“I didn’t do it!”…“The dog ate my homework”…“He started it!”
Every child learns at some point that failure is bad and dodging blame is a winning strategy. By the time we’re working adults, avoiding association with failure is all but second nature. This self-protective reflex harms the companies we work for, because they can’t learn from failures if people don’t admit and analyze them. In any industry where innovation is crucial for survival, an ability to learn from failure is an essential skill. And leadership makes it happen.
To suggest that you, as health care leaders, may need to fail more often may sound counterintuitive, if not downright irresponsible, given the current state of affairs in the industry. But encouraging the right kind of failure in your organization may be exactly what’s needed to spark innovation where it’s lacking.
One of the things I’ve learned in two decades of studying learning in organizations—in every conceivable work environment, from fast food restaurants to hospitals—is that learning from failure starts with un-learning. Our childish notions of success are intimately twined with self-esteem, status, and the need for approval. They’re childish, because as adults we understand that knowledge is in constant flux, technology keeps changing, and we’re rarely doing the exact same thing twice. Expecting failure-free performance is simply unrealistic in a dynamic context. But we’re so conditioned to conceal mistakes that it becomes easy to fail to learn from them. To be more effective, we must un-learn spontaneous responses and reprogram our approach. This starts with a deeper understanding of failure.
In my research, I’ve found that failures fall into three basic categories: preventable, complex, and intelligent.
Preventable failures are those that can be avoided through alert management and careful action. These failures typically occur when people deviate from prescribed procedures in routine work, whether in manufacturing or services, often as a result of lack of training, or inattention.
In contrast, complex failures occur when many interacting elements come together in unanticipated ways. Hospitals, aircraft carriers, and nuclear power plants are vulnerable to these kinds of failures because of the variability and complexity of the work. A particular combination of people and problems may never have occurred before. Triaging patients in a hospital emergency room, responding to enemy actions on the battlefield, and running a fast-growing start-up all involve unpredictability and hence an inherent risk of failure. Calling complex failures “bad” is counterproductive – it fosters a mindset that makes it harder to catch and correct small problems before they mushroom into serious failures. In hospitals, for example, most adverse events are the result of a series of small failures that went unremarked and unfortunately lined up in just the wrong way. Small failures are inevitable in complex systems – but accidents aren’t. Preventing complex failures starts with helping people circumvent self-protective reflexes.
Intelligent failures are more than not “bad”—they’re actually good because they provide valuable new knowledge that can help an organization leap ahead of the competition. Discovering new drugs, creating a radical new business model, designing an innovative product, and testing customer reactions in a new market are tasks that require making intelligent failures along the way to success. Intelligent failures come with thoughtful action in new territory. Experiments, which necessarily involve both failures and successes, line the path toward successful innovation. And so the sooner you make intelligent failures, the sooner you learn what succeeds.
Too often, however, all failures in organizations are treated as if they were preventable. No one wants to be associated with a failure, because the message is clear – those who made them are losers. But when you consider these three types of failures – the distinctions are easy enough to make – treating them all the same doesn’t make sense.
Successful organizational learning from failure thus starts with diagnosis – the foundation for effective leadership action. First, if a failure is of the intelligent kind, celebrate it. Eli Lilly’s Chief Scientific Officer throws a party when thoughtful projects fail. Why? Not only to make sure people feel that failure is not stigmatized in R&D, but also to encourage scientists to speak up about a failing course of action sooner rather than later. It’s just plain human nature to cross your fingers and hope that more time or more resources are all you need to turn a failing project around! By celebrating intelligent failures, Lilly encourages timely reassignment of valuable resources to new projects.
Second, complex failures warrant immediate analysis, taking care to include multiple perspectives from the different people, professions, or departments involved in the breakdown, to learn as much as possible from the failure. This multidisciplinary analysis is vital to solving system problems and avoiding future failures of a similar nature. Great hospitals like Intermountain Healthcare and Minneapolis Children’s Hospital, routinely engage in this team-based learning. Finally, preventable failures call for root-cause analysis to find out what went wrong in an otherwise routine process. Was it a training gap, or perhaps fatigue? This in turn should be used to help prevent the same failure from happening again. Toyota’s famed production system does this analytic work extraordinarily well.
No matter what kind of failure occurs, avoid playing the blame game – the pull to identify culprits rather than causes. The blame game has long been popular in medicine, but it’s deeply counterproductive. A better formula for success goes something like this:
1. Aim high
2. Encounter failures
3. Learn from them
The Gauntlet Before Health Care Leaders is to Eliminate Unnecessary Care
By William Chin, MD
Who better to achieve higher quality outcomes and reduce the waste in care than the physicians leading this process? If we are the best people to do this, then let's start. Or, we need to stand aside and stop lamenting the change happening around us. Read more
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