Reflecting on Our Journey Sharing Appreciative Inquiry Within the British National Health Service
One of the wonderful things about Appreciative Inquiry is the inherent invitation for anyone to take it and make it theirs by using it in their own settings. This article highlights how three British National Health Service staff applied AI in profoundly generative ways, resulting in a new book full of practical examples. We also see how it worked its magic within their own lives.
Over the past ten years, one of our most significant areas of work has been with staff in the British National Health Service (NHS). The NHS is one of the biggest employers in the world – some estimates put it as high as the sixth biggest, with approximately 1.5 million individuals working in a variety of roles – in hospitals, community services and central bodies. It’s a valuable part of life in the UK and has been under a lot of pressure in recent years, so we at Appreciating People felt motivated to contribute and support
staff within it. It can be surprisingly hierarchical, so it has been rewarding to share such a peer- and strengths-based approach with those who are open to it.
Shifting ourselves and impacting a huge system
In 2013 Aqua, an organisation supporting change and quality improvement in the NHS, asked Appreciating People to run workshops for healthcare staff using an AI framework to focus on improving safety. The prevailing approach was one of “inquiring into error and how to avoid reoccurrence”. We reframed the focus to “strengthening and enhancing safety”.
In planning for those sessions, we discovered the Learning from Excellence (LfE) and Civility Saves Lives movements as well as the concept of Safety-II (Hollnagel 2014) and saw its affinity with AI – see Appreciating People’s blog on Safety-I & II. Dovetailing these three strands has led to us working with staff in approximately forty trusts over the last eleven years, often supporting clinical governance teams who have seen the benefit of using an AI framework to learn more about moments of excellence and to spread that learning using quality improvement.
Many offshoots and innovations emerged from those years. Health Innovation West Midlands and Appreciating People shared them at the World AI Conference (WAIC) 2019, which inspired us to publish Appreciating Health and Care, a Practical Appreciative Inquiry Resource for the Health and Social Care Sector, elevating the stories and encouraging appreciative approaches. We received a fantastic range of contributions, leading to an additional e-book with seven more stories from talented and dedicated healthcare staff.
Becoming offshoots
Our three wonderful colleagues telling their stories below provide examples of their use of AI in a wide range of ways in healthcare. It was this which led us to conclude that such passionate and talented individuals engaging wholeheartedly with AI are one of our key “offshoots”. Each of them has taken AI to new heights in their own “communities” and in significant policy-forming networks.
It seems one success factor in our work has been akin to Gervase Bushe’s recommendation for appreciative leaders – tracking and fanning. Through various avenues and forums, we kept in touch with many of these talented individuals, valuing their roles and initiatives and, where necessary, encouraging them to spread their appreciative wings. The LfE community has used AI and greatly supported its spread with events, research grants, publishing resources and articles.
Kayleigh Barnett
My journey with AI began nine years ago during a training session with Appreciating People. At the time, I wasn’t in the best place emotionally, but with encouragement from my boss, I embraced this mindset shift and began leading AI training at work. It took me a couple of years to fully grasp the power of reframing conversations and shifting perspectives, but it then transformed my personal and professional life.
Since then, I’ve refined my AI practice, contributed to the AI Practitioner journal, presented at conferences and co-authored Appreciating Health and Care. This work has inspired national programmes,1 empowering health and care staff to reimagine their roles and tell new, positive stories about their work. The excitement and hope in these teams is one of my proudest achievements. I co-host the Caring Corner podcast with my friend Katy Fisher, amplifying real- world stories of AI in health and social care. Katy has been an incredible partner, helping me deepen my understanding of compassion in care and our shared vision of a strengths-based approach.
AI has quieted my inner catastrophiser and shaped me into a leader focused on understanding my team’s strengths and joys. By aligning tasks with what lights them up, I aim to create a fulfilling and impactful workplace. It has given me a community of compassionate and inspiring people, deepening my resilience and joy, and my courage to be my authentic self.
Katy Fisher
My career was born in the deficit-based approaches of the NHS, working within patient safety, building structures that sought “the harm” and the problems. I promoted that approach and was proud of how many problems we found and seemingly fixed. However, the budding shoots of the magic of healthcare grew from under the concrete of clinical governance. It stubbornly snuck round windowpanes and through cracks in the pavement.
Wherever I was investigating, auditing, interviewing or apologising, the growth and dignity, love and care insisted on blossoming. I started to realise the structures I had been building would never document the key moments of beautiful human connection and care that I witnessed between staff, patients and carers.
At this point, I met Kayleigh and realised that in witnessing and trying to capture the good, I was effectively using AI. Within the field of patient safety, I started to build the study of the SAFE patient and of appreciation in all its forms, insisting on recognising exemplary care even in traumatising and distressing situations. When I started to build AI into a serious investigation and truly saw its power within tragedy, I knew that this process could benefit thousands of patients and staff.
My journey has taken me from building structures to seek the good, to writing articles and contributing to books and podcasts. I co-host the Caring Corner podcast to capture the stories from staff who every day deliver and build on the magic of human connection. I thrive in being a “hospitality” leader – inviting all voices into the room. I am forever grateful that AI has led me to meet some of the most compassionate and strong people I know, and allowed me to seek the good in my personal and professional life.
Daniel Hodgkiss
The essence of AI has shaped my thinking and my support for improvement/ transformation in a multitude of settings. In one local authority, I used strengths to focus on the positive core of individuals and teams, enabling me to be vulnerable but brave in trying new ideas, thinking outside the box, and not limiting our potential for growth. I realised that moving to excellence requires believing in and harnessing undervalued positive energy.
In healthcare, I have been able to really embrace the need to nurture what’s strong and to support improvement. As patient safety manager, after training with Appreciating People, my team and I shifted from reactive thinking to become the embodiment of proactive positive deviants! We created cultures promoting psychological safety, moved from action planning to improvement planning, and generated energy and environments to create a paradigm shift, proving that whole fields can grow from green shoots when we believe and give life to vulnerability, braveness and creativity.
I created “right cause analysis” (in contrast to root cause analysis) using the 5D model to delve into our ability to “learn from excellence”. We became an award- winning service and showcased a positive lens of patient safety as part of the new Patient Safety Incident Response Framework.
Following a presentation at WAIC 2019, I had a conversation with Tim Slack. Together, we dreamt of shining a spotlight on the ever-growing expansion of Appreciative Inquiry within health and care settings. This evolved into co-authoring Appreciating Health and Care in a partnership between Health Innovation West Midlands, Appreciating People and Aqua.
We have given a platform to individuals shining lights on bright spots across health and care. In webinars for the Q Community, the Taos Institute and the Cooperrider Center, we’ve created and tapped into networks of appreciative practitioners supporting those wanting to make seismic shifts in team and organisational cultures. We facilitate a wealth of conversations to support staff, patients and their families in health and care settings. This paradigm is shaping local, regional and national programmes, educating and up-skilling the next generation of practitioners and championing asset-based healthcare.
I feel privileged to be part of a special community wanting to use and explore AI. It also shapes me professionally and personally, helping me to focus on growth, resilience and sustainable improvement.
