Patrick Hymel – CEO, MedSnap
Innovation is what occurs when success is the last step in a whole series of failures. Properly handling failure and unexpected results is a critical skill when working as a manager at a start-up or managing a new project at a larger organization. Yet these skills are seldom discussed and today I’d like to share a few insights on how to handle failure, personally, and as a manager, wherever new ground’s being broken.
In 1998, I was a first year emergency medicine resident at Charity Hospital in New Orleans. At the time, Charity was the busiest emergency department in the nation. We served a very poor, very sick population of patients. One day, I saw a 70 year-old man, a patient, whose chief complaint was: “I fell two weeks ago, and I can barely walk.” He smelled of recent alcohol use, which, unfortunately, was not uncommon in our patient population. On exam, his vital signs were normal, except his heart rate was slightly fast, just under 100 beats a minute. He did not have a fever.
My initial impression of his left leg was that he had a large bruise around his left knee. It wasn’t warm or red, it was a dark purple. I suspected that perhaps, he had a fracture, so I sent him for X-rays, which came back normal. So I presented the patient to my senior resident, I ordered some crutches for him to go out on, wrote him a prescription for non-narcotic pain medication, even though he had been demanding narcotic pain medication while he was there, and I sent him out, I discharged him from the emergency department.
Four hours later, he was back in the emergency department after being found face down on the sidewalk, less than a mile from the hospital.
This was a watershed moment in my medical training and not just because of the consequence of my error. I recognized that there was a lens between what I observed and how I interpreted it. Untested assumptions based on prior anecdotal experiences in the emergency department, or even personal biases, could negatively affect how I weighed each observation and arrived at a clinical diagnosis. But this point has far reaching implications beyond the practice of clinical medicine. You are not as objective as you think. Untested assumptions and biases can prevent us from seeing both dangers and opportunities.
But when our assumptions fail, and we are forced to confront an unexpected result; this is actually an opportunity for us to update our model of the world. Understanding this is critical if you’re going to work in an environment where life and death decisions are made, or, if you’re leading a team of innovators towards the next big thing.
So I was assigned to present the patient at Morbidity and Mortality Rounds, or M&M. M&M was a monthly mandatory closed-door meeting of all emergency department physicians. Over the course of the year, everyone had to present a mistake that they had made. And you weren’t allowed to choose your own mistake, the other physicians chose it for you. Everyone was fully engaged during the presentation and everyone made mistakes. Because the whole time you were sitting there going: “I could’ve made the same error. If that’d been me, I might’ve done exactly the same thing.”
If instead of doctors treating gunshot wounds and heart attacks, we’d been a group of developers working a start-up, this would’ve been the most innovative environment imaginable. Because the limits of our knowledge and our biased assumptions were being openly and thoroughly pushed in new and better directions. I learned that mistakes, when they are acknowledged as such, are actually opportunities for us to update the model of the world, to test our limits and really get to what our biases are, to measure the refraction of the lands that distorts what we would observe.
The key is communicating these insights across your team. When shared in a no-blame environment, where everyone can speak openly about their thoughts and perspectives, our entire team got better, much better. I also learned that judging the qualifications or capability of one person given one outcome could be very misleading. Not all mistakes are due to thinking incorrectly. And a lot of the times good outcomes occur even when we’re thinking wrong. There’re many reasons for this, why it can be so hard to see this, and one of them is because your brain is wired against you. Your brain is not objective.
Neuroscientists have learned that our new observations are heavily influenced, how we interpret what we observe is heavily influenced by our existing assumptions. One area of your brain called the dorsolateral prefrontal cortex (DL-PFC) – that’s a mouthful – dorsolateral prefrontal cortex actually tries to take new observations and make them fit into your older assumptions by default. In order to override this process, you brain has to use an entirely different area called the anterior cingulate cortex (ACC).
So, if you run a scientific experiment, start a project to launch a product, and the result is not what you expect, this’ll create a very negative reaction from your brain. And the dorsolateral prefrontal cortex will try to delete those new observations from your memory, making it very hard for you to learn from your experience. It could be hard to see failure as such a powerful learning experience, because we really only hear talks about success. For example, Steve Jobs is perhaps the greatest CEO of this generation, given the effect that he had on so many different industries.
So I’m not going to talk about his successes today, that’d be a cliché, but talk about his failures, specifically, what happened to them during his second tenure at Apple. Because during his first tenure, there were many mistakes, public errors. For example, in 1980, Apple released the Apple III computer, which was their answer to the business community. It was a terrible computer with terrible quality issues. The support lines that would take calls from computer owners whose computer had stopped working would tell them: “Lift the computer six inches off the desk and drop it to try to reset the chips onto the motherboard.” True story.
The Apple Lisa, which is a 30 million dollar project, and the forefather of the Macintosh, was a terrible computer, it was very slow, and very expensive, and it occurred at a time in 1983, where Apple basically lost the business community for 20 years. You all remember the 1984 commercial announcing the release of the Macintosh with the Superbowl, but you probably don’t remember the 1985 commercial that announced a product called Macintosh Office. That product at the time, did not actually exist, and the commercial, which was spearheaded by Steve Jobs, actively implied that business consumers were lemmings. They were marching right off a cliff. He was fired from Apple in 1985, but he returned and went on to have a long strain of very innovative product launches without a serious misstep.
How? He must’ve found a way to keep the errors and failings on the inside of the company. We know that innovation cannot occur without setbacks and failures. How did he do this? It’s been said that all chefs make mistakes, but the great ones don’t let it out of the kitchen.
So I’d like to share a few insights on how to keep failure in the kitchen, although I don’t know all of Steve Jobs’s tricks. First, it’s not about trying to eliminate all opportunities for error within your organization. Micromanaging this will incentivize your employees to stop taking risks. Recognize that unexpected results are actually a part of the creative process. The key is communicating their insights across the organization. Always take time to process the unexpected using your entire brain. Your initial knee-jerk reaction will likely be wrong, and if it’s negative you will prevent, you will decrease the opportunity for your team members to communicate openly across the organization. Decrease the distance between you and those on your team who are dealing with your organization’s most pressing problems. It is much harder for setbacks, difficulties and failures, and the insights associated with them to make their way up to multiple layers of management hierarchy than it is to be expressed one on one.
For example, during his second tenure at Apple, Steve Jobs would select 100 of the smartest people – his words – in the organization, according to him, regardless of their hierarchy or rank within the organization, to come with him for a multiple day off-site retreat where he would present his vision for the company for the coming year, and then, ask for their personal feedback. Imagine the effect, though, that this had on the managers who weren’t invited. How open would you be if you knew your boss might have a one on one with the members on your team? Not only must innovators learn to overcome setbacks and failures. We have to learn how to see the opportunity hidden within them. This can be difficult, but I’ve got good news.
We can actually train to get better at it, by finding your beginner’s mind. At the pinnacle of his basketball career, and after winning three national basketball championships in a row, Michael Jordan stepped away from basketball and spent a year and a half playing professional baseball. When he returned to the NBA, he then went on to win three championships in a row, even though he was nearly 32 years old when that second three-peat started. Many commentators observed that Jordan was a better player, a better coach on the court, and a better leader, after his baseball career than before. I believe that this is because he spent a year and a half as a beginner. Not all of us can take time to take a long sabbatical and follow a dream, but we can all today, right now, commit ourselves to never stop being a beginner at something. The more familiar you are with failing at a task, the more intimate you become with that internal negative voice that tells you you can’t do something, And it’s that negative voice that hinders you from seeing the opportunity in each setback; being a beginner helps you learn to control your negative voice.
Take up a new instrument, learn a new language, travel outside your comfort zone, get your news from a source that doesn’t share your worldview. This is why Richard Feynman played bongos and worked in a biology lab. It’s why Bob Dylan went electric and then country. And it’s why Tiger Woods should consider a professional baseball career. Since the path to success is often strained with failures, often we’re asked: “How long should we persist? How long should we continue to fail?” Eric Ries in his excellent book called “The lean start-up,” put forth a concept of failing fast.
While most entrepreneurs who’ve read Eric’s book understand what he was getting at, I’ve heard it misinterpreted as “give up fast.” And I disagree with this. Based on my experience, often it takes several pivots and changes to your business plan before you find the formula for success. A start-up’s mission is where it’s decided to dig the big problem that it’s trying to solve. Each product, then, is an attempt to chip away at the mission. Products can fail, but missions endure. We need to dissociate failure of a product from stopping the mission. Don’t ever stop your mission, don’t ever stop trying to accomplish what you set out to accomplish in the world. The only thing you should really be afraid of is failing to test the assumptions that underlie your product or mission. Or mistaking positive feedback from friends, colleagues, or focus groups, as evidence that you’re digging in the right place.
Don’t fear failure, and seek out criticism from the customers that will sustain your business as early as possible. It’s a better way of putting that concept, although, not as short. Failure is a part of the process when you’re breaking new ground or working in an environment where chaos reigns. Managing failure requires an openness of communication, sharing the results of a failure and communicating this across the organization. Your brain works against you. You’re not as objective as you think. But we can all train ourselves to see the opportunity in each setback by finding our beginner’s mind. Make sure you’re digging in the right place, and then don’t stop.
Two years later, I was a senior resident in charge of the emergency department. An intern came to me and presented a 24-year-old female who was in the emergency department simply to get a refill on her antibiotics. She’d been diagnosed two weeks earlier with pneumonia on the right lung by a private physician but had lost her health insurance. So she came to us. The intern had already written her a prescription for a refill of her antibiotics and was prepared to discharge her immediately.
She sat upright on the examination table and was in no apparent distress, except, her vital signs weren’t normal. She was breathing more than 20 times a minute, which is fast even for someone who’s relatively healthy and has community acquired pneumonia. So I asked him: “Get a new chest X-ray before we discharge her.” The new chest X-ray showed pneumonia now in both lungs, which is a serious complication. We would later learn it was due to infectious endocarditis, which would’ve been rapidly fatal. It’s an infection of your heart valves, and would’ve been rapidly fatal if we hadn’t sent her upstairs for medical treatment immediately, which is what we did.
So, afterwards, the intern was very impressed, you know that… he was impressed with my clinical observation skills and wisdom, but it wasn’t an observation that saved that patient, it was a failure. Thank you.
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