Medical student / Blogger
· 5 min read
I've missed more than 9000 shots in my career. I've lost almost 300 games. 26 times, I've been trusted to take the game winning shot and missed. I've failed over and over and over again in my life. And that is why I succeed. - Michael Jordan
This is one of the most famous Michael Jordan quotes. Also one of my favourites. It speaks of trial, error and success that the process to reach it brings. Of course, his basketball greatness is proof for this process. However, Nike used this quote in one of their commercials.  And the purpose of commercials is more often than not to sell the company's products. Does it really hold true? That this is the way to success and improvement?
There are two major industries that come to mind where failure can affect people's well being to a great extent. Aviation and healthcare. These two industries are profoundly different, yet especially similar in one thing - people's lives. Failure is not an option. At least that's the basic instinct that we have.
When an airplane crashes the chance that the people on board will all die is almost 100%. Plane crashes are the result of a mistake during flight. Whether it's the crew, the communications, the airplane itself or the mechanics. It's risky business. But the amount of planes that crash each year is so small, that they still account for an incredibly low amount of deaths on a yearly basis. Each time you fly, there is a 1 in 5 million chance that your plane will crash. Yet every time a plane crashes there's chaos - largely because the news is tragic and the media companies benefit from tragedy and the extra readers. The investigators, however, are concerned with one thing only. Finding the black box and identifying the cause of the crash.
Doctors hold many strings when it comes to patients' lives. They are directly accountable when a patient's conditions either improves or deteriorates. All is well when the patient gets better. The doctor is the saviour and the one most with the most credit for the patient's well-being. No problems there. What happens when exactly the opposite happens? Patients get worse, don't get cured, or in worst cases even die. Who's to blame for this? It's the doctor of course. What's the doctor's response? Usually, they convert a "mistake" into a "complication". They mask the real reasons behind their failure by carefully removing themselves from the explanation. But what measures do they take in order to improve the chances for the patients to get well? Unfortunately, very little.
After a plane crashes, the most important part is the black box. Two, actually. One that records the instruments and one that records the communications in the cabin. A team dedicated for investigating airplane crashes analyses all of the complex circumstances. After they're successful, the airlines take action. They search for ways to decrease the crash rate of their planes. Sometimes, the things that caused the crash or a series of crashes are very insignificant. For example, two similar levers meant for two completely different processes. Or maybe the power distance between the pilot, co-pilot and the engineer are too big.  Whatever it is, the airlines take action by designing the cockpit in a different way or making the team-building and communication courses mandatory for all personnel. And they've done this since the early beginnings of aviation. Mostly because flying was since forever considered very risky. They breed a culture, where failure is almost welcomed because they can learn from it. It's not stigmatised. They decreased the rate of plane crashes from 25% in 1912 to 0.0000002% in 2018. They achieved an improvement of a factor of 125,000,00.
However, the state of healthcare when it comes to failure is very different. Between 44,000 and 98,000 patients die each year as a result of preventable medical errors.  In comparison to the aviation industry, the only time the hospital and medical professionals are obligated to research into the exact causes of deaths is when there's a lawsuit filed against them. And I don't mean medical causes, I mean the procedural mistakes that cause patients' deaths. If there's no obligation, no one will analyse these processes by themselves. Why would they? But if there's no analysis, there cannot be any improvement. This is the common practice in healthcare systems and that's how it's been since almost forever. When doctors treated diseases by blood-letting they didn't analyse this technique (common practice until the late 19th century). If the patient got better it was because of blood-letting. But if not, the disease was considered just too deadly. They never tested and challenged their assumptions. There is no comparable culture to the one in aviation. Yes, when a plane crashes the pilot most likely also dies and thus cannot bear the consequences. In the doctors' case, they don't die when the patient dies. They have to bear consequences. If nothing else they bear the ethical consequences. But other doctors learn very little in the process compared to pilots. The chances of patients not dying during routine procedures remain the same.
The aviation industry has a century-long culture of analysis of mistakes. Healthcare, on the other hand, has a centuries-long culture of not entirely admitting to mistakes. The culture of people is hard to change, but there are some exceptions. In 2002, Gary S. Kaplan was appointed chief executive of Virginia Mason Health System in Seattle. After observing a Toyota plant in Japan and their relationship with failure, he transferred a similar principle to his hospitals. He started to foster honesty about failure so that others could learn and improve the healthcare system. He managed to save thousands of lives and a lot of insurance money just by initiating a system, in which doctors could admit to their mistakes. In fact, in 2013 the Virginia Mason was considered as one of the safest hospitals in the world. They recorded a 74% reduction in costs produced by lawsuits. This means that they actively adapted their procedures to improve patient safety and decreased the number of malpractice cases. In a way, Kaplan changed the culture and their relationship with failure for the better of patients and the staff. All this by simply changing the way doctors looked on failure.
This all shows the incredible power of failure analysis. But the key here is to change the relationship to it and establish a system for improvement. We hear countless times that failure is good and that we can learn from it. Even that we have to fail in order to succeed. But more often than not, failure demoralises us and we lose the will for analysis, future changes and improvement. However, usually the most effective and most useful improvement is the one that stems from it. Every major entrepreneur today is saying that. Why wouldn't it be true?
Let's now return to Micheal Jordan. He is considered to be the greatest basketball player of all time. However, he didn't even make the team in high school, yet he went on to become an all-time great. No matter what happened to him, he wanted to prove to himself and to others that he can do better.
Don't take this as a discouragement. Michael Jordan was great, but he had to become great. Aviation didn't go from 25% crashes to 0.0000002% in one day or one year. Not even one decade for that matter. Just as Kaplan didn't manage to decrease the amount of money spent on lawsuits by 74% immediately. It's a process that needs to take place before success and knowledge do. It's compounding knowledge in a way.
Therefore, take this as an encouragement.
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