Positivity in Practice: Use What Is Working Well to Fix What Isn’t

by Louise Dunn

In your practice, are you trapped by problems with people or procedures that, no matter how many times you lecture, correct, or warn, you never seem to be able to fix? Maybe you are trapped by the failure to deliver exceptional medical care and client service to every patient, every client, every time. If you find yourself frustrated when using the same tools (lecturing, correcting, warning, or adding more management layers) to fix a problem, it’s time to try something different. Break free of the trap by using a new tool—the positivity tool.

Appreciative Inquiry (AI) is a process where you use what is working well to fix what isn’t working. AI focuses on positive assets, capabilities, procedures, and resources to solve other problems. Consider this example: A practice has a senior wellness program that is seeing record participation, but a newly implemented wellness program has low client acceptance and no amount of effort has improved the numbers. What is the difference? What is being said or done that garners higher client acceptance in the senior wellness program, and how might the practice translate that success to the new program?

Taking time to explore what is working best in a successful situation helps to identify the team’s strengths, best practices, and peak performances. Then, those strengths can be applied to design a strategy to improve what is not working well elsewhere in the practice.

The AI process focuses on a cycle known as the 4-D Cycle:

• Discovery—finding out what is valued, motivating, and/or effective
• Dreaming—facilitating dialogue and identifying common themes about the vision for what will work best
• Designing—creating action-oriented statements, ideals, and provocative propositions
• Destiny—applying initiatives

The AI process hinges on asking positive questions on constructive topics. It is not about accusations and inflammatory questions. Consider the difference between these two questions:

1. “Why can’t we ever post charges without mistakes and missed charges?”
2. “Can you describe what happens when the correct invoice is created and what small changes could be made to improve accuracy in those wrong invoice situations?”

Which question would you prefer to answer?

AI differs from the traditional problem-solving routine most of us are accustomed to, where we approach every problem based on the assumption that people and processes are broken. Look at the two questions in the prior paragraph—the first one screams that the team is always messing up and the invoicing process needs significant fixes. In contrast, the second question inquires about specific steps and focuses on positive dialogue to explore changes. Changing what questions are asked and reframing them in a positive way is the first step toward moving the team to look for a solution in what is working well.

While a more traditional problem-solving technique (identifying the key problem, analyzing root causes, discussing possible solutions, and developing an action plan) may be necessary for some issues, AI may be a better choice for solving many dilemmas. Kathryn Primm, DVM, CVPM, owner and chief veterinarian of AAHA-accredited Applebrook Animal Hospital in Ooltewah, Tennessee, points out that “people want to feel valued. Positivity motivates and inspires. We know that even in training dogs, punishment creates bad attitudes and problems down the road. Why not choose to inspire?”

Another example of AI in practice is offered by Nan Boss, DVM, owner of AAHA-accredited Best Friends Veterinary Center in Grafton, Wisconsin. Let’s say your practice lacks consistency of care when it comes to anesthesia and surgery protocols. Boss suggests asking what each of your surgery techs is really good at. Then, as a team, they can consider how to teach each other so that every patient gets the best possible care.

AI is not a cure-all for every problem you and your team might face. The AI process is best suited for specific issues, such as:

• Complex, multicause issues
• Recurrent problems not responding to other solutions
• Worsening problems

When faced with multiple causes to a problem, instead of trying to tackle each issue individually, focus on what is already working well and applying it to the problem. For example, the wellness program suffering from low client compliance mentioned earlier offers a complex, multicause issue. It could involve different cultural perspectives, conflicting personalities, income variances, and an exhaustive list of other factors. Since you cannot “fix” such an extensive list, look instead at what is working (either at your practice or from best practices in the medical field) and build on those successes.

Using AI in your veterinary practice would appear as follows:

1. Choosing a topic based on what is critical for the success of your current strategic plan, which could include problems you want to solve
2. Discovery phase—discussing positive stories about the topic and defining what your team sees as working or not working
3. Dream phase—imagining what the “ideal” might look like
4. Design phase—planning specifically what needs to be done to realize the dream
5. Destiny phase—implementing the plan; the who, what, when, and how to get it done

How will the AI process look in your team? Consider another issue—attracting new clients:

1. Reframe the inquiry process. Instead of stating the problem as “we need to fix our low new client numbers,” try “what are ways we might facilitate new clients in scheduling appointments?” This positive framing changes the focus so team members can focus on what works rather than what doesn’t.
2. Discovery—Gather stories about what attracted recent new clients to the practice. What do team members see as most important to new clients? What are team members most proud of about the practice that they tell other people? Identify patterns—what is the reason past clients came to the practice?
3. Dream—Dream about what might be accomplished by emphasizing the positive points brought out in the discovery phase. Will you enhance what past clients said they valued? Will you stop doing things that are not attractive to new clients? Will you promote what the team has identified as what they are proudest of?
4. Design—Drill down. Time to get the specifics of the strategy for attracting new clients. Who needs to spearhead projects, what protocols need to be changed, and what strategies will be put into motion? You might consider approaches to marketing, appointment procedures, new client packets, surveys, or new team roles such as a Client Experience Team.
5. Destiny—Implementation of the design phase with a clear plan. Write out the project using a project-implementation document.

An additional tip from Primm is to make a plan to evaluate the effectiveness of your new process. Without this, how will you know if you have succeeded? A strategic plan document may look like this:

Title/Goal

Using social media to promote our practice and attract new clients.

Objective

To attract potential clients to our practice website and Facebook page with the ultimate goal of getting them to schedule an appointment.

Design

Strategy—Build our presence on social media through an active and engaging Facebook page—which kind of post has been the most successful? Can we do more of those posts? What are other strategies to try?

People—Consider team members for a New Client Team, who will be responsible for creating and posting the content as well as responding to comments and monitoring the page.

Finances—How many hours per week will each team member spend on these new responsibilities? You might also consider budgeting for continuing education, such as sending team members to a conference highlighting electronic marketing practices.

Time frame—Establish the members of the New Client Team by next week. Register members for a conference or webinar within the next three months. Schedule weekly project development time and biweekly social media postings. (For example, Boss recommends assigning each DVM and tech to one case study per month.)

Metrics—Look up past new client numbers, recent new client numbers, reasons for visits, survey results, and so on.

Notice that this process does not mention what is wrong with the practice. Instead, the focus is on what is valued, which ends up clearly showing what the practice should stop doing simply because it isn’t working. Using this framework, your practice can explore the AI technique and create a standard operating procedure for the AI process and project implementation. It is essential to include all the steps in the AI process; skipping a step will derail the group and give the impression that management does not support it.

Appreciative Inquiry can be a transformative process to bring about positive change and let go of negative questions and demoralizing tactics. Using AI can help your team discover what is working right and what is highly valued in your practice, and then your team can apply this positivity to solving problems and creating strategic plans for the future.

Louise Dunn is owner of Snowgoose Veterinary Management Consulting, based in North Carolina.

 

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