Appreciative Inquiry: Investigating the Root Causes of Success

By Kate Beaumont, Programme Director, IHLM Professional Certificate in Patient Safety.

Kate Beaumont 7

In patient safety we spend a great deal of time focusing on what goes wrong and why. But isn’t it time we started investigating and celebrating success?

We often preface teaching about patient safety by noting how amazing it is that care works so well almost all of the time. Nonetheless, when something does occasionally go wrong we tend to lose sight of the good things that we do and dwell heavily on the bad. This leads to two very serious and undesirable outcomes. The first is that healthcare staff – the very people upon whom we depend to deliver safe, compassionate, patient-centred care – begin to feel victimised and undervalued. At best, this erodes their motivation. At worst, it leads them to leave the healthcare profession altogether. The second problem is of not seeing the wood for the trees. In the words of Professor Erik Hollnagel, our focus on the lack of safety does not show us which direction to take to improve safety.

What is Appreciative Inquiry?

I was fortunate to recently attend a two-day course on Appreciative Inquiry and positive psychology in healthcare, hosted by West Midlands Academic Health Science Network. I had read a little bit about Appreciative Inquiry and was keen to explore how this philosophy could benefit my own work as a patient safety teacher and consultant.

Whereas in Root Cause Analysis we look at clinical systems and investigate what is wrong with them, Appreciative Inquiry teaches us to see how and why they work so well, and how we can build on that to create something even better in the future. First suggested in a 1987 research paper by organisational behaviour experts David Cooperrider and Suresh Srivastva, Appreciative Inquiry encourages us to understand clinical systems by asking questions and engaging staff in appreciative conversations. Conversations that bring people together to share learning and in so doing, can take an entire team or organisation forward.

What could be the benefits of Appreciative Inquiry in healthcare?

A lot of people, myself included, think we need to re-humanise healthcare and become more compassionate toward each other, as well as toward patients. Dr Robin Youngson, author of Time To Care: How To Love Your Patients and Your Job, uses Appreciative Inquiry to do just that. Through his Hearts in Healthcare website he notes that:

“Every health worker begins with a desire to alleviate suffering and to help patients recover from illness and injury. The capacity for compassion is innate.”

This mirrors my own thinking, fifteen years ago, when I noted in my masters degree dissertation that the National Health Service in England: “is in the deeply privileged position to have as its employees, professionals who almost universally have an inherent desire to care and whose greatest motivation and satisfaction arises from fulfilling their caring potential.” I observed that it was devaluing by colleagues, not by patients, that led healthcare staff to feel unappreciated and unvalued.

As professional carers, our compassion can fade or be eroded as we struggle to maintain our sense of inner value and our capacity to care. But Appreciative Inquiry offers us the tools with which to bring people together and enable them to feel recognised and valued once more.

Can Appreciative Inquiry help make healthcare safer?

In From Safety 1 to Safety 2, Professor Erik Hollnagel offers a refreshing perspective on patient safety, which encourages us to move from ensuring that “as few things as possible go wrong” to assuring that “as many things as possible go right”. He notes that the rare cases of failure attributed to human error do not explain why human performance practically always goes right. He believes that patient safety professionals should use Appreciative Inquiry to look at the many cases where things go right and try to understand how that happens.

I couldn’t agree more. I have read too many incident reports describing failures to recognise and respond to deterioration and have analysed the failings in detail to try to elicit root causes. I’ve never been asked to investigate success, yet I can imagine so many healthcare scenarios where things have gone well and there is great practice that needs to be celebrated and shared. Hospitals are brimming with what Professor James Reason calls “Humans as Heroes”. We should pay more attention to that heroism.


You can learn more about Appreciative Inquiry and how to use it to make healthcare safer and more compassionate at the forthcoming IHLM Professional Certificate in Patient Safety, taking place at The Conrad Hotel in Dubai from 30 April to 4 May 2017. Click here to download the full brochure and click here to book your place on the programme.

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