Active Inquiry and "And What Else" Strategy in Problem-Solving

Here is a quick way to change your question-asking strategy to get the heart of the problems you face as leaders.

Recently, a former colleague and healthcare leader reached out to me. She was concerned about one of the nursing units she oversaw. Patient satisfaction scores had significantly declined for this unit. The conventional approach would have been to quickly identify potential causes and implement solutions. However, I decided to apply the principles of active inquiry and the "And What Else" strategy to get to the heart of the matter.

1. Initial Assessment: I asked the leader, "What is going on here with the decline in patient satisfaction scores?" She replied, "Patients are scoring us as poor and are unhappy with their care." I asked, "And what else is happening?" She replied, "Our response rate is low." I asked again, "And what else?" She replied, "Staff rolls their eyes at me when I discuss patient satisfaction scores."
2. Active Listening: Instead of jumping to conclusions or proposing solutions immediately, I actively listened to her responses. Additional conversations with team members took a similar suite. Team members shared various reasons, such as increased workload, communication issues, and changes in the patient population. They shared that they want to avoid hearing about scores when struggling on the floor. 
3. And What Else: After hearing their initial thoughts, I asked, "And what else might be contributing to this decline?" This simple question encouraged them to think deeper and uncover additional factors they hadn't initially mentioned.
4. Further Exploration: As they continued to share, we discovered that there were also issues related to staff morale, a lack of training in handling difficult patient situations, and a disconnect between management and frontline staff.
5. Collaborative Problem-Solving: With a more comprehensive understanding of the problem, we discussed potential solutions collaboratively. This included additional training for staff, addressing communication gaps, and implementing strategies to boost morale.
6. Continuous Improvement: Instead of implementing quick fixes, we decided to monitor the situation closely, gathering feedback from patients and staff to assess the impact of our changes. This allowed us to make ongoing adjustments and improvements.

By applying active inquiry and the "And What Else" strategy, we uncovered the root causes of the decline in patient satisfaction scores and addressed them comprehensively. This approach led to short-term improvements and fostered a culture of continuous improvement within the department.In conclusion, active inquiry and appreciative inquiry are valuable problem-solving paradigms that encourage a deeper exploration of issues in healthcare. They promote a holistic understanding of problems and enable leaders to implement more effective and sustainable solutions.