect and caring, we can’t sustain the respect and care for our customers. ‘Building Bridges’ [the AI program in his system] has begun to restore that respect and care and recognition.”

 It builds collaboration by practicing collaboration. Cheryl Scott of Group Health said, “This forum effectively brings different voices into the same room to create a vision of the

organization, to collectively discover how that vision will be achieved, and to begin taking the actual steps that will bring about change. It gives us the tools we need to achieve consistent alignment throughout the delivery system. . . .”

Diane Robbins of the same system reflected that “There was a striking level of convergence in this effort, and the energy and excitement that was generated as a result of this convergence was remarkable. In other words, the experience of many diverse people discovering and exploring their common ground was unprecedented in our history.”

 It restores creativity, energy, and hope. Susan Clark of Fairview reflects that “CQI helps us identify what needs to be improved in our systems and processes, but it doesn’t cause us to be very creative in plotting our future. AI, instead, takes full advantage of our highly talented and innovative work force.”

Meg Leach of the same system says that “My clients are hungry for another approach - one that acknowledges that not everything is a problem to be solved, that they have done much that is right and they can use that to build even better processes and groups. AI delights weary man- agers. It gives them energy.”

Diane Robbins of Group Health sums it up nicely: “The health care environment is so very diffi- cult these days. People need inspiration, hope, and energy more than ever. AI seems to awaken these things in people. It seems to be a fast way to go to the heart of the issues . . . to remind people of what really matters, and why they’re here.”

Health care organizations can no longer afford to operate as if the needs of the business and the needs of the people doing business are at odds. They must begin to operate with the realiza- tion that people - employees, customers, and suppliers - are not only the greatest resources for creating the organization’s future, they are the only resource. Health care professionals and organizational leaders must look beyond the organizing principles, processes, and change-management practices of yesterday. They must seek out innovative processes, such as Appreciative In- quiry, that collectively and positively engage people in the design of their own future at work.

Appreciative Inquiry is a new model of organizing, for a new century of opportunities. Its possibilities are limitless, within the war-torn, stressed out, overtaxed world of health care. To- day, this day, let’s choose to engage with one another in meaningful and positive ways - so that today’s interactions, conversations, and stories can become the seeds of a well-lived destiny.

REFERENCES Chandler, David. 1998.. “Appreciative Inquiry as a Means of Engaging Employees in the Mis- sion and Strategies of an Organization” (research submitted in partial fulfillment of the requirements for the degree of Master of Science in Organization Development, at the George L. Graziadio School of Business and Management, Pepperdine University).

Cooperrider, David and Srivastva, Suresh. 1987. Appreciative inquiry in organizational life. In Research in Organizational Change and Development. Ed. Richard W. Woodman and William A. Pasmore. Pp. 129-169. London: Jai Press, Inc.

Cooperrider, David. 1990. Positive image, positive action: The affirmative basis of organizing. In Appreciative management and leadership: The power of positive thought and action in organizations. ed. S. Srivastva, D.L. Cooperrider and Associates. pp. 91-125. San Francisco: Josey-Bass.

Cooperrider, David, Barrett, Frank, and Srivastva, Suresh. 1995. Social construction and appreciative inquiry: A journey in organizational theory. In Management and organization: Relational alternatives to individualism, ed. Dainne Hosking, H. Peter Dachler, and Ken- neth J. Gergen, pp. 157-189, Brookfield USA:Avebury.

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Whitney, Diana and David L. Cooperrider. 1998. The appreciative inquiry summit: Overview and applications. Employment Relations Today, 35(2): 17-28.

Whitney, Diana and Carol Chau. 1998. “Appreciative Inquiry: An Innovative Process for Orga- nization Change,” in Employment Relations Today, 25(1):11-21.

Amanda Trosten-Bloom is the founder and President of Clearview Consultants in Golden, CO, and an organization development consultant with 20 years of leadership and consulting experience. A licensed nursing home administrator as well as organizational consultant, her expertise and experience crosses industry lines and includes work in the health care, service, manufacturing, high tech, and scientific arenas. She supports organizations in building and changing their cultures through transformation processes which are founded on the principles of Appreciative Inquiry.

Diana Whitney, PhD is the managing partner for the Corporation for Positive Change - an international consulting firm which uses Appreciative Inquiry to facilitate organizational, community, and global social change. An internationally-recognized writer, speaker, and consultant, she consults in the areas of organization transformation, strategic culture change, communication, and leadership development for the private, government, and non-profit sectors. She is a co-founder of The Taos Institute in Taos, NM, through which Appreciative Inquiry is taught to consultants and leaders of change.

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