Thinking black cloudsAnother week – another report highlighting NHS performance issues.  This time around it’s a report highlighting the high number of serious surgeries which are cancelled on the day they are scheduled.  A significant proportion of patients have had their operation cancelled more than once.  Stress for patients, frustration for doctors plus wasted time and resources.  You may already have been involved in discussions within your team about how to sort this out.  Reasons must be identified.  Solutions must be developed.  Actions must be put in place.

But this blog isn’t about cancelled operations.  It’s about the mindset that typically prevails when we are trying to improve something and the unintended negative impacts.

The negative downward spiral

We generally have a tendency to focus on what’s going wrong and what’s not working.  “This is failing”.  “We don’t have resources”.  “That’s not being done well enough”.  “They/we/you didn’t do what they/we/you were supposed to do”.  We then try to figure how to fix the problem or solve the puzzle.  The fixation on failure and under-performance breeds blame and negativity.  The more and more we look at the problems the more they multiply.  They multiply in both severity and in number.  The more problems we have and the bigger they are, the more stressed and negative we feel.  The more people who are discussing the problems, the more people who feel the same.  Morale heads in a downward spiral.  If this goes unchecked it feels like we’re circling the drain with no way back.

No wonder some simply dissociate or bury their head in the sand.  But we can’t ignore the problems.  We have to face up to them and deal with them.

Could there be another way to look at this?

If a negative approach leads to negativity then it would be logical that there must be a positive alternative.  But our instincts tell us we must ask the tough questions and face facts if we are to improve.  Surely anything else is simply naive?

The well-established approach of Appreciative Inquiry is driven by a number of psychological principles, including the idea that a positively asked question will lead to positive change.  The model is summarised very well in this short video.


I’ve painted a rather bleak picture of focusing on the problem.  You may find there are benefits to taking different approaches at different times.

Take a few moments to consider:

On balance, is my approach more ‘problem interrogation’ or ‘appreciative inquiry’?  What is the impact of that?

Stephen McGuire – Head of Development