Evaluating Appreciative Inquiry as an Organizational Transformation Tool: An Assessment from Nepal

Human Organization, Winter 2008 by Messerschmidt, Don

Two women's health projects in Nepal are examined for impacts from using Appreciative Inquiry (AI) as an organizational transformation and team building tool. This paper describes AI, and then looks at its use in Nepal to help improve access, quality of care, and utilization of essential obstetric care (EOC) by pregnant women. AI is ostensibly designed to assist hospital, health post, and health project staff improve their attitudes towards work and their service to clients. Typical accounts of AI impacts are told in "success stories," analogous to storytelling and mini-case studies in anthropology. The focus here, however, is on issues of evaluating AI, itself. Some AI practitioners eschew attempts at "rigorous" evaluation of their own work and maintain that AI is fundamentally "different" and not amenable to objective (especially quantitative) measurement. The results of the AI assessment on the two health projects are discussed in light of the ongoing debate about the nature of development in general, and the place of AI, the issue of evaluating AI, the use of logical frameworks ("log-frames"), "problem solving" approaches, and both quantitative and qualitative measures. The evaluation-of-AI literature (very scant) is reviewed, and one promising new methodology that combines AI with log-frame indicators is described.

Key words: appreciative inquiry, project evaluation, women's health, obstetric care, Nepal

Introduction

Appreciative Inquiry (AI) is a relatively new rapid development, research, and training tool that elicits success experiences from staff and builds upon "the positive" to affect transformational change within organizations, institutions, and communities. This participatory action tool has been used in organizational development (OD) since the 1980s in team building workshops for business corporations and institutions. Today, it is also allied tangentially with the "Positive Psychology" movement (Fredrickson 2000; Gillham 2000; Seligman 2002; Snyder and Lopez 2002). AI was initially designed by OD specialists for use in North America, and most of the AI literature reflects that focus.

For over a decade, AI has been adapted to international development on poverty reduction, public health and education projects, by sociologists, applied anthropologists, organizational developers, and others. It is used as a participatory tool for exploring local contexts and creating positive transformations and personal commitments for change and improvement. Practitioners generally describe AI as a tool for empowering local people to take control of their lives and jobs, to achieve agency, and to improve their roles and working conditions. Compared with other popular development strategies, like Participatory Rapid Appraisal (PRA) and Participatory Learning and Action (PLA) (ILED n.d.; Mukherjee 2004), AI practitioners consider AI to be even more participatory, positive, and proactive.

Like PRA and PLA, AI engages people in groups or teams to discuss, analyze, and plan specific activities and actions within their institutions (district hospitals and rural health posts in this study). AI practitioners strictly follow a highly formulaic phase-wise or cyclical structure that places an extraordinary emphasis on success stories. Storytelling is a means to raise awareness of past and current accomplishments that affirm one's own, a team's, or an organization's worth as the basis for constructing a better future. From an anthropological perspective, AI as applied to international development tends to deal with modern institutions and organizations recently embedded with traditional societies, with cross-cultural implications.

The positive approach of AI is grounded in a "theory of affirmation," which directs change agents away from preoccupation with the "root cause of 'failure" towards the "root cause of success"(Cooperrider 2000). It encourages imagination, innovation, and inspired positive actions in place of traditional approaches focused on problem solving. It relies on the discovery of rich and inspiring accounts, metaphors, and themes, told in a "new language" of development, through stories that highlight peak experiences, which then become the fuel for remarkable developmental change (Cooperrider et al. 2001; Odell 1998).

This paper focuses on the application of AI on two women's health projects implemented by the Government of Nepal with international donor assistance. One was the "Women's Health Project" (WHP), part of a regional "Women's Right to Life and Health" program funded by the Bill and Melinda Gates Foundation through Columbia University's Mailman School of Public Health with technical assistance from the United Nations Childrens Fund (UNICEF). The other was the "Nepal Safer Motherhood Project" (NSMP), supported by the United Kingdom Department for International Development (DFID) with technical assistance from Options Consultancy Services of London. Both projects were implemented by government staff assisted by local non-governmental organizations (LNGOs), through the Family Health Division of Nepal's Department of Health Services.