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Appreciative inquiry, positive deviance, and civility

Issel, L. Michele PhD, RN

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Health Care Management Review: 1/3 2017 - Volume 42 - Issue 1 - p 1
doi: 10.1097/HMR.0000000000000142
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As I write this editorial, the 2016 Presidential Election remains in full swing. The unpleasantness of the rhetoric across the spectrum of voices and the profound focus on “fixing” have me reflecting on a trend in recent submissions to Health Care Management Review (HCMR). The trend, or hopefully just a spike, involves research reports of bullying among health care workers and cyberbullying related to the workplace. Whether this is a trend or a spike, the fact that the topic has scholarly attention may say something about our health care organizations, systems, or society at large. It feels as though scholars look for, talk about, and focus on the bad, the ugly, and the wrong. Undeniably, these exist in our health care organizations and deserve to be understood as a step toward prevention. But, as the Editor (and an individual), I’d prefer to shift the balance toward more focus to be on what we want more of, like successes, beauty, and the correct.

Making that shift requires that scholars use a different set of tools and frameworks that redirect attention from the negative toward the positive aspects and elements. Several such tools and frameworks exist, such as appreciative inquiry. The value of appreciative inquiry stems from being an approach useful for health care organizations seeking to improve by focusing on the good, the successes, and the brilliant within the health care organization (Herington et al., 2015). Creating and having exemplary role models tends to be effective in achieving broader goals. The same ought to hold true in health care organizations and discoverable through research. Reflection, use of exemplary cases, and action research can be used as part of appreciative inquiry. Another approach is to identify positive deviance, as an exemplary outlier with seemingly paradoxical success. In some instances, we may not know about these cases because we have not been looking for them, and in other cases, we looked past them. Positive deviance involves focusing on assets and involvement of the members of the organization.

Identifying and studying the successes stories, using rigorous methodologies, does more than generates new knowledge about health care organizations and management of those complex systems. It also generates compassion, civility, and inspiration. These qualities are not luxuries, but essential elements of healthy health care organizations. I hope that some HCMR readers and authors will take up the challenge to understand how to foster these qualities in our health care providers and systems. Surely, that would be what our patients, customers, and workers would want.

L. Michele Issel, PhD, RN


Herington C., Dadich A., Fulop L., Ditton M., Campbell S., Curry J., Smyth A. (2015). Finding brilliance using positive organizational scholarship in healthcare. Journal of Health Organization and Management, 29, 750–777. doi:10.1108/JHOM-11-2013-0256
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