Appreciative Inquiry for Quality Improvement in Primary Care Practices


  • Ronald Fry
  • M. C. Ruhe
  • S N. Bobiak
  • C Carter
  • R E. Fry
  • L Wu
  • S ZyZanski
  • D Litaker
  • S Weyer
  • J Weiner
  • K Stange


Quality Management in Healthcare/Lipincott Williams & Wilkins, 1 ed., vol. 20, pp. 30-36, January (1st Quarter/Winter) 2011



Abstract Purpose: To test the effect of an Appreciative Inquiry (AI) quality improvement strategy, on clinical quality management and practice development outcomes. AI enables discovery of shared motivations, envisioning a transformed future, and learning around 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 fieldnotes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. Results: PSD rates did not change. Fieldnote 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 one 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.

Ronald Fry

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Weatherhead School of Management
Case Western Reserve University

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