Appreciative inquiry - a tool for staff engagement


12 / 12 / 2014 4.47pm

Appreciative inquiry (AI) is a technique that has been used in a number of staff engagement exercises in organisations such as Guy's and St Thomas' NHS Foundation Trust. It involves a small group of staff being released to focus on key questions. It can be applied to reviewing projects through a series of structured questions covering vision, design and delivery.

  • Vision - what would have been the effect of carrying on as before?
  • Design - what changes did you put in place and how did you evaluate them?
  • Delivery - what changes were implemented and how did you sustain them?

Benefits of the process

The benefits were the clearest for the staff involved in the exercise. Staff felt that they were listened to and were able to contribute to improvements. They also felt they had greater clarity about their roles and were more part of the team. This laid the basis for better interaction with patients and generation of good ideas, which were part of the overall programme of service improvement.

Methicillin-resistant Staphylococcus aureus (MRSA) rates had reduced, appraisal rates improved and sickness absence reduced. Although not all of these improvements could be wholly attributed to the staff engagement process, it's hard to separate effects of the method itself, as change can be part of better management overall. The engagement process in itself supports and strengthens good managers.

Key success elements of implementation

  • The sustained and visible commitment of the most senior leader, those who listen and respond to suggestions and implement them, even if other managers are not supportive.
  • Quick wins demonstrated that something new was happening.
  • Celebrations of achievement were reinforcing.
  • The value of role models at all levels was recognised.
  • Going against traditional hierarchy and implementing new ideas by taking risks to change.
  • Should be seen as part of the day job for all managers. It is best to work with volunteers and work around those that do not wish to take part. Not all volunteers will have the right combination of skills. Middle managers in particular need support to adopt staff engagement values, capability and behaviours. Those that are unsure or avoid engagement will need to be addressed. Promotion and selection can help bring new approaches.

The risks

  • Listening to staff does have risks, managers may be forced to hear things that they would rather not, but it means issues are tackled. The process can help remove concerns and overcome misunderstandings.
  • Listening to all staff may slow down the implementation of change, but if handled well it enables productive discussions and helps collective energy be put into problem solving.
  • How an organisation handles mistakes in implementation will be a litmus test of its commitment to the process. This will be where staff decide if the approach is real. If it reverts to a blame culture, staff engagement will be seen as only an ideal in theory. It has to be accepted that there will be mistakes and that lessons will be learned from them.
  • In any change process there will be early adopters and resistors with most staff falling in the mid range. There will need to be multiple methods to shift most staff to the new state. Resistors can raise legitimate issues and when won over can be the best advocates. A viral effect of the good example will not be enough on its own, although it is clearly necessary to promote and share success. 

Key messages

It is clear that staff engagement will only be successful where the local organisation believes it will help it achieve its objectives. The level of resources that the trust is willing to invest will affect the outcome.

  • Staff engagement can be driven by negative drives (poor scores, bad reputation and so forth) or positive ones (what could be achieved with more involvement). It is more likely to be successful where the positive drivers are the main ones. It will also work better where staff engagement is seen as developing a two-way relationship with staff, rather than as a management tool. 
  • The quality of senior and middle management is key. Are they committed to staff engagement and do they have the skills to make it work?
  • How prepared is the organisation to run with staff suggestions?
  • Ownership of issues - success is directly linked to the degree of ownership at the top of the organisation.
  • The senior team need to believe in the value of the process in order to deal with implementation issues and also convince staff. Scepticism needs to be overcome and expectations met.
  • Senior leaders need to engage when workforce suggest solutions to issues.
  • Symbolic issues can have great resonance, for example, the active presence of the chief executive can play a significant role in showing commitment to a new approach.
  • Take criticism of how things are currently done - the trust's board needs to have courage and be willing to accept and learn from criticism, treating this as part of the process.
  • Support needed among senior leaders, management and staff during difficult implementation. If no support is given or seen to be only half present, the atmosphere of risk aversion will persist and the flame of involvement and innovation will be extinguished before it has a change to ignite.
  • External facilitation can play a valuable role, as long as there is a process to develop champions in the organisation.
  • The purpose of staff engagement must be clearly understood and conveyed otherwise tension will arise. is it a top down communications tool led by senior managers or is it a process involving all staff? Ideally it should be the latter.
  • Some trusts tended to work with volunteers who were trained up to lead the big conversation. Other sought to train all those that had a leadership role to take staff engagement into their approach. the latter approach does mean that all managers are communicated with, but can mean reluctant attendance and informal resistance.
  • Organisations need to be clearer about the role and purpose of staff engagement, or else it will lose steam. In one trust, staff engagement laid the basis for a new approach to working with patients.
  • Staff engagement is not an end in itself, it is a means to improve the overall way things are done.
  • Process measures are required, for example, delivery of events can be useful at the start, changing staff views in the medium term, but in the longer term an organisation needs to look at outcome impact, for example, on levels of absence and staff turnover.   
  • The most important enabler of sustainable staff engagement is now many and how well middle managers adopt genuine staff engagement values.

Further resources

Find out how Guy's and St Thomas' NHS Foundation Trust used Appreciative Inquiry during organisational development, read their case study.

In addition, Heather Tierney-Moore, CEO of Lancashire Care Trust adopted Appreciative Leadership across her organisation, find out more by downloading their case study published by Kingsham Press.

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