How did an ‘Appreciative Inquiry’ intervention to improve infection control in maternity care work? A qualitative study in India

Objective
To investigate how Appreciative Inquiry (AI) influenced infection control practices. This study was a part of a larger interrupted time series study.

Methods
AI, an organisational change agent focuses on positive aspects (what is done well). During the intervention, all cadres of hospital personnel were brought together to share their experiences of saving women’s lives during childbirth. They agreed on do-able action plans for improving infection control in their hospitals. Between three and six months after the intervention, 31 in-depth interviews were conducted and observation checklists used to investigate the perceived influence of AI on clinical practices, human resource management and work culture.

Results
AI was perceived as having a positive influence on team relationships; improving communication across the power hierarchy of hospitals; fostering trust and cooperation with inclusion of the marginalized and non-technical staff in the team; and developing better understanding of one’s own role and those of the others. The intervention did not lead to changes in human resource policies, financial and information systems or leadership and governance. Pre-existing factors such as power and autonomy of leaders, the leader’s motivation for change, leadership styles and a background of organizational reform such as accreditation influenced the AI process.

Conclusions
AI can lead to changes in infection control practices in hospitals. AI meetings serve as a forum for team building, shared decision making, problem solving, capacity building and a means for developing a shared ideology and values for service delivery, thereby setting-up an organisational ‘work culture’. Reforms such as accreditation appear to put organizations into a receptive, high alert, active mode.