P3.A008: Prescription for Joy: Using Appreciative Inquiry to Improve Culture and Find Joy in the Emergency Department

Background: The aftermath of COVID, high patient volumes and staffing inefficiencies resulted in a crisis of low staff morale, high left without being seen (LWBS) rates and a sense of helplessness and negativity amongst Emergency Department (ED) staff. Despite hospital leadership supporting increased staffing, a culture shift was necessary. Appreciative Inquiry (AI) is a methodology and model of organizational development that employs a relentlessly positive, whole-system collaborative approach. AI leads to improvement by discovering and amplifying strengths rather than fixing problems. Change occurs through a summit meeting which follows steps known as the 5D cycle (See Figure 1). To date, the adoption of AI in healthcare settings has been limited. In partnership with hospital leadership, we conducted an AI summit at a large freestanding children’s hospital to improve morale in the ED.

Methods: A steering committee comprised of physicians, hospital administrators, and nurses DEFINED the affirmative topic for the project: finding joy at work. Participants included hospital leaders, ED doctors, nurses, subspecialty consultants, clerks, social workers, research assistants and child life specialists. At the summit everyone shared highpoint stories to DISCOVER what brings us joy at work, and who we are when we are at our best. This phase looked deeper into what gives meaning to our work and a Strengths Map was built. Next, our DREAM for the future was visualized into a list of opportunities. Summit participants voted on these, and top winners fell under three major categories (see Fig 2). These opportunities progressed to the DESIGN phase where brainstorming and prototyping gave form to our DREAMS. DELIVERY was addressed by work groups delineating small steps toward realization and continued work post summit.

Results: Within 6 months leadership noted improved staff morale. When successful results of the summit are shared at staff meetings, ED staff have come forward with innovative ideas, manifesting sense of ownership in improving our workplace. Physicians, nurses and support staff feel empowered to implement change.

See Figure 2 for summit results at 6 months.

Conclusion: Culture change can start by asking positive questions. The whole-system approach and sharing highpoint stories demonstrates that despite different roles and skills, we all value similar things, which fosters connections and recognition with each other. As positive changes occur, more people feel empowered to offer ideas for improvement thus illustrating the reiterative nature of this process. We are experiencing joy by magnifying our strengths.