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Health care must learn to embrace failure


Forty is the new thirty. Orange is the new black. And failure is the new success.

It seems these days that no success story is complete without a failure (or two) along the way: the bankruptcy that gave birth to a successful company; the entrepreneur who lost it all just before hitting the Fortune 500. Entire issues of the Harvard Business Reviewand the New York Times Magazine have been devoted to failure. In the business world leaders are often told: “Fail fast, fail early, fail often.”

In many sectors it is understood that to innovate, we must accept – even celebrate – failure.

Healthcare needs positive innovation. At nearly 12 per cent of our GDP, healthcare is a huge part of the Canadian economy, and one in which new ways of doing business are needed – yet it is an industry that has not accepted that part of improvement must be a willingness to fail.

Thus when we fail in healthcare we often double-fail: once in the event and again when we are unable to recognize, name and learn from that failure.

In healthcare, where lives are on the line, failing early and often understandably sounds unpalatable. But of course we do fail in healthcare. And while we don’t want to encourage failure, we do need to shift away from a culture that can’t acknowledge failure towards one where it is understood to be part of the process of improvement.

Failures in healthcare occur at two levels: the level of the individual patient and the system level.

It is often easy to recognize failures at the patient level. These are when medications get mixed up, unnecessary infections occur or poor communication leads to harm. We are getting better at communicating failure at the provider-patient level. Organizations are adopting policies and approaches that facilitate sharing – moving away from “blame-and-shame” cultures in order to improve.

However, learning within a single organization is not enough when there are thousands of organizations that make up our health system. Right now we have limited means to facilitate learning from each others’ failures across organizations. This is particularly worrisome in an industry where similar environments and sets of interactions repeat themselves. An ambiguously labeled vial that leads to medication error in one long-term care home will be identical to vials in hundreds of other homes. A cleaning process susceptible to human error used in one operating room will be used in dozens of other operating rooms the same day.

System level failures in healthcare happen but are harder to see.

In a public healthcare system, too often system failures end up as fodder for Question Period battles rather than impetus for learning. When investments have been made in new models of health service funding and delivery that don’t work out, it can be difficult to proclaim failure as a means to move toward success. But in the absence of a willingness to be open about policy ideas that didn’t pan out, we risk continuing to invest in sub-par models of care delivery and we hinder our ability to achieve excellence as a system.

Patients and the public are part of the answer.

We all put tremendous faith in the healthcare system at times of incredible vulnerability. Patients and families want to trust in our system, they need to believe that when the stakes are so high, it will work. But providers and organizations also need to trust patients and the public that they will not only understand our failings but help us do better.

The best way to honour a person who has been harmed by a healthcare failure is to do everything possible to learn from that failure so that it will not be repeated.

Solutions are not easy. Some can be learned from other industries, some will be healthcare specific. We need structures and processes so learning can occur across the system. We need the health education system to prepare providers for a career learning from, and not burying, failure.

Failures must become teachable moments, not professional risks.

In an industry as large and complex as healthcare, where innovation is a must, we are bound to make errors. But it’s the double-failure that we should worry about: the inability to name and learn from our failures so that we can do better.

Joshua Tepper is the CEO of Health Quality Ontario,a family physician at St. Michael’s Hospital in Toronto and an Editor at Healthy Debate. Danielle Martin is a family physician and Vice President at Women’s College Hospital.

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5 comments

  1. Ada Giudice-Tompson

    Great article. Unfortunately, there are much larger issues at play. Many of the barriers to achieving transparency in healthcare stem from institutions designed to promote health, innovation, trade and investment. More and more we see ‘money’ as the driver not ‘patient safety’ and our laws, policy and standards are written to perpetuate investment and prevent the resolution of our broken system.

    • John Smith

      What suggestions do you have for changing the policies and standards in place that have been deep rooted in financial gains, rather than focusing on patient health?

      One of the solutions proposed in this article was to address the “patients and the public.” As an undergraduate student with limited understanding of Canada’s health care policies, what are steps that I can take to help move our system forward?

  2. Claire Seymour

    Thanks for this article, I support moving from a “blame” culture to a culture of “learning” following failure. I think this article would be rounded out by some concrete stories or cases where sharing failure (different from encouraging failure) is celebrated and what the gains have been for patient safety and morale. A hybrid of anecdote and data. Can anyone share an example?

  3. Brian Schwartz

    Josh and Danielle, you are spot on. In clinical medicine isn’t that what morbidity and mortality rounds are all about? We should conduct M&M rounds on health system issues. In emergency preparedness and response (in all domains including health) we improve policies and processes (because we always fail at something) by conducting hot-washes, debriefs and after-action reports after every incident during the recovery phase, and incorporating lessons learned in our future plans. This is not rocket science, and has little to do with money.

  4. Duff Sprague

    I’m likely overstating the obvious.

    The conundrum is that failures in the delivery of services so critical to our wellbeing that they are important enough to be publicly funded – health care, child protection, environmental safety etc. – while the most important errors to learn from they are also likely to be those having the most serious negative consequences. Once the error is public, sector leaders’ energies are directed at crisis management – containing the reaction, making public assurances that there will be a quick response and identifying who is responsible.

    We dedicate significant human resources to support all of the above actions with little left over to focus on learning from the failure.

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