Published: 12/08/2004, Volume II4, No. 5918 Page 20 21

A spiritual community that began life in the 1960s and knows a thing or two about large vegetables is proving to be an unlikely nurturer of harmony among NHS staff. Andrew Hobbs reports

Manchester Heart Centre lead cardiologist Professor Clifford Garratt reflects: 'As consultant cardiologists we were all fairly sceptical.We thought it sounded very touchy feely, and we were uncertain we would get any benefit from it.'

And well he might. Not only was he apparently subject to yet another of these change management programmes with an obtuse name, but it was being propagated by members of a 'spiritual community' from the Scottish wilderness best known for growing oversized vegetables with the aid of a full moon.

However, Professor Garratt now concludes: 'There is no doubt that we learnt a great deal about each other's aspirations for the department and it was very useful in terms of communication between consultant staff and achieving a set of common goals.'

The subject of this surprising about-face was 'appreciative inquiry' (AI), a technique introduced to Manchester Heart Centre two years ago. Part of Central Manchester and Manchester Children's University Hospitals trust, it has had to cope with a massive expansion in services in recent years and currently has almost 400 staff.

Directorate manager Anthony Nally believes AI is particularly suited to change management in the NHS because its positive approach boosts morale in an institution under attack. It is unusual among organisational development techniques in its focus on what already works well.

'The basic premise is that anything you want more of in your organisation is already there - It is just that you do not see it. It is also very simple and easy to understand, and it focuses on individuals and what motivates them, so it allows you to make changes that last because individuals are the foundation of any organisation.'

This year some 40 staff, most of them from the centre's three catheter laboratories, went to three awaydays in March, May and July, with a separate day attended by six consultant cardiologists.

This pilot phase has had a significant impact already, says Mr Nally, with staff turnover and sickness absence down by around 3 per cent and 2 per cent respectively, improvements to patient privacy and better communication between medical and non-medical staff.

AI was developed by David Cooperrider and Suresh Srivastva in the US in the 1980s on the premise that organisations change in the direction in which they enquire. So an organisation that enquires into problems will keep finding problems, but an organisation that attempts to appreciate what is best in itself will discover more and more that is good.

AI is a four-stage process (discover, dream, design and deliver). The version used at Manchester Heart Centre began with everyone dividing into pairs, telling each other stories about a time when they felt good about their work.

In the second stage, key words or ideas from people's stories are identified and used to draw pictures and 'dream'what the organisation would be like if those peak moments from the stories were the norm. These 'dreams' are then put into words as 'provocative propositions', not unlike mission statements. At the design stage, detailed planning spells out the steps needed to turn dream into reality. (At MHC, this was done in small multidisciplinary groups, focusing on patient care and dignity, trust and respect between colleagues, a more enjoyable working atmosphere, internal communication and clarity of roles. ) The 'deliver' stage is self-explanatory.

The process required three away-days plus some meetings in small groups.

The third day included training 10 people to elicit stories from other staff not present, to roll out the 'inquiry' further.

Robin Alfred, one of two trainers from the Findhorn Foundation Consultancy Service, which led the Manchester process, says: 'To bring AI and the spirit of appreciation into the culture of a place, you need a leadership willing to carry people with it and walk the talk around it. You particularly need a lot of management support at the design stage for aspirations to become reality.'

Targets were not the main motivation for bringing AI consultancy into the cardiac unit, which has always been ahead of its key performance indicators, claims Mr Nally.

Change was inevitable as the unit is scheduled to increase cardiac surgery by 45 per cent and non-interventional cardiology procedures by 122 per cent from 2001-06, requiring expansion from 235 personnel to 400. The question was how that change would be managed.

'Any organisation growing at this rate could collapse and implode. There is something special about the commitment and passion of people at MHC and I wanted to pull that together and get people off the treadmill of results, targets, stress, ' says Mr Nally.

Choosing consultants from Findhorn to support NHS change management might seem incongruous to those familiar with the story of the Findhorn Community, founded in the idealistic 1960s and noted for an ability to grow huge vegetables on inhospitable sandy ground by taking instructions from nature spirits. This 'spiritual community', which is based near Inverness and promotes no religion, has grown from three founders to 400 members, most of whom live in an eco-village and run more than 30 organisations and businesses.

Mr Nally chose Findhorn after attending some of their courses and recognising a shared interest in transformation, at the personal and organisational level. 'I liked the way they worked, ' he says, 'and I wanted to bring in more emotional intelligence and a spiritual element - a more holistic way of seeing the individual'.

AI is catching on in NHS service development. It is used by the cancer services collaborative improvement partnership and the service improvement programme of the National Institute for Mental Health in England.

At local level, trusts including Hammersmith Hospitals and Hampshire Partnership have adopted it. And the NHS Modernisation Agency is championing AI, with a website dedicated to it.

Those who attended the third away-day earlier last month were very positive. Catheter laboratory technician Anne-Marie Gee says her first reaction was anger at what she felt was a waste of money. But she has seen improvements in working relationships, communication and efficiency.

'The biggest change is the approachability of the management and the [medical] consultants. I've worked at the Heart Centre for quite a few years and it was very much 'us and them'. Now management seem more open and approachable.'

Key points

Appreciative inquiry is a method that can help NHS staff during periods of change management.

Staff turnover and sickness absence are already down at one heart centre that has used the technique.

People who have attended the awaydays say approachability to senior staff is improved.

Further information

NHS Modernisation Agency appreciative inquiry.

www. modern. nhs. uk/scripts/default. asp? site_id=24&id=12414

Findhorn Foundation consultancy service. www. findhorn. org/consultancy