title: Appreciative Inquiry for quality improvement in primary care practices.
abstract: OBJECTIVE
  To test the effect of an Appreciative Inquiry (AI) quality improvement strategy on clinical quality management and practice development outcomes. Appreciative inquiry enables the discovery of shared motivations, envisioning a transformed future, and learning around the 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 field notes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes.
  
  
  RESULTS
  The PSD rates did not change. Field note 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 1 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.
authors.affiliation: Department of Family Medicine, Case Western Reserve University, Cleveland, OH 44106, USA. mary.ruhe@case.edu
authors.forename: Mary C
authors.initials: MC
authors.lastname: Ruhe
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Bobiak
authors.forename: David
authors.initials: D
authors.lastname: Litaker
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Carter
authors.forename: Laura
authors.initials: L
authors.lastname: Wu
authors.forename: Casey
authors.initials: C
authors.lastname: Schroeder
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Zyzanski
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weyer
authors.forename: James J
authors.initials: JJ
authors.lastname: Werner
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Fry
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011320:Primary Health Care / Q000458:organization & administration*; D011322:Primary Prevention / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D044469:Racial Groups; D012737:Sex Factors