In medicine, failure can be catastrophic. It can also produce discoveries that save millions of lives. Tales from the front line, the lab, and the I.T. department. SOURCES:Amy Edmondson, professor of leadership management at Harvard Business School.Carole Hemmelgarn, co-founder of Patients for Patient Safety U.S. and director of the Clinical Quality, Safety & Leadership Master’s program at Georgetown University.Gary Klein, cognitive psychologist and pioneer in the field of naturalistic decision making.Robert Langer, institute professor and head of the Langer Lab at the Massachusetts Institute of Technology.John Van Reenen, professor at the London School of Economics. RESOURCES:Right Kind of Wrong: The Science of Failing Well, by Amy Edmondson (2023).“Reconsidering the Application of Systems Thinking in Healthcare: The RaDonda Vaught Case,” by Connor Lusk, Elise DeForest, Gabriel Segarra, David M. Neyens, James H. Abernathy III, and Ken Catchpole (British Journal of Anaesthesia, 2022)."Estimates of preventable hospital deaths are too high, new study shows," by Bill Hathaway (Yale News, 2020).“Dispelling the Myth That Organizations Learn From Failure,” by Jeffrey Ray (SSRN, 2016).“A New, Evidence-Based Estimate of Patient Harms Associated With Hospital Care,” by John T. James (Journal of Patient Safety, 2013).To Err is Human: Building a Safer Health System, by the National Academy of Sciences (1999).“Polymers for the Sustained Release of Proteins and Other Macromolecules,” by Robert Langer and Judah Folkman (Nature, 1976).The Innovation and Diffusion Podcast, by John Van Reenen and Ruveyda Gozen. EXTRAS:"The Curious, Brilliant, Vanishing Mr. Feynman," series by Freakonomics Radio (2024).“Will a Covid-19 Vaccine Change the Future of Medical Research?” by Freakonomics Radio (2020).“Bad Medicine, Part 3: Death by Diagnosis,” by Freakonomics Radio (2016).
Chapter 1: What personal experience changed Carole Hemmelgarn's life?
Even though the signs, the symptoms, and me as her mother kept telling them something was wrong, something wasn't right, they wouldn't listen to me. So by the time... By the time she was failing so poorly and rushed to surgery and brought back out, there was nothing they could do for her. The first harm was unintentional that they did to our daughter.
It was all the intentional harms after that where we were lied to. The medical records were hidden from us. People were told not to talk to us. And the fact that it took the organization three years, seven months, and 28 days to have the first honest conversation with us, those were all intentional harms. And that's why in healthcare, we have to have transparency.
Because how many other children suffered because of the learning that didn't take place?
Hemmelgarn says she filed a claim against the hospital, but she didn't move forward with a lawsuit because of the emotional toll. She ultimately took a different path. In 2021, she co-founded an advocacy group called Patients for Patient Safety U.S. It is aligned with the World Health Organization.
She also runs a master's program at Georgetown University called Clinical Quality, Safety and Leadership.
When harm does reach the patient or family, that is the time to really analyze what happened. And while you never want to harm a patient or family, one of the things you'll hear from patients and families after they have been harmed is they want to make sure that what happened to them or their loved one never happens again.
The example I can give for myself personally is I did go back to the very organization where my daughter died, and I have done work there.
Today on Freakonomics Radio, we continue with our series on failure. In the first episode, we acknowledge that some failure is inevitable. We are, by definition, fallible human beings, each and every one of us. And that failure can be painful.
I don't think we should enjoy failure. I think failure needs to burn on us.
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Chapter 2: What are the consequences of labeling patients in healthcare?
Okay. And what are the steps you take to turn that failure into a useful thing? Learning, I guess, is the noun we use these days.
Immediate diagnosis, right? We step back. OK, what do we set out to do? What actually happened? Why might that be the case? What do we do differently next time? I mean, that's a sort of a rough outline of an after action review. It could be flawed assumptions. It could be flawed calculations. It could be any number of things.
And we don't know until we put our heads together and try to figure it out.
It was several years into her engineering career that Edmondson decided to get a PhD in organizational behavior.
I was interested in learning in organizations, and I got invited to be a member of a large team studying medication errors in hospitals. And the reason I said yes was, first of all, I was a first-year graduate student. I needed to do something. And second of all, I saw a very obvious link between mistakes and learning.
And so I thought, here we've got these really smart people who will be identifying mistakes And then I can look at how do people learn from them and how easy is it and how hard is it? So that's how I got in there. And then one thing led to another. After doing that study, people kept inviting me back.
I see. She loves failure, they say.
That's right.
Edmondson focused her research on what are called preventable adverse drug events, like the one from the Redonda Vaught case.
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Chapter 3: How does transparency impact patient safety?
And I also developed these ways of studying delivery out of the little particles by putting certain enzymes in them and putting dyes in a little gel that would turn color if the enzymes came out. And I could see that happening. Like I said, the first 200 times or first 200 designs or more, it didn't happen.
But finally, I came up with a way where I'd see it come out after an hour, after two hours, after a day, after a second day, up to over 100 days in some cases. So I could see with my own eyes this was working. So that made an enormous difference to me, too.
But failing 200 times costs a lot of money and obviously a lot of time. Did you ever almost run out of one or the other?
The experiments I was doing weren't that expensive, especially the delivery ones initially because they were in test tubes. I worked probably 20-hour days. And so the expense wasn't that great. And I've always been good at manufacturing time.
Now, let's say someone is in a similar situation today to where you were then with an idea or a set of ideas. that they believe in, that they think they are right about. They think it's an important idea, and yet they are failing and failing to get the attention of the people who can help manufacture success. How do you think about the line? I think of it sometimes as a line between grit
And quit, right? Economists talk about opportunity cost. Every hour you spend on something that isn't working is an hour you could spend on something that is working. But then psychologists talk about grittiness and how useful it can be to stick things out. Do you have anything to say to people who might be wrestling with that?
Well, I think it's a great question, and I ultimately think it's a judgment call, and we can never be sure of our judgment. You like to try to think, are these things scientifically possible? I think that's one thing. Secondly, it's good to get advice from people. That doesn't mean you have to take it, but it's good to get advice.
I certainly personally have always erred on the side of, I guess, not quitting, and maybe that's sometimes a mistake. I don't think so. I think it depends on what could happen if you are successful. If you are successful, could it make a giant difference in the world? Could it help science a lot? Could it help patients' lives a lot? And so if you really feel that it can, you try that much harder.
If it's incremental, sure, then it's much easier to quit.
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