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Randomized Controlled Trial
. 2011 Jan-Mar;20(1):37-48.
doi: 10.1097/QMH.0b013e31820311be.

Appreciative Inquiry for quality improvement in primary care practices

Mary C Ruhe  1 , Sarah N Bobiak, David Litaker, Caroline A Carter, Laura Wu, Casey Schroeder, Stephen J Zyzanski, Sharon M Weyer, James J Werner, Ronald E Fry, Kurt C Stange
Affiliations
Randomized Controlled Trial

Appreciative Inquiry for quality improvement in primary care practices

Mary C Ruhe et al. Qual Manag Health Care. 2011 Jan-Mar.

Abstract

Purpose: To test the effect of an Appreciative Inquiry (AI) quality improvement strategy on clinical quality management and practice development outcomes. Appreciative inquiry enables the discovery of shared motivations, envisioning a transformed future, and learning around the implementation of a change process.

Methods: Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical-record review assessed change in PSD rates. Ethnographic field notes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes.

Results: The PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives, and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited 1 or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change.

Conclusions: An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective.

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Figures

Figure 1
Figure 1
Each oval in the Figure names the step (bold), its purpose (underlined), and examples of techniques (italics) that can be used to facilitate the AI process. Between-meeting work is depicted next to the ovals. Used with permission from Carter CA, Ruhe MC, Weyer SM, Litaker D, Fry RE, Stange KC. An appreciative inquiry approach to practice improvement and transformative change in health care settings. Quality Management in Health Care. 2007;16(3):194-204
See this image and copyright information in PMC

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References

    1. Crabtree BF, Miller WL, McDaniel RR, Stange KC, Nutting PA, Jaen CR. A survivor's guide for primary care physicians. J Fam Pract. 2009 Aug;58(8):E1–E7. - PMC - PubMed
    1. Cohen SJ, Halvorson HW, Gosselink CA. Changing physician behavior to improve disease prevention. Prev Med. 1994;23(3):284–291. - PubMed
    1. Solberg LI, Kottke TE, Brekke ML, et al. Failure of a continuous quality improvement intervention to increase the delivery of preventive services. A randomized trial. Eff Clin Pract. 2000;3(3):105–115. - PubMed
    1. Woolf SH. Changing physician practice behavior: the merits of a diagnostic approach. J Fam Pract. 2000;49(2):126–129. - PubMed
    1. Cohen D, McDaniel RR, Jr., Crabtree BF, et al. A practice change model for quality improvement in primary care practice. J Healthc Manag. 2004;49(3):155–168. discussion 169-170. - PubMed

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