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. He was in full cardiac arrest and was pronounced dead shortly thereafter. I’d failed to diagnose necrotizing fasciitis, which is a serious tissue infection. Wikipedia calls it a flesh-eating infection. The findings that I’d overlooked, his fast heart rate, and his exquisite sensitivity on exam, I had incorrectly assessed as drug-seeking behavior.
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.