Time for some appreciative inquiry...

In the past couple of weeks I have begun learning - or re-learning - what Appreciative Inquiry is.  I say re-learning as I was exposed to the concept in the area of community development in the mid-1990s and probably before that in the area of child and adolescent psychology.  Since then I've been applying the concepts (unconsciously??) in the areas of performance management and employee development in my leadership roles.

Perhaps this subject matter is old knowledge for many of you.  In my current educational pursuits it came as something of a revelation to me and a reminder of my previous experiences.  I may not have labelled my past work within the context of appreciative inquiry but clearly that's the framework in which my previous experience fit. 

So what is Appreciative Inquiry?  AI is an approach that "...deliberately asks positive questions around affirmative topics to ignite constructive dialogue and inspired action within organizations and communities." (Bliss Browne, Imagine Chicago, 2008).  This approach stands in sharp contrast to how we typically approach organizational challenges.  For the most part we have all been raised and educated in a system - particularly in a business environment - that asks us to identify problems or gaps in performance, analyze or seek out root causes, evaluate possible solutions and implement action plans.  While we may achieve success, our approach can lead to feelings of inadequacy, threat, defensiveness and conflict on the journey towards a solution.  In contrast, AI works from an underlying premise that our organizations and our people are possessed of very many assets, capabilities, resources and strengths that can be discovered, affirmed, encouraged and utilized. 

As I have come to see it over the past couple of weeks, AI fits very well with a number of topics I have already addressed in this blog over the past number of months - employee engagement, servant leadership, performance management, reward and recognition, and inspiring and shared vision.  AI requires a decidedly different style of leadership and a different approach to problem solving than what we may have become accustomed to.

So why my focus on AI at this time?  In some respects my focus comes from the coincidence of my current learning on the subject and the recent (ongoing) negative publicity for Alberta's health care system.  Many of the same themes we saw play out in 2012 have continued on into the current year.  Not only do I have the opportunity to see politicians and media making hay with "all things wrong with our healthcare system" I also get the opportunity to see many of my friends on Facebook or other forums comment about the latest news on health or on their own less than stellar experience with a doctor, an emergency room visit, or a hospital stay.  For someone who has spent the last 25 years or so of their life in the health system its more than a bit demoralizing.  I can only imagine how tough it is on the those who have to work in the system every day.

To recap, in the past couple of months the news headlines of the day have included continuing investigation into queue-jumping in various parts of the system, the ongoing battle between the government and the Alberta Medical Association on contract negotiations, Alberta's looming multi-billion dollar budget deficit which is leading to belt-tightening in all government ministries, and more than a few other stories or letters to the editor about bad patient care outcomes.

Some politicians, some in the media and others have weighed in with gusto on all or part of these stories to paint a picture of a health system not performing anywhere near what is required or expected.  Not unexpectedly, those with an axe to grind or positions to advance have been doing their level best to make as much of these problems as possible.  I contend that they are distorting and expanding on the data out of proportion to reality - and not showing true leadership.  Case in point has been the focus on $100 million in Alberta Health Services expenses that were the subject of a recently completed Auditor General's report.  Some would have you believe that the entirety of the $100 million is wasted or the result of abuse by management and staff.  Moreover, I have seen advertisements that then equate these expenses to what could be obtained in additional staff, new equipment or more surgical procedures if only these dollars were more appropriately used and people held more accountable. 

The reality of the situation is quite different in my estimation.  According to the Auditor General's report, the $100 million in expenses covers off a wide range of expenditures by 26,000 different people of which less than 1% is attributable to claims by AHS Board Members and Senior Executive - the top dogs that most people like to go after.  What many fail to realize that captured in the $100 million figure are expenses for such things as travel by front-line staff to perform their patient care duties, expenses for managers to bring their staff together and perhaps provide them a cup of coffee (e.g., "executive hospitality), and transportation costs for patients - all very necessary expenses in a health care organization with a provincial scope.  Much was also made of gift shops buying hockey tickets or other items for resale.  From my own personal experience I know that these efforts are directed at fundraising for various health facilities or program improvements - they are not done for any personal benefit.

Does our health system have challenges and issues to overcome?  Most definitely.  And if there are clear and singular abuses of power, responsibility and power deal with those in a fair and expeditious manner.  However, my concern is that by continuously focusing on all that we think is wrong we will actually lose real opportunity to build off all that is right in our system and to create an environment that promotes creativity, innovation, efficiency and quality.  Appreciative Inquiry holds out far greater promise in my estimation for building a strong foundation for the future strength and effectiveness of our health system than does this supposed "accountability" paradigm we find ourselves in currently.  AI holds out the promise of being far more proactive and creative than the current approach of some loud voices.  Imagine the strength of looking within our health system for examples of success and how those could be replicated for the benefit of the entire province!

If you are looking for an example of this that hits closer to home for you imagine if you approached your spouse, child or other loved one in the same way we are focused on our health care system.  I'm sure there are habits, behaviours or performances that you identify as being less than optimal.  I'm guessing that your relationship would not long survive a constant process of "problem-solving" with them.  I suspect that if you focused on their deficits you would succeed in creating feelings of threat, defensiveness and demotivation.  I don't see the reality of our current health care system much differently. 

Appreciative Inquiry is probably not going to be easy to adopt or make widespread in the current environment.  But with some courage and leadership I believe it is a better way to move forward and build public confidence in our health care system. 
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Greg Hadubiak, MHSA, FACHE, CEC, PCC
TEC Canada Chair/Executive Coach/Senior Consultant
hadubiak@wmc.ca

Helping leaders realize their strengths and enabling organizations to achieve their potential through the application of my leadership experience and coaching skills. I act as a point of leverage for my clients. I AM their Force Multiplier.