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

Human Organization, Winter 2008 by Messerschmidt, Don

Project Response

The factors and perceptions noted above all affect how and why locals utilize EOC services or not. Project planners felt that if public access and utilization were to be improved, then systems of accountability, participation of stakeholders in management, staff commitment to teamwork, good attitudes, and positive results required immediate attention. Recognizing this, both projects contracted AI facilitators from the private sector to run AI workshops at all projectsupported health facilities, with the goal of achieving positive transformation of the EOC services system, including staff attitudes and skills. The facilitators followed the standard 4-D Cycle in workshops, to: (1) develop a process and vision for staff of participating health facilities and other stakeholders; (2) create breakthrough teams and action plans; (3) introduce innovative methods to manage change, facilitate group activities, and promote a more positive, holistic view of people, processes, and systems; and (4) train local coaches and trainers to sustain the effort.

The effectiveness of all project inputs including AI was judged against standard logical framework indicators such as: (1) increased utilization of EOC services by women with obstetric complications; (2) more positive providerclient-stakeholder relationships realized; (3) breakthroughs generated to improve facilities management, quality of care and service, technical inputs, a rights-based approach, team spirit and effectiveness, inter-departmental cooperation and collaboration, and individual and group learning; (4) problems addressed and dealt with proactively, demonstrating positive ways of working, good morale, establishment of an "appreciative culture," accountability, commitment, motivation, ownership, creativity, and sense of pride; (5) improved interpersonal communication and relationship-building skills; and (6) improved relations between hospital staff and community support groups.

Stories About Change

Stories are part of the way group members see themselves, and stories about AI activities are indicative of AI's impacts and results. Stories (or mini-case studies) are used to create histories and justify actions (hence, are qualitative but only mildly evaluative). "Stories are an old way of organizing knowledge" that, "when used as strategic tools,... confront denial by encouraging-in fact, requiring-the willing suspension of disbelief (Wack 1984). When done carefully and well, story analysis is a useful anthropological tool, and is frequently borrowed by non-anthropologists (who think it is easy to use).

A key objective of AI's 4-D Cycle is development of an institutional "vision statement," which reflects stories about change accomplished and looks forward to change intended. Then, if change happens, success stories will emerge. An institutional vision includes short and long-term timelines and a range of objectives and goals for both health care staff and communities to strive for. "Shared vision" is also expressed through stories that exude group pride, team spirit, and mutual commitment towards a "cause" or agreed-upon goal. Virtually all medical, nursing, and paramedical staff persons involved with the projects, and community members on hospital and health post support committees, have shared these sentiments and frequently expressed them through positive stories. But, while such vision statements are readily articulated by staff and exist as oral histories and sometimes in writing, when carefully examined the sustained efforts necessary to continue the transformation appeared weak. The authors of an earlier review of NSMP noted that after only a few years of AI's "Foundation for Change" approach (despite follow-up workshops) there were already "indications that the changes will not be sustained at their present level" (Hodgson et al. 2003:25-26). Our findings are similar.