A bit of a departure for the Positive Change Methods podcast this week! We’re going to alternate the short episodes that we’ve had previously with occasional interviews with Appreciative Inquiry practitioners and thought leaders in the area of positive change, so that you can get the benefit of their experience and insight.
This week, I’m very honoured to have as my guest my friend Wendy Burton, who has a lot of experience in using Appreciative Inquiry in the fields of service improvement and innovation in the National Health Service or ‘NHS’ in England.
Wendy highlights the critical role of creating a safe environment for healthcare professionals. She explains that staff creativity and innovation are stifled when they do not feel secure and hopeful about the future. This insight is backed by research from Michael West at the King’s Fund, which shows that teams that feel appreciated and safe are more likely to provide better patient care and satisfaction.
One of the key takeaways from the episode is Wendy’s concept of “tools as permission slips.” She emphasises that using the right tools enables teams to think differently and explore new solutions. Appreciative inquiry, in this context, serves as a foundational method that encourages teams to focus on what is working well and how they can build upon that success.
Wendy also shares compelling stories from her career, including a transformative experience where she worked with a struggling NHS trust. By employing appreciative inquiry over a five-day workshop, the team was able to identify bottlenecks in their service delivery and collaboratively redesign their processes. This hands-on approach not only revitalised the team’s spirit but also led to tangible improvements in their service.
We also delve into the integration of appreciative inquiry with other methodologies like Lean and Design Thinking. Wendy provides practical tips for practitioners looking to combine these approaches effectively, emphasising the importance of maintaining an appreciative mindset throughout the process.
As the conversation unfolds, Wendy’s passion for her work shines through. She reminds us that the journey of using Appreciative Inquiry is not always linear; you need patience, resilience, and a commitment to nurturing an environment where creativity can flourish.
If you’re interested in learning how to foster a culture of innovation and collaboration within your team, this episode is a must-listen. Wendy’s insights are invaluable for anyone involved in healthcare, coaching, or organisational change. Listen now to discover how appreciative inquiry can be a powerful catalyst for positive change!
Includes:
- How Wendy Uses Appreciative Inquiry in the NHS
- The Importance of Psychological Safety in Innovation
- Tools as ‘Permission Slips’
- Combining Appreciative Inquiry with Lean and Design Thinking
- Using the Emotional Intelligence 4-Quadrant Model as Self-Care for Practitioners
… and much more!
Listen to the episode with the podcast player below or subscribe via your favourite podcast app.
And if you like it, please share and recommend it to your friends!
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References in this episode
Psychological safety supports innovation – see for example this article by Professor Michael West (PDF download)
Lean methodology (this is just one of the many introductory articles out there, including some that are NHS-specific PDF downloads)
Design Thinking (again, there are many articles out there)
Stephen MR Covey: The Speed of Trust (video talk)
Wendy’s LinkedIn profile – I don’t know if she ever looks at it so maybe best to email me if you want to hire her as a coach, and I can pass the message on!
Interview with Wendy Burton – transcript
Andy Smith: This episode of the Positive Change Methods podcast is something new. We’re going to intersperse the short episodes that we’ve had previously with slightly longer interviews – about half an hour – with Appreciative Inquiry practitioners and thought leaders in the area of positive change.
This week, I’m very honoured to have as my guest my friend Wendy Burton, who has a lot of experience in using Appreciative Inquiry in the fields of service improvement and innovation in the National Health Service or ‘NHS’ in England.
Welcome to the Positive Change Methods podcast, Wendy Burton. First thing to ask, what is your job and how do you use Appreciative Inquiry in it?
Wendy Burton: So my main job is with the NHS. So I was a nurse for 40 years and I retired and returned on two days a week. And in that work is where I mainly use Appreciative Inquiry through the methods that I employ. And so my role there is coach and helping teams to cope with change across the whole of the northwest coast [of England] and then helping them to spread and adopt new ways of working and innovation The other two: so I’m self employed as a coach and a restorative practitioner and in that work I go into work with teams that are in difficulty really or teams that need help with change, particularly looking at things like values and behaviours and leadership, and , specifically around the restorative elements, so when there’s been some form of an issue and they’re recovering themselves as a team from that.
So that’s my second role, and then my third one is for the Nursing and Midwifery Council, the NMC in the UK. And so I work as an advisor on one of the fitness to practice panels. So when a nurse is referred for questionable practice, then a panel get together to review the evidence and make a decision about whether she or he should or shouldn’t stay on the register because of the risk to the public.
Andy: Right, okay, well the restorative practitioner one sounds interesting, we may get you back at some point in the future to ask you about that. But this time let’s focus on the first one. do you use Appreciative Inquiry in the NHS?
Wendy: Okay, gosh, where do you start? And so my job in that particular role is to work as a team coach or a system coach. So we work across whole systems. So in the NHS you’ve got regions. So for example some of my regions are Cheshire, Merseyside, Lancashire, Cumbria, parts of Manchester, parts of Wales… and so those systems have all got physios and they’ve all got doctors and they’ve all got nurses working on stroke, for example, but they’ll all do it differently. And obviously the NHS needs to be efficient, we need to save money and we need to make sure that we get the gold standard of care and make sure everybody works to that standard. So we also are currently introducing innovation into those services. So we’re helping them to think about, could we use a robot or could we use an app, or what might a change of practice look like for us? And Appreciative Inquiry fits in really nicely in all of those areas, really. I think I couldn’t use the rest of my toolkit without having Appreciative Inquiry in the middle because, you know, it’s that heliotropic view where you’re looking outwards and saying what could be good. And, you know, sadly, the NHS staff are very tired and anything that inspires them to get that intrinsic motivation to want to go on and to believe in the story that you’re telling them, is…
Andy: Heliotropic meaning metaphorically turning towards the sun, turning towards the image of a positive future?
Wendy: Yeah, yeah. So sometimes we’ve got to dig deep in the NHS to find that because they’re tired, the staff are tired, and although Covid was a good few years ago now, they’re still recovering, so, you know, they’re working harder than ever. And any little bit of help we can give them to be hopeful and outward looking, helps them. But also there’s really strong evidence in the NHS that staff won’t be creative and they won’t find innovation if they don’t feel safe and hopeful about the future. So, you know, there is a method behind the madness, really. It’s not just being fluffy, it’s about using techniques that help to get the best out of them as well.
Andy: That’s interesting, that they won’t be innovative unless they feel safe. I’ll be asking you about links to research for that, to put in the show notes later on.
Wendy: Right. Oh, so if you look up Professor Michael West at the King’s Fund, he’s done years of research on it and he actually managed to prove with his research, and I do quote it a lot, that in acute trusts, so when you’re in hospital and you’re poorly, if a team feels safe on a ward and they feel appreciated and comfortable in their role, then they will be more in a position to think about satisfaction for the patients and what that might mean and how you might create that. And he’s proved that you get reduced mortality by doing that with your patients.
Andy: Wow. I’ll put a link in the show notes to that. So, Appreciative Inquiry is at the centre of what you do. How does it enable everything else to work?
Wendy: Well, it’s a tool, isn’t it? It’s a tool. And I firmly believe that a tool – and this isn’t my quote, it’s another coach’s quote, but I really believe that tools are permission slips to act differently. So by using the right tool, you give the right type of permission to find a different outcome, if that makes sense. So I never use just one tool because I’ve, you know, I’ve been in the NHS 40 years, I’ve seen every iteration of the NHS and along the way I’ve been like a rolling stone, picking moss up. So my kit bag is full of permission slips and so I will get to know a team and think what will work best for this team. And then – but Appreciative Inquiry has to be in the middle of that, because what we’re saying to teams is, you clinicians know better than anyone what the NHS needs, where it’s going wrong, where it’s doing well. Therefore, how do we come together in a really fair way, collaboratively, that helps you to decide what needs to happen in this service. So Appreciative Inquiry are lovely questions to sit in the middle of that work.
Andy: Ah yes, I’m really interested in this idea of tools as permission slips. Because sometimes when I’ve been training people in Appreciative Inquiry, I’ve had people say to me afterwards, “I’ve finally got a name for what I’ve been doing and the way I’ve done things”. And yes, I’ve heard that kind of “hadn’t been recognised” or “hadn’t been legitimised” before. So is that what that saying means? Or is there more to it?
Wendy: Yeah, there is more to it. And I don’t, you know, I’m trying to not sound – I’m gonna get really colloquial now, but I’m trying to not sound “big ‘ead, no bread in the ‘ouse”. But I’ve been doing it a long time, so what it means to me might be different to what it means to a new practitioner coming in. So when they’re young in the practice and they’re coming into coaching or into facilitation and they’re trying to work with teams, then using the language of Appreciative Inquiry and the label of it helps them to get things through the red tape. So if they say to a senior team or a manager or an exec lead or a champion or a sponsor of a project, I’m going to do this and I’m going to use Appreciative Inquiry, it gives them permission to act in a certain way and to focus on that outcome.
I use it slightly differently. So a permission slip for me means, you get in with a team, you get your sleeves rolled up, you’re a player in the field, and then you use your permission slip to open the thinking up to different ways of doing business. So almost saying to them, that’s great what you’re doing, and I know you’re surrounded by lots of problems, but that’s a really good example. How could we spread that? What would spread look like? And if you woke up tomorrow and the commissioner said, please make that happen, what would be the thing you would do? So it’s around. And I think I learned this many moons ago off a really well tuned coach who talked about golden questions with me and said, ‘what are your golden questions going to be?’ So my golden questions in the main are appreciative questions that trigger permission to think there’s another way of doing this. Very often in the NHS, staff think they need a boss or a ‘head of’ to say to them, “yes, you can do that.” And so my work is to get in at the gravel and saying to them, “Your boss doesn’t care, the boss just wants the job done. So how are you going to do it? Really well.”
And it can be the nitty gritty of the day job, really. And that’s when you start thinking about things like Lean. So process mapping: tell me what the process looks like. And then saying, well, there’s your bottlenecks. What might be good if you change that? How might you make that look differently? Where’s the energy in the room to work with that change? So it depends on who you’re asking us to what answer you’d get on permission slips.
Andy: Right. So I’m going to ask you an appreciative question, actually a standard one from appreciative interviews. ‘Tell us about one of your best experiences using Appreciative Inquiry in your work.’
Wendy: Okay. Okay. It’s a good – I’m going to say it’s probably seven-ish years ago. Yeah. and I was working in a trust that was in real difficulty and many NHS colleagues will have gone through that. Where there’s been no money, there’s been no staff, there’s been no resource, there’s lots of complaints; the local Healthwatch oversight group are on you, complaining about you and putting things in the press about you. And a quite senior manager, who I knew really well, came to see me and said, ‘ Oh, I think we need you to do some work with this team and I’m giving you permission to act differently with them. What would that look like?” And so we took them out of practice for five days. So we closed the service down for five days, which you just, you can’t do in the NHS. But we did; we used agency staff to backfill and we offered a skeleton service and we pulled all the practitioners out to a venue and we used Appreciative Inquiry with Lean at the time. And, we got them to map from start to finish: ‘What’s this service you’re offering? Tell me where the bottlenecks are.’
So we started from a negative, from ‘What are the problems?’ And then we sent them home for the day and they came back the next day and we said, ‘Okay, split into your subgroups. Now, each one of you pick a subgroup that you’ve got energy for.’
So I have a real thing in coaching about, if you’re going to ask a team to do some work, you need to find the ones with the energy and if they’ve not got energy, they’re not going to make it work. ‘So pick these six things where do you want to work today?’. So you’re starting them off with permission straight away.
Andy: So even if they all wanted to work on the same thing and no-one wants to work on the other five, that’s the one you go for?
Wendy: No. So it’s a conversation, isn’t it, in coaching about, “There’s these five things you all need to work on. These five things, you voted for them, you said they were bottlenecks, so who’s going to go where?”
And then once they’ve gone, “I’ll do that one,” if you get 10 in one and two in another, you say, “We really need some more in this group.” And what I find is, people by then have bought in. So they’ll say things like, “Well, I really wanted to do this but I’ll go there and I’ll visit that group in an hour. So they start to be quite collaborative about how they work then. And so over the course of the next five days, they redesigned all the bottlenecks one by one. And in the middle of that was, “What would it look like if you woke up tomorrow when it was fixed? If you had a magic wand, what gives this life? How have you strayed away from what gives it life? How can you stray back? What might it look like?” a
And we used cutting up of pictures and buzzwords and little diagrams. I wish I’d kept the work. I probably do have it somewhere on my iPad. And then we said, “Okay, that’s the service spec.” And then at the end of that five days, they took that service spec to the commissioners and said, this is what we think will work. And the commissioners said, “Okay, we will monitor you. We want to see the measures and the outcomes. But it’s broke. You’ve attempted to fix it. Let’s go.”
So there was that one, and I’ve not followed that up because obviously I then moved on to another role not long after that. And there was another one, Andy. And you might remember this because I remember being involved with you at the time where we decided in the Health Authority that I was in – that’s quite old language, but, you know, that segment of the NHS – we decided that we knew system leadership was on the horizon and we knew that none of us were ready for it. So we did a course and we called it Social Pioneers and we designed it from start to finish. And then we brought all the leaders in and said, “Here’s the story.” And we told an appreciative story and said, “This is what we think the future is going to look like and we really want you guys to be sovereign in that change. We don’t want others coming and telling you how to run a continence service. You know it. So for you to be able to do that and to run stroke and to run a diabetic clinic, you need to be the voices in the system that are influencing change.”
So we ran a programme with them and we taught them all kinds of new skills. And in the middle of that was an Appreciative Inquiry workshop. I’m sure you remember it. And those practitioners have all gone on to bigger, better things. And so. So they. What they did was they went back to the system with that new knowledge and put that knowledge into practice themselves as practitioners. And many of them are now in really senior roles across the NHS. One of them, Sarah, is in local hospice as the Chief Operating Officer and uses those skills and techniques in her day job with the teams that she’s working with. So that was working at a strategic perspective and saying “We know we need to equip you differently so what might that skill set be?” And there was another lady on that course and I’m still in contact with her. In fact I’m doing a podcast with her soon on psychological safety which is one of my – I get a be in my bonnet about that. And she uses that and she’s an artist as well and she uses it in her art and, and she uses it when she’s out working with primary care every day and often says to me “Do you remember that course? That’s what made me who I am today.” So really good things.
Andy: Yes, you never know what lasting changes you’re going to spark. And this is because I tend to come in, do some training, and then go away again. I rarely get to see the long term results. But it sounds like there has been some long term influence for the good there, which is good to know.
So I’m going to have to get some sort of link to an overview of Lean from you to put in the show notes. I’m not familiar with it really although I’m sure some of our listeners will be. So you’re using Appreciative Inquiry with Lean and you use it with Design Thinking?
Wendy: Mhm.
Andy: Right. For practitioners who want to use Appreciative Inquiry with one or other of those approaches, any practical tips for combining Appreciative Inquiry with either of those?
Wendy: I suppose for me the practical tips are, and I’m saying this tongue in cheek because my husband says I’m really chaotic and he’s always saying to me “Fail to plan, plan to fail.” But actually in my day job, that’s what it’s all about for new practitioners. So if they approach a project that they’re running, or a ‘piece of work’ we call it that they’re running, they think “How am I going to do this?” They need to have done some learning around Appreciative Inquiry to understand the difference. I don’t know if you’ve read any of Franklin Covey, the work that they do, they talk about ‘leading at the speed of trust’ and they say that if the roots of the tree are not strong and you’ve not got integrity in your work, and you’ve not got credibility, it doesn’t matter, your project will fail because you’re not bringing people with you. So it’s really important that we use the right language. So any practitioner that’s thinking, “Oh, I’m going to go and use that in my day job,” they need to be able to have a pitch that says, “This is what Appreciative Inquiry is, and this is what it’s not. This is what it will do, this is what it won’t do.” And then they need to look at whatever other tools they’ve got in their toolkit and think, “How do those two go together? How can I blend them and get the best out of both of them so we get a better outcome at the end of the work. And what are we going to measure appreciatively as well as other metrics?” So that’s what, even today, after 40 years, that’s still what I do to make it work. But it really does worry me that we mis-label it when we’re younger in our practice.
And then the other thing is, although I said that I use it in Lean and I do these days, I’m not doing so much Lean, so I’m more towards the ‘what could be?’ rather than ‘where are you stuck? What are your problems?’ So Lean is about – it’s finding the problems, it’s finding the seven wastes, it’s mapping everything, it’s finding places that you’re stuck. “That’s your bottleneck,” and it’s talking about, “Okay, we know what’s wrong now, how do we fix it?”
Very often staff get stuck at ‘how do we fix it?’ And that’s where Appreciative Inquiry would come in, isn’t it? But you’ve started them off on a negative because you’ve said, “Tell me all the rubbish in the system.”
So it’s risky and you’ve got to be a really confident practitioner to go, “Yesterday you told me it was rubbish, and today we’re going to look to the future with hope.” And if you can’t manage that as a coach, you’ll lose them. It’s really risky. So you’ve got to be able to find the right tools. So what I have found in my current practice is that Design thinking is the tool that is really nice, marries really well with Appreciative Inquiry. So you’ve got the 5D process for Appreciative Inquiry, haven’t you? So you’ve got Define, Discover, Dream, Design, and Deliver. In Design Thinking, you’ve got Empathise, Define, Ideate, Prototype, and Test. And so appreciative questioning fits in right through there and keeps the lens on “What can we do nicely and better and what would benefit the patient and what will be healthier?” And they often get stuck and say, “Yeah, but we’ve got this problem.”
And it’s about saying to them, “Whoa, Neddy! We’ll get to the problem when we come to the planning stage. So reining them in and disciplining them into staying in that appreciative mindset, and the two work really nicely together I find .
Andy: Interesting, it sounds like you’ve got a book in there, or a course or something.
Wendy: I wish, I wish.
Andy: Okay, so I have another question. What have you learned from using Appreciative Inquiry in practice that you didn’t get from your training or from books you’ve read about it?
Wendy: What have I learned that I didn’t get from my training? So what I learned from practising it was that it’s not necessarily always linear, so it’s iterative and so is Design Thinking, and I like that. and I learned that you can’t have hard edges. You’ve got to allow people to meander, to change and to slowly build the safety net that they need to talk about change. And so your coaching and your facilitation skills become really important into – I suppose it’s like making a cup of tea in the UK, you know, you put your milk in, your sugar in, your tea bag, and you mash your tea and then you stir it and then you pour it and it’s not quite dark enough, so you leave the pot a bit. And it feels like that. With using Appreciative Inquiry, you’re constantly nurturing them along to the next step and the next step. And you only get that by playing with the tool, by immersing yourself and being a player in that environment.
Andy: Yes, and noticing where they are and listening to concerns.
Wendy: Yeah. And do you know what else, Andy, I find? So I’m a natural introvert, believe it or not. And so I get my energy from being in a quiet room on my own, and when I have to go and work with a team of 50 and ‘extrovert’ myself, that’s exhausting for me. And I love it, but I need to go away and recover afterwards. And on the days where it’s really challenging, I think an Appreciative Inquiry practitioner needs resilience and they need inner belief and they need to really trust the tool that even when it feels wrong, it’s right. And don’t give up and dig a bit deeper today. And how are you going to dig deeper? So even though we’re talking about Appreciative Inquiry, how are you going to dig deep for yourself before you start, so that you stay in a safe zone? Because what you’re doing is holding an appreciative space for others to be creative. And what I really love is, I haven’t got all the answers or the idea. In fact, I’ve probably got none. But what I’ve got is a space where they can come together and go, light bulb, light bulb, light bulb. And they’ll only do that as they warm up through Appreciative Inquiry, I find.
Andy: Yeah, they’ve got the answers. As facilitators, we haven’t. I mean, probably, as somebody with 40 years experience in the NHS, you’ve probably got loads of answers, but they wouldn’t necessarily be the right ones for that group or for those people. No, you have to believe that they’ve got the answers. What you’ve got are the questions, to help them put their attention in the places where they’re going to find it – collectively, not just individually.
Wendy: Yeah. So looking after yourself in an appreciative way whilst you’re delivering is important. So do you remember a model as a tool, a permission slip that you designed years ago and I think you’d taken it from some other work that you’d found and said, this is what it looks like to me and you taught it to me and it was a box, a four box grid and it said self, other and down the side, I can’t remember what it says. I’ll have to look it up.
Andy: Oh, I think it’s the emotional intelligence quadrant, the one scale being self and other, going left to right, and then the downward scale is awareness and management. Being self aware, being aware of what the other person’s feeling, being able to manage your own emotions and being able to handle and influence the emotions of others.
Wendy: Yeah, So I use that a lot for myself before I go into sessions and I’ll ask myself those questions in an appreciative way. “What are you feeling? What’s making you feel that way? How do you want to feel? What would be different and what do you want them to get from today?” And then I ask the same questions about the other, but I also… So I’ve created, if you like, go on, go and do it now, make it so. But then I take that tool with me to those events and if I sense them dipping or we’ve got something going on in the group that’s a bit disruptive, I will stop the group and say, let me show you this tool and I’ll put the tool up on the screen and then I give them an example of it and say, this is what happened to me when I went to work with dental. And I say dental because that one was stuck in my head because it was traumatic and how powerful that tool was. Ah. So although we’re talking Appreciative Inquiry, you’ve also got to be appreciative in your preparation of yourselves as well. Quite important, really.
Andy: So that was the interview with Wendy Burton. She mentioned that as well as working for the NHS, she works independently as a coach, and you might be wondering, where do I find her online so I can hire her. Well, she’s in the lucky position of getting all of her work through word of mouth, so she doesn’t have much of an online presence. I’ll put her LinkedIn profile in the show notes so you can contact her – I’m not sure she’s kept it up to date, because she hasn’t needed to, but it’s there.
Alternatively, if you email me at andy@coachingleaders.co.uk, I can put you in touch with her.