Best Story

Alisha Patel was senior VP in charge of quality at a hospital which had tripled in size over a three-year period. The stress of their expansion was being felt by everyone and patient satisfaction had been suffering. At nurse manager meetings Alisha would ask with a critical tone, "What going wrong? Why are your satisfaction scores dropping?" The managers' answer was always the same, "We are understaffed. Many of our nurses are working double shifts. There's nothing more we can do without more staff." Alisha grew more frustrated each quarter, the managers grew more resistant and angry, and Alisha was beginning to bring it home to her partner.

In hopes of some solution, Alisha attended an Appreciative Inquiry Training, thinking she had to try something! On the first day, she realized she was part of the problem. By speaking in critical ways that blamed and shamed the nurse managers, she basically contributed to a negative culture unable to create positive change. During the training, Alisha suddenly realized not all patients were dissatisfied; the score weren't zero. She'd just focused on what was wrong, what needed fixing. She learned that the secret to satisfaction could be found in the experiences of satisfied patients and that the nature of her question would make all the difference in how the managers responded.

At her next nurse manager meeting she shared her realization and asked, What do you know about the patients that are satisfied? What more might we learn from them?" She asked the nurses to pay attention to what was creating satisfaction, talk with patients who were satisfied and learn from them, observe nursing practices that best supported patients care and wellbeing. At the next meeting nurses were buzzing with conversation when Alisha entered. Everyone had stories to tell, ideas to share, and changes they'd already implemented. Alisha filled an entire white board with their creative ideas. Alisha sat excited and cautious at the end of the meeting. Could it be that easy, she wondered? Could it simply be changing the focus to what we want (instead of fixing what we don't want) and asking generative questions to widen our view of what's already working and what else is possible?

When the next quarterly reports came out, Alisha was eager to see if the positive change she anticipated was going to be proven. Sure enough, patient satisfaction was up on every unit and one unit had 100% patient satisfaction! In addition, her relationship with the nurse managers improved, morale in each unit improved, as did retention. And her husband was happy to have her arrive home uplifted with positive stories to share!

Origin Story

For my entire career I have focused on facilitating the potential of people and organizations to achieve their goals. Early on I facilitated parent/child relationships then leadership and team development through experiential learning (adventure-based learning/ropes courses). In order to bring experiential learning to more people and make it affordable for schools and non-profits, a colleague and I designed a portable low ropes course which we patented and later won the Association for Experiential Education Creativity Award. The following year we were introduced to Appreciative Inquiry, which provided a concise framework for teaching the way we facilitated--focusing on what worked and asking questions that encouraged creativity, success, and practical application.

Eventually I began to realize people are inherently team players and readily share leadership--it was the design of the activities that brought out those characteristics. In other words, teamwork and leadership emerge when the cultural/environmental structure calls for or supports those characteristics. This lead me to a career change. I began to work toward culture and systems change, transforming structures to bring out inherent teamwork and leadership. My primary focus was using Appreciative Inquiry, one of the most effective and widely used approaches for fostering positive change, to support strategic planning. It wasn't until I co-authored Conversations Worth Having with Jackie Stavros that I realized the simplicity of culture transformation. Everything we do involves conversation--with ourselves or others--and those conversations move us toward desired outcomes...or not. Two simple practices --which every person can use--are capable of turning any conversation--any time, anywhere, and in any situation--into one worth having.

It's simple. It is practical and immediately implementable. Focus on what you want instead of what you don't want. Ask generative questions, which widen the view, change the way people think, and expand possibilities. It is the simple on the other side of complex and I am passionate about sharing it with others. Collectively, people can create organizations that flourish and communities that help every living being thrive. We simply have to change our conversations!