Optimizing Your Failures

Traditional wisdom teaches us to learn from our mistakes, “learn from your mistakes” “What doesn’t kill your makes you stronger.” The old sayings are incomplete, of course. Sometimes mistakes and misfortunes in life can also give us PTSD, lead to bodily harm, or change our lives forever (see: pretty much every book by Ian McEwan).

Other times, small, insignificant decision may seem innocuous at first but go on to become key ingredients in irreversible mistakes. Some people call the process the butterfly effect, and Clayton Christensen has made an entire career out of small, seemingly reasonable decisions creating downfalls of giant corporations.

From selecting a career to picking the restaurant for a first date, some mistakes can be costly. Can what we know about catching small mistakes keep us from making big ones?

Fail Fast, Fail Hard

A classic management school case study is the Toyota Production System (TPS). TPS in its original form as conceived in the late 1940s featured an andon cord. Andon cords are physical cords that hang down along the sides of a Toyota production line to create an alert whenever a worker notices an error – any error, even if it’s insignificant. If the error cannot be resolved within a set period of time, the entire production line automatically stops until the issue is resolved.

Many root-cause error analyses reveal that bad outcomes are seldom caused by just one big mistake. Instead, a critical error tends to arise from the unlikely combinations of many small problems and/or oversights. Therefore, to prevent one major problem from recurring, an organization often has to modify many, many aspects of its operations.

TPS puts the whole process on its head. Instead of identifying a big problem after it occurs then going back to correct all the missteps, why not make small problems so prohibitively detrimental so big problems do not occur in the first place? Similar ideas have since been adapted into other industries, including in health care at leading hospitals like Virginia Mason Hospital in an attempt to replicate Toyota’s success.

The implication to real life is this: plan your failures early! Before committing to a career in writing, try submitting to a newspaper Op-Ed. Find out whether you write well enough to be accepted and how you deal with rejections. Before applying to medical school, try volunteering at a hospital to see if you can tolerate another human being’s suffering. Before taking your new date to a new steakhouse, eat there with friends and find out whether ordering the award-winning T-bone will make you look like an impressive date or just a messy eater. The point is not only to “see what it’s like” but more importantly to ensure that if you are to fail at all, you fail early.

Build Mistakes Back Into the Process

I had the opportunity to place many central lines in my work. The central line is an IV that is placed in one of the largest veins in the body for the purpose of administering special medications in the intensive care unit.

Inserting a central line is a simple process, but it is also one of the main reasons why patients in intensive care units get infections. That is, until checklists began to be used. Central line placement is one of the first procedures in American medicine that received widespread recognition that a checklist is essential to safe, efficient execution. As Dr. Atul Gawande might say, a “stupid checklist” can do more than the most expensive medication.

Although a checklist can be helpful, it cannot be created in a vacuum. Each item is tested and revised constantly based on field data. Some items on the list are designed to prevent major errors from occurring: “check patient identification.” Therefore, the purpose of each item on the checklist isn’t to prevent just one big mistake: each item also creates an environment in which future mistakes are less likely to occur. But some items seem at first more procedural. For example, in some hospitals the surgical “time out” requires each team member to introduce himself/herself. The authors of these lists found that it improves team cohesion and reduces errors, but it could only be discovered by an on-going learning process.

In this way, a checklist is essentially a written tally of “learning from your mistakes.” In personal life, have a mechanism of recording your mistakes. A personal journal is a great choice of recording nonspecific daily learning points. Actual checklists are also excellent ways. If you used a recipe for cooking, take a pen and revise it after you take a bite. Keep this year’s holiday shopping list, so next year you can remember whether the Zhu Zhu pet for your niece was even in the neighborhood of a good choice.

Stop and Think

The medical checklist is more than just a list of things to check off in any order. During a medical procedure, there also exist hard-stops where a specific task must be performed before the next stage of the process can be initiated. For example, before cutting the skin, a surgeon must perform a “time out” to identify the correct patient, the correct surgical site, and the correct medical staff. At the end of each procedure, there also exist hard-stops to count all the equipments, needles and gauze, before the skin can be sealed.

Hard-stops are used both to avoid catastrophic mistakes and to force us to step back and look at the big picture. Although clinicians have to manage sick patients, complete paperwork, and coordinating care with specialists, most clinicians still perform daily rounds. Rounds are built-in hard-stops where members of the medical team stop their current tasks and gather to see patients, review laboratory data, and create a plan for the day. It is also a hard-stop during the day’s activity when even what may be inconsequential observations at first glance can be brought to the entire team’s attention.

Sometimes personal lives can move faster than professional lives. Make yourself a checklist for things you want to accomplish is a great idea, but create a regular hard-stop and “round” on your tasks to make sure these things are actually done. I have found driving to work 10 minutes early and then using that extra 10 minutes before walking into the office to be a lifesaver on numerous occasions.

Putting It Together

Of course we all want to make the right decisions every time. However, we should also come to terms with the fact that to err is not only human but also inevitable. If we can accept that, these theories give us the optimal way to err: fail fast and hard, find a way to reincorporate your mistake back into the process, and don’t forget to create hard-stops along the way to check your progress.

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Howard Chen
Vice Chair for Artificial Intelligence at Cleveland Clinic Diagnostics Institute
Howard is passionate about making diagnostic tests more accurate, expedient, and affordable through disciplined implementation of advanced technology. He previously served as Chief Informatics Officer for Imaging, where he led teams deploying and unifying radiology applications and AI in a multi-state, multi-hospital environment. Blog opinions are his own and in no way reflect those of the employer.

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