| Linda Hutchinson
Case study: Learning from Excellence
Using appreciative inquiry to boost quality and safety in healthcare
Critical incidents, adverse incidents, serious untoward incidents. All these are common terms in quality and safety improvement in healthcare. Analysis of what went wrong is essential in identifying ways to prevent future events happening. Yet the focus is on the mistake, the error, the negative. It misses all the learning from good and excellent practice.
This was the premise for starting Learning from Excellence. Dr Adrian Plunkett, a paediatric intensive care consultant, spent time as a patient. He received care that was in parts excellent and wrote to the hospital to thank the individuals involved. Later, at a chance meeting with one of them, it was clear that the positive feedback had not been passed on. Adrian realised that we were not valuing excellence, compliments or positivity. Spurred on by this experience he set up a small pilot in his unit for identifying excellent practice and directly thanking those who had achieved it.
What is Learning from Excellence?
On one level, it is a simple reporting system. Any team member can complete an online form describing what happened. The person named as the one who showed the excellent practice is sent an email thanking them from the person reporting. It is private, but not anonymous.
The impact this must have on morale is obvious. This is not the standard letter that comes down from the boss. It is a peer to peer, genuine and sincere acknowledgement for something very specific.
And the impact is not just on morale. Often the person may not have been aware that their action or words had such a positive impact on someone else. Having their attention drawn to it means they seek to do it more frequently. Adrian gives examples where the behaviour that is recognised and given thanks for then increases. As a quality improvement technique, the simple ‘thank you’ may prove to be one of the more powerful.
A further development was to mimic the team discussions about significant events. When I used to work in a hospital, these were the monthly Mortality and Morbidity Meetings. A more negative and depressing name one could not imagine. Instead, Birmingham Children’s Paediatric Intensive Care Unit holds Appreciative Inquiry sessions following training by Appreciating People, an organisation specialising in change through strengths based approaches.
Adrian is keen to emphasise that Learning from Excellence is not a substitute for adverse incident reporting and analysis, it sits alongside it. And it seems to have struck a chord with many people. Other units and clinical settings have taken it up, not just in the UK. There is even a school who is adapting it for their use.
The impact on patients and involvement of patients and families is an area that Adrian would like to see develop. One of their Appreciative Inquiry sessions included a parent who gave very useful feedback. Adrian’s team are looking to do this more often.
A formal Health Foundation funded evaluation has started looking at the impact on behaviours. There is also a planned assessment on staff engagement and retention. This is being supported by the West Midlands Academic Health Science Network (WMAHSN) who have supported a series of Learning from Excellence workshops and Appreciative Inquiry training sessions around the West Midlands region, enabling the initiative to spread. They are also sponsoring a conference in November.