RAP Lesson Learned #2: The Power of Meeting People Where They Are

Rhonda Barcus, Program Specialist

Last time, I shared a little about the first lesson I learned from RAP (Recommendation Adoption Process), the process we use to gather outcome data from hospitals who have participated in an onsite project through Rural Hospital Performance Improvement (RHPI) Project. That first lesson was about the power and impact of just having a conversation with someone. The second lesson concerns the power of “meeting people where they are.”

 

RAP involves asking lots of questions about how the hospital implemented the consultant’s recommendations and how that affected measurable outcomes. This is a conversation which could easily put someone “on guard”, feeling like they have to justify their actions, or sometimes, inaction. When we created the RAP process, we based it loosely on an organizational development model called Appreciative Inquiry (AI). AI focuses on discovering what is going well and the strengths and assets and seeks to create more of what already “is.” This approach is very unlike the medical model or problem solving model which focuses on the deficits, illness, or problems. 

The first question in the RAP process is “Tell me what is going well.” As the administrator (or sometimes entire leadership team) begins talking about their successes, my next question is “and what else?” We continue with this line of questioning until they can no longer name another success. The power of this approach is that it often leads to the interviewees saying, “Wow, I didn’t realize we had accomplished so much!” 

The next part of the conversation is geared towards next steps or discovering what hasn’t gone well. Instead of asking about the problems, the focus is on what the hospital would be doing to create the best possible outcomes from this project. The question then might be, “If you could imagine the best possible outcomes for this project, what would you all be doing more of or differently?” This very naturally leads into a discussion about recommendations not implemented or setbacks to the project. Done in this way, the conversation is not defensive or negative because in the spirit of AI, it focuses on “what could be.” It is a subtle, but very effective way to get at the barriers or sometimes resistance but does so in a way that is motivating to moving forward.

The other critical piece of RAP that reinforces “meeting people where they are” is the way the stage is set from the beginning of the conversation. We have discovered that most projects take one to two years to implement. I always begin a conversation by letting the hospital know that. There is often a sigh of relief heard through the phone followed by, “Thank goodness, we were worried you would think we hadn’t done enough.” It is amazing the incredible amount of work most hospitals have already done on a project but they expect to be told that they should be finished in nine months. Thorough and thoughtful implementation takes time but is more likely to lead to a sustainable project with lasting results.

Next time, RAP Lesson Learned #3: The Power of Team.