Why Hospitals Don’t Learn From Failure

This is an excellent article by Harvard Professor, Amy C Edmondson. In it, she states:

“My central argument is that hospitals don’t learn from failure because of two interrelated organisational issues. Firstly, at the frontlines of patient care in hospitals the interpersonal climate often inhibits speaking up with questions, concerns, and challenges that might have contributed to catching and correcting human error before patients are harmed.2 Moreover, the culture of medicine more generally discourages admission of error, thereby greatly diminishing a given hospital’s potential to learn from mistakes, both consequential or not. Secondly, features of the work design and culture of most hospitals make workarounds and quick fixes the dominant response to failures, rather than root cause analysis and systematic problem solving,7 which contribute to organisational improvement and innovation.”

See the link below for the full article:


Devastated following a complaint

“I was devastated to get a letter from the Health Care and Professions Council (HCPC) to say that I was being investigated following a complaint by the relatives of one of the patients I had looked after for some time.  I remembered the patient well as I had spent a lot of time with him and had done my very best for him.  It was therefore very upsetting that there was a complaint against me despite doing everything I could to the best of my ability for the individual.   

I began to doubt my own judgements on what I was doing in my day to day work with other patients.  I feared for my job, my professional registration and my reputation.  The organisation I was working for at the time paid for a solicitor and barrister. I had done nothing wrong and yet I was made to feel like a villain and perpetrator rather than the compassionate caring health professional I tried so hard to be. It was a hard time of worrying and waiting. It lasted almost four years.    

Almost four years later and two days into the hearing, the case was thrown out. Caris’s book, Failing Intelligently, has been hugely helpful in working through some of the issues that this situation generated.”   

We want to thank this anonymous contributor for sharing their story. There will be many others out there who in the course of professional activities have faced complaints and allegations that are not founded. Nevertheless, they have had to go through the hard process of investigation and suffered over a period of time. These things are never easy and can lead to a profound sense of failure and failing even when the individual has not done anything wrong. It is crucial that individuals in this position seek the support that they need and do not struggle alone.

Book launch speech, 29th June 2019: James Devine, Chief Executive, Medway NHS Foundation Trust

When asked to speak with a topic like failing intelligently, you are never quite sure whether Caris has formed a view that you are someone who has failed intelligently, or whether she is discreetly telling you that you have failed unintelligently but regardless I am genuinely pleased to be here tonight and share in this very special occasion.

Some failure in life is evitable.  It is impossible to live without failing at something, unless you live so cautiously that you might as well not have lived at all – in which case you fail by default – <JK Rowling>

No more perhaps than in healthcare where if our nurses, anaesthetists and surgeons didn’t take calculated risks, we may still be living in a world where people die needlessly from disease and conditions that today we treat with relatively simple surgery or treatment.  

But as a chief executive and former HR Director, it perhaps will be no surprise that I believe it is how an organisation responds and supports its people to take those risks – to help them prepare to fail intelligently – we often refer to this as ‘culture’ and I’ll come back to that

But that is where the secret lies – but creating the right environment takes time and hard work.  In healthcare, we work with ambiguity, ego, competitiveness,– yet years on, that hasn’t materially changed.  Why? Well, I think that the book perhaps answers that question.  We have 2 fundamental needs – love and the need to achieve, everyone needs to feel important. Yet we live in a world where to succeed is seen to be more important than to love – but how connected are they or do they need to be, in order for you to fail intelligently and confidently?

When you don’t create the right culture, an organisation can become paralysed – no-one will make decisions or all decisions are made by the most senior person – and often because people don’t want to get blamed if it all goes wrong.  As I said, that’s the secret – people.  Whether we recognise love or achievement, we are all human.  All of us will fail, and for healthcare organisations, we must always recognise that it is the people that will generate the culture – and the culture that supports people to plan for failure.  It doesn’t have to immediately generate a negative thought or feeling.

The author Stephen King once said that we make up the horrors to help us cope with the real ones – and that’s often the case with failure – we fear it so much, because it becomes something so big and irrational in our minds, that we don’t take the risk.  That could be in your professional careers, or in your personal lives as we stand here tonight.  But often not taking the risk, means that only do you not fail and learn, but you may miss out on something or someone, and that something or someone may be the best thing that ever happened to you – if only we didn’t listen to that critical inner voice, or planned better for the inevitable failure.

Growing up, we are not taught to fail, our instinctive reactions to failure are therefore usually defensive – But as we all know, failure is inevitable.  It is how prepared we are for that failure that drives us forward, and allows us to learn. In the organisational context, some of you will know that the average tenure for a Chief Executive in the NHS is just 22 months – why, because often they fail in the eyes of regulators and Boards, that they move on, sometimes voluntarily, sometimes not – is it because they do not bring perceived success quick enough or create the right culture. But how in that timeframe is one expected to fail intelligently, encourage others to do the same, be given the freedom to get things wrong and measure tangible success?  Our attitude toward failure is more important that our attitude toward success and that’s because one is seen to be negative and the other positive – I don’t think failure is always negative – how many of you tonight were in relationships with the wrong person, but you didn’t realise it until you found the right one – I hope that right one is the one you are here with tonight.  How many of you thought your career dreams were impossible at times, until you took the risk and got there.  How many of you thought you would ever have a book published unless you took the risk and prepared to fail? 

It doesn’t mean you hold back your fears of failure or rejection, but you accept that some failure is inevitable and plan for it – often the failure is far less that you ever imagined it to be to the point that you ask yourself what you were so scared of.

I mentioned earlier the 2 fundamental needs of love and the need to achieve.  Are they mutually exclusive?  Can you really achieve unless you love and are loved? On the need to achieve, we take calculated risks when we move from one employer to another, or take on that new project, or undertake surgery on a patient that your colleagues have declined. Is the need to achieve and love also to feel supported, appreciated and recognised in a personal or professional life? I think so.

On love specifically, to truly give your heart to something or someone fully and without question, is a risk – but like planning to fail intelligently, you don’t give these precious things to just anyone.  You give them to someone who you know will support you to achieve and love you back.  Professionally, or personally, when you get it right, all your past fears, failings or rejections, don’t mean anything anymore.

And despite fears of failure or rejection, like a phoenix that continues to rise from the flames, we know that success is not final, failure is not fatal – it is the courage to continue that counts.

Thank you , I hope you have a wonderful evening.

Book launch speech, 29th June 2019: Caris Grimes, Consultant Surgeon and Author

Nobody in their right mind wakes up one morning and decides that they want to write a book on failure.  Now, some of you may doubt whether I have ever been in my right mind, but lets put that aside for now! 

The context in which I did so is this: 

In 2011, my marriage came to an end after 14 years which left me with a sense of failure. 

I then went through 5 years of being both single mum and fulltime surgical trainee and feeling that I was doing neither well.  I was not at home enough to be what I thought a good mum should be and I wasn’t at work enough to fulfil my own expectations of what a good surgical trainee is. 

I then became a consultant and had to start taking responsibility for my own complications and the impact of my decision-making.  

Then as special punishment for the new consultant, my department asked me to take on the role of Patient Safety Lead and Mortality Lead in General Surgery – which has ultimately led me to investigating Serious Incidents – such as potentially avoidable death. 

Then, if that wasn’t enough, I decided to set up a Bereavement Service, to allow bereaved families to come back and ask any questions or raise any concerns they may have. 

I therefore found that I was dealing with some aspect of failure fairly frequently, and did not feel that I really understood failure enough to do it well.

As a Christian, I also felt that God was calling me to write  a book on failure and I didn’t want to do it.  Every time I felt a little nagging – “write the book, write the book” I would say No.  I explained to God that there are many things that I would like to be known for and to be good at, but failure has never been on the agenda. 

It came to a head one evening when I was praying and I felt the nagging again – “write the book, write the book”.  In exasperation I said to God “OK! I will write this blinking book but on one condition. I want you to give me one example, from the Bible, of someone who did everything well and still failed catastrophically. Because if I’m going to write a book, I don’t want to just write in on error, I want to write it on that sense of failure you can have even when you are doing everything to your best ability.” 

I shut my eyes and had a sudden, immediate and clear picture of the cross of Jesus. I was gobsmacked. 

“Ok.., God…” I said, “Can I just clarify? Are we now calling Jesus a failure?  And if we are, are you asking me to write a book for which my non-Christian friends, family and colleagues are going to think that I am a lunatic, and my Christian friends, family and colleagues are going to think I am a heretic??” 

Ladies and Gentleman, friends, family and colleagues, I have been reassured that for those of you who know me that none of you can possibly think of me as any more of a lunatic or a heretic than you already do by me writing a book. … Which I guess is reassurance of sorts ! 

Finally, there are four take home messages for tonight on failure: 

1. Failure is everywhere. There is no part of our lives, no organisation and no industry that failure, feelings of failure or fear of failure does not effect from time to time.  And yet our bookshops are littered with books on success. 

2. Failure can be extremely painful. It can be associated with very strong negative emotions of shame, guilt and fear.  We need to support friends, family and colleagues who are experiencing these. 

From a healthcare point of view, no healthcare professional goes into work with the intention of causing harm.  And therefore, when a healthcare professional or professionals are involved in anyway in a failure, then there is no-one who can blame and condemn them for their role in that they themselves. Therefore, a culture of blame in our relationships or in our organisations is not just counter-productive, it stops individuals and the organisations learning. 

3. Failing Intelligently is hard. Failing well involves not being defined by your failure, but seeing it as separate from you and a tool to help you learn. It also involves taking responsibility for your part in failure, apologising and learning from it.  But this is difficult. It is difficult at work and it is even more difficult at home. I am sure that if you twisted my husbands arm hard enough he may just admit that, although I have written the book, that when we argue, I am not the best at failing well. 

4. Failure is important.  Research from organisations, education and individuals show a similar theme. That those that only ever succeed, ultimately fail.  But those that learn to fail well, ultimately succeed because failing well leads to adaptability, versatility and resilience. 

Please do buy the book. I have tried to keep it short and sweet.  My stubbornness and belligerence meant that I was not prepared to write a book more than five chapters long. I would love to receive positive feedback on the book. But I also need to receive the negative feedback too, because without this I cannot fail intelligently. 

Thank you.