Using Appreciative Inquiry to Decrease Incivility and Promote a Healthy Work Environment: A Literature Review

Saturday, 23 February 2019

Kelly C. Tomlinson, MSN, RN1
David P. Hrabe, PhD, RN2
Joyce Zurmehly, PhD, DNP, RN, NEA-BC3
Barbara Warren, PhD, RN, PMHCNS-BC, FNAP, FAAN2
(1)Department of Nursing, City of Hope, Duarte, CA, USA
(2)College of Nursing, The Ohio State University, Columbus, OH, USA
(3)College of Nursing, Ohio State University, Columbus, OH, USA

Using Appreciative Inquiry to Decrease Incivility and Promote a Healthy Work Environment: A Literature Review

The contemporary healthcare environment is complex and stressful. As healthcare professionals struggle to meet the needs of patients, families, and communities; tension and negative attitudes often prevail. This high-stress atmosphere can lead to an unhealthy work environment in the form of disruptive behavior, lateral or horizontal violence and/or bullying (Vogel, 2016; Bujold, 2015; Dondale, 2012). Beyond the concern of an unhealthy work environment, incivility can lead to high employee turnover, negative patient outcomes and increased healthcare costs (Gillen, Kernohan, Begley, & Luvben, 2017; Oyeleye, Hanson, O’Connor, & Dunn, 2013; The Joint Commission, 2016; Townsend, 2012; Wilson, Diedrich, Phelps, & Choi, 2011; Ulrich, Lavandero, Woods, & Early 2014).

Attempts to meet the needs of healthcare staff and patients with current traditional methods of managing and creating change have been ineffective (Trajkovski, Schmeid, Vickers, & Jackson, 2013). In a Cochrane review of interventions regarding incivility in the workplace, there was little evidence that problem-focused individual or organizational interventions effectively addressed incivility (Gillen, Kernohan, Begley, & Luvben, 2017). A different approach is needed.

Appreciative inquiry (AI), developed by Cooperrider and Srivasta (1987), constructs a shared vision in a positive manner with the underlying premise that the focus of one’s attention is what becomes one’s reality (Trajkovski, Schmeid, Vickers, & Jackson, 2013). Evidence supports that AI can be an effective intervention to create a more positive organizational climate, affect how individuals appraise their environment and increase employee engagement (Bushe & Kassam, 2005; Campbell, 2013; Richer, Ritchie, & Marchionni, 2010; Ruhe et al., 2011; Trajkovski, et al’s. (2013).

To deliver high quality, safe patient care, a work environment should promote positive interactions, clear communication, and collaboration. Appreciative Inquiry is a promising strategy to address incivility and promote a healthy work environment.

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