Discussion Post

***I would like to write about how I observed how a nurse leader implemented change in an organization with applying the 4D framework of appreciative inquiry (AI) and an example***

Identify – from your perspective, the greatest advantage of using appreciative inquiry (AI) to implement change. Provide an exemplar.

Discuss an organizational change in which you have been involved or have observed.

Apply the 4 D framework of AI.:

1. Discovery Phase,
2. Dreaming Phase,
3. Designing Phase and
4. Delivery Phase.

Instructions
Initial post: Reflection, application with exemplar and 2- 3 resources.

Instructions
Initial post: Reflection, application with exemplar and resources.

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Solution

Appreciation Inquiry

Using the appreciative inquiry (AI) process in the decision-making and change implementation process is very important in an organization. Most organizations especially hospitals have adopted the 4D appreciative initiative in improving the care processes. According to Oliver (2017), the use of the appreciative inquiry process in decision making and change implementation process helps create and implement a common goal in an organization and solve discourses. This paper is a reflection on the application of the AI process in my workplace.

In the hospital, there was an increase in hospital-associated infections in the intensive care unit and thus the chief nursing officer was concerned about the rates and started the process of improving the hospital-associated infection rates. The chief nursing officer called for a collaborative inquiry on the issue. All nurses in the critical and surgical care units were called in a meeting in discussing about the increasing rates of hospital associated infections. The collaborative meeting entailed looking for the available resources and processes that would help positively impacting on the hospital-associated infections in the hospital. In the meeting, every nurse was given an opportunity to positively discuss about the capability of the hospital in handling the issue, considering the available resources. This is the discovery stage of the AI process. For example, in this stage, the stakeholders established that many nurses could help in training and educating the new entry nurses on how to improve the quality and safety of care to the patients. The nurses also established that the organization has enough water and sanitization resources that are essential in improving care hygiene and HAI rates (Roshana et al., 2020).

The nurse leader led the group in envisioning the future standards of care for the ICU unit and other critical care units in the hospital. For improved provision of quality and safe care especially in the intensive care units, the nurses predicted that the organization was in a position to effectively support and uplift the prospective strategies to improving the HAI rates.  The consultative gathering of stakeholders established that the clear possibilities towards the issue were that the organization could improve HAIs by 60% with the available resources. Some of the things considered were the readiness for change, availability of funds for providing key materials for hygiene management and for supporting training programs of the units’ healthcare providers. Some of the programs that lacked probability of success was high level of supervision due to lack of enough nurse leaders in the unit to provide scheduled supervision and reviews for quality nursing practices.

The design stage involved coming up with effective strategies for reducing the HAI rates. The nurses for instance verified the possibilities of having monthly training on HAIs and implementation of the nursing care standards such as hand sanitization as key processes of improving the HAIs.  The nurses led by the CNO established that the training programs and sanitization resources were available and would be effectively implemented.  The stakeholders asked for continuous support from the administration in supplying the sanitization materials and maintaining regular evaluations on adherence to the set standards of operation in improving the quality of patient care. According to the resolution, the programs were to be continuously implemented and evaluated for continuous improvement of the patient care safety and quality. All nurses in the units were required to regularly attend the patient safety improvement workshops which are usually quarterly. Provision of key hygiene materials such as gloves, sanitizers and handwashing materials among other hygiene supplements would be availed by the hospital all through.

References

Oliver, C. (2017). Critical appreciative inquiry as an intervention in organizational discourse. Organisational Development in Healthcare, 205-218.

Roshan, R., Feroz, A. S., Rafique, Z., & Virani, N. (2020). Rigorous hand hygiene practices among health care workers reduce hospital-associated infections during the COVID-19 pandemic. Journal of primary care & community health, 11, 2150132720943331.