Why FAIL is Not a 4-Letter Word

Dr Rachel Morris: Do you ever come home from work, really excited about the ways in which you’ve failed? Do you wish you could fail more? And do you boast about it when you do? Of course not. That would just be weird. No matter how much we tell ourselves that we can only be successful if we’re prepared to fail. And that true learning comes from failure. We still beat ourselves up and obsess about it when we do. This is a very special episode of You Are Not A Frog. It’s a live panel discussion recorded at the Faculty of Medical Leadership and Management: Leaders in Healthcare conference in November.

I’m joined by Dr Taj Hassan, consultant in Emergency Medicine and past president of the Royal College of Emergency Medicine. He’s on the board of trustees for the FMLN amongst many other different roles. I’m also joined by Dr Claire Edwin, a GP trainee and one of the National Medical Director’s clinical fellow, and Dr Sally Ross, a GP, appraiser and NHS England clinical advisor, who has spent several years working both in general practice, in the NHS and in the Royal Navy.

We chat about various failures we’ve experienced how we could deal with failure better, and how we often fail more by not acting when needed rather than failing through the stuff that we actually do do. So, join us to find out why people-pleasing can lead to failure, how a simple acronym like AFOG can help turn a failure into a learning experience, and how we should go about disclosing our failures to our teams without losing their trust.

Welcome to You Are Not A Frog, the podcast for doctors and other busy professionals who want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP, now working as a coach, speaker, and specialist in teaching resilience. Even before the coronavirus crisis, we were facing unprecedented levels of burnout. We have been described as frogs in a pan of slowly boiling water. We hardly noticed the extra-long days becoming the norm and have got used to feeling stressed and exhausted.

Let’s face it, frogs generally only have two options: stay in the pan and be boiled alive or jump out of the pan and leave. But you are not a frog. And that’s where this podcast comes in. It is possible to craft your working life so that you can thrive even in difficult circumstances. And if you’re happier at work, you will simply do a better job. In this podcast, I’ll be inviting you inside the minds of friends, colleagues, and experts—all who have an interesting take on this. So that together, we can take back control and love what we do again.

For those of you listening to the podcast who need to get some continuous professional development hours under your belts—did you know that we create a CPD form for every episode, so that you can use it for your documentation and in your appraisal? Now, if you’re a doctor and you’re a fan of inspiring CPT, and you’re sick of wasting a lot of time you don’t have on boring and irrelevant stuff—then, why not check out our permission to thrive membership?

A joint venture between me and Caroline Walker, who’s The Joyful Doctor. Every month, we’re going to be releasing a webinar fully focused on helping you thrive in work and in life. Every webinar is accompanied by an optional workbook with a reflective activity so that you can take control of your work and your life. You can increase your wellbeing, and you can design a life that you’re going to love. You’ve got to get those hours, so why not make your CPD count to CPD that’s good for you. So, check out the link to find out more.

Hi there, everybody! Welcome to everyone who’s listening back on the You Are Not A Frog podcast, and we’re delighted to be here at the final session of the Leaders in Healthcare conference 2021 with the Faculty of Medical Leadership and Management. So, thank you guys for having us.

I’m very delighted to be able to host this panel discussion with three esteemed colleagues and leaders all about failure. Because I think failure is something… Well, we’ve done some podcasts about failure, but it’s something we’re still not that comfortable with. Nobody really likes to fail. I thought, what a brilliant opportunity to get some people together to hear a few sort of battle stories and to think about actually why failure… Why we learned so much from failure and how we can do it better and learn better without beating ourselves up. It’s one thing that we do very well in healthcare is beat ourselves up when we fail. And then we might fail to learn from our failure, which isn’t even…

Before we go any further, let’s just introduce our panel. First of all, we’ve got Dr Claire Edwin, and Claire is a National Medical Directors clinical fellow. So, Claire, tell us a little bit about you and what you do.

Dr Claire Edwin: Hi, everyone! Well, I’m one of the National Medical Directors clinical fellows for this year. Working between NHS England in the Faculty of Medical Leadership and Management, which is basically an opportunity to get sort of parachuted in to work with senior leaders and managers in healthcare organisations throughout the UK. And it’s a great privilege to be here today. Feeling a little bit nervous, given how much more experienced my fellow panel members are. Hopefully, I can provide some insight into my failures, my micro failures.

Rachel: Brilliant! Thank you so much, Claire. Next, we’ve got Taj Hassan with us. Taj—he’s been a consultant in Emergency Medicine for the last 22 years. He’s also the past president of the Royal College of Emergency Medicine. What else are you up to at the moment, Taj?

Dr Taj Hassan: Well, thank you. Thanks for firstly, for inviting me. My failure came yesterday—I lost my voice. So, it’s just coming back. That would have been a difficult panel discussion today. Good to join you all.

Other things that I do—I’m involved in some international work in Pakistan, a South Asian country. Pakistan was originally where I’m from, and we’re trying to help develop emergency medicine in Pakistan. I try desperately to keep my head above water with three young children who constantly tell me I’m a failure. That’s always a good leveller. Thank you.

Rachel: Thanks, Taj! There’s nothing like kids to really bring you back down to earth. Mine just think I’m a constant failure, which is… It’s good for the old ego. Anyway, also we’re joined by Sally Ross. Sally is one of my GP colleagues from our Red Whale leadership courses team. Sally has had a long career in the military—ex-Royal Navy, and works in loads of roles in general practice. Sally, tell us a little bit more about you.

Dr Sally Ross: I’d just like to point out that it’s Claire and Rachel who both used words like experience and long rich, really depicts me old.

Rachel: Thank you, Taj for not going down that route.

Sally: Long career. First off in the military, various leadership training events over that. Then, came into the NHS and I’ve done… Had an equal balance career between the two. I’m now a portfolio GP, and as well as clinical work as a locum now. Having been a senior partner, I do some clinical advising for NHS England, I teach the deanery, teach the trainers, and I’m an appraiser and a facilitating practitioner.

Rachel: I’d just like to kick this discussion off by talking about micro failures actually. When I booked Claire before this podcast episode, she was tangled with, ‘I’ve had lots of little micro failures, and then the big ones as well’. Actually, I think often. It’s the micro failures that we really, really stress about. Claire, what would you describe as micro failures?

Claire: They’re the little things that you do that you might miss, and they might not really have much of a consequence. Some of them, I think, in our day to day life, we don’t really dwell on them at all. When someone asks you about failure, you just wrack your brains like, ‘Well, I have an exam’ or ‘I fail my driving tests’. But, I guess we’re talking about the small things that we all do. In my everyday life, I’m pretty bad at washing up, and my other half is constantly telling me, ‘You just have to rewash things up’.

More recently, sort of professionally, my new role—in a more managerial environment, I have a task every week to summarise a lot of data into a key slide that does go quite high up. The first week I did, it took me hours and hours and hours. And I went over and over the slide several, several times and sent it up and it got signed off. The next day, I received quite a difficult phone call saying that I’d forgotten to change a tiny date on the bottom right-hand corner of the slide. Obviously, not actually that big of a deal in the grand scheme of things, but certainly something I dwelled on and I learned from.

I wrote a note to myself on my crib sheet, so I can’t forget to do something like that again. But I guess the difference between those are, micro failures that you dwell on that are actually quite small and insignificant that perhaps they play on your mind versus the ones that we do and we just don’t think anything of.

Rachel: Taj, what’s your opinion of these micro failures? The things that we encounter every day—do they bother you?

Taj: One micro failure perhaps doesn’t… You knock it away. Then, you get usually as is the way of life. We have a run-up, two, three or four, and then you sort of want to hide in a deep corner. Whether that’s a personal micro failure with my wife telling me that I don’t hang out the washing very well and therefore, it doesn’t dry properly or getting to work and find [inaudible] along with two pairs of Scrubs, which are trousers. Then, of course, the micro failure on the shop floor clinically and emergency departments. They’re a pretty hectic place where it’s possible to perform a number of micro failures per minute, per hour. And that happens. You just really have to have your antenna about you.

I think caring for yourself actually is not a micro failure. I always feel guilty when I don’t do enough exercise, which then doesn’t make me very sharp. I regard that as a micro failure. You can really beat yourself up on a daily basis really well, and try and take a deep breath and keep going forwards.

Rachel: That beating ourselves up is often about these just basic human errors. If we’ve got to change the date, or you read something wrong. No one can operate at 100% all the time. We do feel absolutely dreadful. Now, when I spoke to Sally before this podcast, and like, ‘Sally, we’re going to get together. We’re going to talk about all those times we’ve failed. I love Sally’s response. I hope you don’t mind me sharing it. She’s like, ‘I’m sure there’s loads of times I said, Rachel. But you know what? I can’t really think of any’. Sally, tell us why that is.

Sally: Maybe it’s because I have low expectations of myself. Every day, I’m surprising myself by achieving simple things like flossing my teeth. But the truth is that I think because of my very early military training, I grew up in a culture where when things go wrong, you just embrace it as an opportunity to really analyse why it’s gone wrong. Particularly, if you share it with others, I think you can just stick back to sort of learning from it, or even dare I say, some fun from it. I think I probably should see these things as failures. But, I don’t! I just see them as a routine part of everyday life. I think it just happens all the time to me. I just muddle on.

Rachel: I think you also said to me that everything in the military is set up to almost fail fast in a practice setting. That doesn’t happen when the stakes are really high. Do you think we do that in healthcare or is that very specific to the military?

Sally: I think it’s very difficult in healthcare. The military, I think, is just the best training organisation, certainly I’ve ever come across. The whole purpose is that—precisely as you’ve said, Rachel—you train and train and train so that you don’t fail for real. The problem with healthcare is that, whilst we do that during our training years, it’s not really something you can stop and do. It’d be really interesting to hear what Taj says here. I’m sure that they do have an opportunity to do training in the A&E world, but we very rarely have the time, I think in the NHS to take time out to do quite big training events. I think they are different, they are different situations. I think it’d be wonderful if we could find time in NHS health care in our teams to practice and do lots of simulations.

Rachel: Taj, back to you. Are we embracing failure more these days, and really trying to fail when we do simulations or are we still a bit scared of that?

Taj: No, I think expectations are different, aren’t they? Certainly, perhaps when Sally and I were more junior doctors, you seem to almost muddle through and or maybe just the human nature is that you don’t remember. But certainly, expectations at the medical profession are different now. And that results in greater challenge and the intensity of the demand, whether it’s general practice at the front end, or whether it’s emergency department.

I think certainly, when I was at the Royal College, we were very aware of that, on the need to assist our team members, both in terms of how they care for themselves and their team. I think we were one of the first colleges back in 2011 to develop a strategy around sustainability and enjoying your specialty. That was really quite powerful when we presented that at national conferences because there was almost an acknowledgement of the fact that it was okay to not feel great. It was okay to share that with your team, and it was okay to be supported by your team.

Rachel: And Claire, I know you’ve had experiences of simulation where the baby was really helpful.

Claire: I worked as an expedition medic in Costa Rica about two years ago. We were working in a remote national park every time we were deployed, and we did that three weeks since. We had to do a practice [inaudible] back. This was the first rotation where we were leading a group of sort of 17–18 young people. I was running a [inaudible] exercise. We were in quite a hilly area, quite remote. It soon became apparent that our casualty would require being stretchered. And everyone looked to me as the medic, asking where the stretcher was. Then, I realised that I’d forgotten the stretcher. All the volunteers are obviously delighted that nobody had to be practiced, stretchered across the hilly mountainside. I guess it does teach you the value of off simulation. Afterwards, we had a debrief.

I think often that is where we are lacking in health care – finding the time to do those debriefs and reflect on what went wrong, admit to your mistake, and learn from it. From that day on, we always did a checklist in the morning – what equipment do we have, And who has x, y or z, including the stretcher, which luckily, we never needed to use.

Rachel: That’s a really great example. I know that Sally always says that actually, ‘Fail stands for first attempt in learning’. Is that right, Sally?

Sally: Yeah! I have to credit a colleague, Joe Scrivens for that. But, I think it’s so true – first attempt in learning.

Rachel: These failures that we want to learn from, and if we can learn in simulation so that actually nobody gets harmed, that’s even better. But as leaders, I think we do stuff that’s a little bit more nuanced and a bit more tricky. And we’re often dealing with decisions where you don’t know what the right answer is. You don’t know what the right thing to do is. So, failure… It’s almost a given. You almost need to fail to do stuff in order to learn what the right way to do things are.

Have there been any times in your leadership where you thought actually that, that was a wrong decision? That actually… Okay, we’ve learned from them, and that we’re going to do this now. If so, how did you handle that with your team in terms of saying that in terms of sort of admitting it, in terms of sharing that with them?

Taj, if you’ve got any examples or thoughts about how a leader should admit failure when they genuinely have got something wrong?

Taj: Yeah. I think this is so difficult. We always perceive that in the heat of the moment, especially in somewhere like the emergency department, you have to make decisions right there and then. But actually clinical decisions, we can perhaps set aside. Even the emergency clinical situation, you can stabilise a particular situation to try and gather more information. But I think in the wider setting, which I suppose for me has been a lot of the college work I’ve been involved in for many years in the past.

When I look back on things that didn’t go well and there were times where I really gave reflect. And I realise that some of it was my failure to communicate. It was my failure to engage. It was my failure to build consensus. It was my failure to really understand as much as I should have done. At some stage, you do have to make a decision because otherwise, you sit there in a corner doing nothing. But I think trying to make that judgment of trying to achieve consensus, and when you actually, perhaps are a bit too impetuous.

Rachel: And when that happened, how would you handle it? Have you, sort of just carried on and hoped that it would sort of get away, or face up and make a big deal, or some sort of halfway house?

Taj: Well, I’ve had–-as I say, my fair share of failure in that arena. And I think there have been a couple of times, one where I think I did the right thing. But some of the others in my senior exec group didn’t believe so, and I just worked harder at it ‘til they actually acknowledge that this guy’s working really hard, and perhaps that have whatever bias view. Equally, I’ve been at the other end of the spectrum where perhaps they were right. But I felt really awful about it because of the situation we were in. There was a situation where I really needed to share my emotions and my feelings with that senior group, knowing that one or two of them were very much against my views on that area.

But that’s the nature of tough politics or policymaking. So, I shared that. I just want you to know, all of you that, you know, this has been really hard for me. I’ve been waking up at four o’clock in the morning for the last week, thinking about it. I just want to share about how awful I felt. And I think that was quite humbling for some of those people because they didn’t really appreciate it, perhaps. Because we’re all human, even though we might be in a leadership role. And I think it’s quite nice to share that emotion with people or something, which is a fine judgement decision. But once you make that judgment, then you have to go with a cabinet view. I think those are some of the experiences I’ve had.

Rachel: That’s a fantastic example of modelling vulnerable leadership because vulnerability isn’t about saying something people will agree with, but it’s actually saying something you’re not quite sure how people are going to react. But it’s actually a bit of self-disclosure and a bit of… You’re coming up for your protective thing and actually sharing how you’re feeling about stuff.

Sally, have you had examples, where that’s like vulnerable leadership around failure has been really effective or the times when it’s not quite so effective?

Sally: Yeah, I was really interested in what Taj just said. I do agree that time is something that we undervalue in decision-making. I think that we can get caught out by that. I would add to that–-trying to work alone. I think there’s still a kind of a legacy idea that to be a leader, you’ve got to be the all-powerful person with unique accountability who acts in and makes all the decisions. That very authoritarian style of leadership, I don’t think has a place very often. I don’t think in healthcare, actually. I think that when you act alone… Well, by definition, you don’t get that cognitive diversity, which leads to a stronger decision.

I think one of the best ways to mitigate difficulties and failure if you like, as a leader is to share. But as Taj said, it’s got to be really balanced because you have got to step forward as the person who’s willing to be accountable, you’ve got to allow others to have responsibility. I only give lots of situations over the years where I’ve perhaps, particularly as an extrovert have wanted to step forward and say, ‘Oh, you know–-I can do this, I can do that’. You just have to step back, allow others. I think for me, delegation is one of the arts of leadership and allow others around you to actually run with things.

You’ve got to be willing to let people have their head and know that if they do muck up, that you’ll still support them, and you’ll still be accountable for them.

Rachel: And you’re less likely to fail.

Sally: And if you do fail, then you’re sharing it with others. You’re not failing all on your own.

Rachel: Isn’t there a balance to be struck by it? Because if you’ve got a leader that’s constantly going, ‘I’m not quite sure’ and ‘Oh my gosh, I’ve got that wrong yesterday!’ The constantly showing that it constantly sharing uncertainty and all that, would that not destabilise it too?

Claire: Yes, I think from a junior clinical perspective, I think it’s really wonderful when you have leaders that are quite open and honest. Obviously, we look to our senior–- consortium colleagues or senior clinical colleagues to ultimately make a decision and in really difficult scenarios. In that sort of team-building space, I think it’s really important to hear how people have made mistakes, or how they’ve come to a particular conclusion or decision.

I think it’s really important your leaders, or as a leader, you’re not constantly going through your mistakes–-which we’re talking about failure being micro failures every day, kind of a constant stream of things that your senior is describing to you. If it’s a big failure, you need to have had time to formulate and reflect on that and have a learning point to give to your team. Otherwise, I think, could cause more breakdown in a team, if you lose that trust in your leader.

Rachel: So it’s more like, if you’re a leader, and you’ve, you’ve failed at something, something’s happened, rather than sharing it, while you’re right in the middle of it, maybe take some time, reflect, take some action, and then share it with team wants to sort of know what’s know what’s gonna happen. I’ve got some personal support and all that. But otherwise, sometimes that can. It’s not about losing everyone’s trust, but it can make other people feel a bit uncertain and vulnerable as well. And what the military say about that, Sally.

Sally: You did touch on the word—trust. And I think that that is absolutely key to leadership as well as good communication. Because I think if you have a really good trusting relationship, then the communication isn’t just from the leader to, to the team, but also the other way around. So you’ve got to create an environment where, where people know that you too, as the leader can hear challenge.

But as you were saying earlier, you won’t learn as close or you don’t want to show your vulnerability and your weaknesses too much. But you want to invite challenges when it’s appropriate. And so I think those are really important features of avoiding failure. And I think the other thing is consistency. I think for all of us in anything we do, we need to try really hard to be consistent in our behaviors, because then that leads to better communication and trust because people people just speak especially knowing each other I think, I think it’s important to allow people to know you, even if you feel that makes you vulnerable.

Rachel: That’s a tricky one. But let’s think about different types of failure. We talked about these micro failures and talks about sort of failures through lack of communication. I think when I’ve been talking to people that are outside this recording session, we’re talking about sometimes the feeling that we’ve maybe failed in our careers, when we’ve decided to change from one thing which didn’t suit us to another thing or we just decided not to finish that role.

Why do you think we judge ourselves so quickly as having failed to do something when we’ve tried something, and we’ve just maybe not enjoyed it or not work? So I’m going to come to Claire. I know you told me you experienced that little bit recently.

Claire: Yes. So I out on a core surgical training pathway. I’ve finished my two years and now I’m doing this fellowship. But after a huge amount of rumination, reflection, and boring, anybody that would be listening to me about it, I’ve realised that a career in surgery probably isn’t the best thing for me. And I’m going to pursue a career in general practice, which I’m, when I really take a step back, I’m super excited about I think it’s a much better fit for me, really. I do feel I have this sense probably incorrectly, that it’s like a failure in what I set out to do. I know when I speak to other journalists, they’re like, don’t be ridiculous, I can see that you feel like you’re failing, but you haven’t failed at anything.

There’s, nobody’s not signed, you’re not failed an exam, you can do it if you want to. It’s just it’s validating stuff. And I feel like there is a perfectionist attitude, particularly in doctors, and where if you set out to do something, and you don’t achieve it, it does feel like you’ve, you’ve failed. I know it’s not a failure. But I’m also very sure that I’m not the only person that’s been through that feeling.

Rachel: That’s interesting. Consider having, let’s say lots of career coaching and counselling and stuff like that, I think it’s much more of a failure to persist doing something that you don’t enjoy, that it’s not using your strengths, etc, then actually make the very brave decision to change what you’re doing.

I think that’s another type of failure as well. I’d be interested in Taj’s and Sally’s view on this as well, because I’ve been talking to lots of doctors that feel that they’ve failed, when they and they this is definitely in inverted commas “have difficulty coping”, when they’ve just done a week of nights, and then knackered all the work is just far, far too much.

They’re feeling that they fail, because they maybe had a little cry and a colleague, or maybe lost a little bit with, you know, the managers that I can’t cope with this or sent off a ranty email in the evening, because they’re just feeling so swamped. And then made to feel that the failure is theirs, rather than the system that they’re working in.

I mean, Taj, is this something that you’ve noticed in colleagues or seen at all?

Taj: I think the clinical environment that we’re working in at the moment is certainly the toughest of my 35 years as a doctor. And so I’ve seen a lot of change in that time, and maybe developed a bit of a thicker skin around that, but I look at a lot of by colleagues around me, some of whom I find that really, really hard.

Then there are times that I find that really hard, especially when you’re trying to deliver decent patient care, and you’ve got, you know, 100 patients in the department that made for 60. You’ve got elderly patients who might… on a corridor for 14 or 15 hours, and there isn’t any way to, for them to have a pee, nevermind, get them a cup of tea. So when you see you and your team struggling to deliver just decent basic care, that’s really hard.

You can see people struggling with that, and whether it’s having a cry or just feeling down and it’s really our jobs, for seniors to look out for them and look out for each other. So the two things I say to our teams is, “Your first priority is to take care of yourself and each other.” Because if you can’t do that you won’t care to take care of patients. And your second priority is to look after the really sick people. And then after that, the third priority is really just to communicate and explain to everybody else, they’re going to have to wait a long time.

Now that may not resonate very well with some managers or some politicians. But that’s the world we’re in. And there is no magic cavalry coming over the hill, because the hole that we’ve dug ourselves has occurred over the past decade through underfunding by our government. And we just need to be honest about that. We will get out of it, but it will take a long time. And so we have to take care of each other.

Rachel: Sally, have you? You’ve been doing a lot of work in general practice these things similar?

Sally: Yeah, I do agree with everything Taj said, only thing I would say about the underfunding is, I think it’s only underfunding if we think that year on year forever, we can continue to deliver and deliver and deliver. So if we’re not going to set a reality on what a national service can provide, then yes, it will always be underfunded. So I think I strongly agree with Taj I think we’ve got to be really robust at prioritising.

Rachel, you and I spoke recently and both Taj and Claire have contributed one of the two pieces to my toxic trio, which I’ve just recently during the lockdown period I sort of identified. I think there are three things which are really not good in medicine, and which make us more likely to fail. And they are for me, our lack of prioritisation, and Taj just spoke to that beautifully.

I think perfectionism. Claire mentioned that trying to live with passion, and then what the other one I would add, which perhaps is more of a GP thing is people pleasing. And I think that those three things together, luck, prioritisation, perfectionism, and people pleasing, are just likely to condemn us to fail.

I don’t think any doctor should be doing that. I think we just have to recognise we simply cannot do those things. But then going back to the things we talked about earlier, if we communicate, and we’re honest, and we’re open, we can just explain the situation we’re in. And so sometimes I think the people pleasing is the one that needs to go first. I don’t think perfectionism is healthy. But I think certainly trying to achieve high standards is always important, just as Taj said, and I think of all of them, the most important thing to cling on to is prioritising.

Rachel: I think a lot of the failures that I’ve had in my career are not when I’ve done things that were wrong is when I haven’t done things that were right. So I haven’t had the right conversation with somebody, I haven’t put my foot down and said, That’s not okay. And that is probably because the people pleasing, because I’m scared of the consequences of doing that.

So I can think of one of my biggest failures with a team that I was leading, just letting some bad behavior carry on because I was too scared of the consequences of addressing it. And I think in the NHS, we are really nice people, we like to be friends, don’t we? When I’ve gone into surgeries that and GP practices do team coaching, the biggest issue is not necessarily that they’re all at each other’s throats, although some of them are.

But often, you go in, they go, “We’re all such a nice team, we love each other here, it’s too nice.” And no one is talking about the elephant in the room, or the big thing that’s happening. And so there’s this people pleasing, wanting everyone to love each other all the time and not addressing the big issues.

That is much more of a failure than some of the stuff that we, you might try and address this, you might do a bit clunkily you might upset someone for a bit. And that feels like a huge failure at the time that you can go and apologise and whatever but actually letting it go on and on and on. Has that been your guys experience?

Sally: When you’re running a practice in general practice? Obviously, you’re employing your own staff. And and this absolutely what you’re saying Rachel speaks to a couple of instance, we hadn’t the practice really around things like staff absence. And they’ve been a couple of occasions where I have just absolutely had to address things. I’m so glad I did. And I’m sure it made me unpopular.

There was a time when one of our nurses who lived very close to me at home, we had snow and she didn’t turn up for work. And ordinarily it wouldn’t have been noticed, because the day she didn’t turn up was my day not in the practice. But on this particular occasion. I was doing an appraisal in my practice. And I happened to be there in my wellies, and my jacket, my snow jacket, and she wasn’t there and I said, well, where is she and everybody said, Oh, she couldn’t get in because of the snow.

It was just really awkward for her that her near neighbor who lives 500 yards away, managed to get in despite the snow. And I am afraid I insisted that that lady took a day’s unpaid leave. Because I felt that was absolutely not acceptable. And I think you know, there are times where you just have to, you do have to do things I’m sure I was very disliked for that.

But what it did was it set a message and a tone in the practice that we all had to pull together as a team. Everybody else has made it in. You couldn’t just have the sorts of you know, exception, because you can’t if you allow that sort of thing to go then before you know it, everybody’s got a vague reason for taking time off. So I think people pleasing is is to be avoided at times. I think we should all try to be very nice people at work. But we don’t go to work to win a popularity contest.

Rachel: You genuinely can’t please all of the people all the time. In a second, Taj. I’m just gonna come to you and say do you think the biggest failures or failures of omission or commission.

Just a comment from Maya Lacan in the chat in his view, “Bigger than people pleasing as offensive practice and transferring risk to other providers too much investigation and too much? Too much medicine. So this whole defensive thing, you know, defensive practice trying to avoid this short term hurt, which in the long term leads to longer [incorrigible].”

Taj, is this sort of thing that you’ve seen?

Taj: Yes, I think risk transference is a major issue that is clogging up in a chair of that there is no doubt and a think that that part of the quality bar of the expectations and the resulting potential for litigation angle investigation, criminal investigation.

In my 20 years here in Yorkshire, there have been at least three of my colleagues where mistakes they have made on the shop floor have led to a criminal investigation, which took at least 18 months to two years to resolve. And they were all three cases that, when I looked at them, I thought, “Wow, you know, there but for the grace of God, go I.” And so those are huge challenges. And they’re really distressing for the teams involved.

Going back to your other point about omission, or commission. And I think one of the things that I’ve always always been very strong on, and I’ve reflected on times when I failed to do this is a zero tolerance towards people being rude to my staff, or to me, I can tolerate it to myself, because I usually give them two chances, and then I take them into into a room and have a pleasant conversation.

It’s really interesting when you bring a specialty colleague up, I’m not gonna name specialty colleagues now, but and say, you know, you’ve just had an interaction with one of my junior doctors. And I want to tell you that, you know, on reflection, I think you’ve been incredibly rude. Now, I just wanted to get your thoughts on that matter, and it really does stop them. And of course, they will have their own narrative. And, and I will say, “Well, you know, I’m believing the person in front of me.

So I need to understand how you’re going to help me resolve this.” You know, so the, the onus is on you to come come down and apologise or come down and have a discussion, but how are you going to resolve this, otherwise, we’re going to end up escalating it, and it’s going to go from a conversation where something bad happened, and I wasn’t there to something which then will require investigation. And, and people know me for that now.

And, I’d like to think that the culture of our department is better for not just me, but my colleagues as well who do this, you know, in different ways. You have to get people to be civil. We work to toughen the environment for specialties to be rude to each other. And to you know, the old adage of, oh, I’m a wall, not a sieve. But as an admitting specialty doctor, and I don’t take any of those patients from the emergency department. So I think that that narrative has changed, because we have more senior people on the shop floor and create creating a better culture.

Rachel: just sort of going back to, you know, this culture, and there’s been a lot of comments in the chat, I’ve been keeping an eye on about the culture of blame when something goes wrong and blame failing the blame game.

“What can leaders do?” This is a question that’s come up in the chat. “What can leaders do to facilitate learning from failure? Rather than blame?”

Because I know that the whole point that we wanted to talk about here was that actually learn it, failure is a way of learning and it’s probably the best way of learning that we have, unfortunately. And as leaders, we need to obviously role model that but what else can we do to facilitate that? And there’s another question that I think goes with this. So lots of people feel completely disheartened after failure, and just like beat themselves up, feel absolutely awful. “So what can we do as leaders? Anot to blame people, but then to help them not just feel so utterly crushed? And disheartened?”

I mean, Claire, what about you from a sort of trainees perspective? What do you wish your leaders and your, you know, your consultants could do with you?

Claire: If I’ve reflected on anything over the last few days, it’s just the beauty of having time, and unfortunately, something that it is hard to make space. But I think the more we talk about those sorts of little failures, or quite big failures that you might be reflecting on a lot. And you share that with your team, the less likely massive failures are going to happen.

I think that would be the best way and to get that sort of culture shift, if it’s possible, to admit to mistakes and learn from them. But I, you know, I’ve been keeping an eye on what the chat has been saying. And yeah, in a world where litigation is high, and like Taj, saying criminal investigation is possible. That does conflict with the ability to open up to your mistakes.

Rachel: Yeah, yeah, definitely. When you think, you know, we’re all told you’ve got to speak up or whatever and then Something goes wrong and all the blame is put on one particular person. And we’ve seen a very prominent case of that which is, which is almost put us. I don’t know how many years back in terms of wanting to speak up about stuff. It’s been really, really difficult.

Sally, what’s your take on that? How can leaders facilitate learning from failure rather than blame?

Sally: I think you’ve got let people talk about. So you’ve got to find time, I appreciate as Claire says, There isn’t much time this is where coaching conversations are really helpful, and just having a very, very brief coaching agenda in your mind with somebody so but I think when people have failed, they’ve got to be allowed to out it, because otherwise, they’ll carry this baggage forever.

You’ve just got to give them even if it’s only two or three minutes of real deep listening and enable them to out it. And you don’t necessarily have to, you know, no requirement for platitudes necessarily, especially if there have been mistakes. But there has to be, I think, a non judgmental listening so that people feel heard.

Therefore, even though they might acknowledge and accept that they have made a mistake, they recognise they’re not alone, and that they can now park that, because it’s been heard and outed, they can now move on and take the benefit of the learning with it. I think the important thing is to front up to people, and let them talk about it.

Rachel: I think a lot of people can feel quite a lot of shame, can’t they? When they fail. Because I know that there’s a big difference between guilt and shame. If you’ve, you’ve definitely made a mistake, you feel guilty, because you wish that that hadn’t happened, you regret your actions. And that can be quite healthy emotion, because that actually just shows that you’re, you’re human, right?

Shame is, I’m a bad person, because I did that I’m an awful person. And if you carry that around, that’s that that’s really hard to deal with. And I think that we did a podcast recently about the second victim syndrome where you know, someone shared, you know, when often in mistakes as healthcare professionals cause harm.

Then the second victim being that the healthcare professional that made that mistake. That’s something that people find it very hard to talk about and admit to other people, the more you bottle up, the more you tell yourself those toxic stories. And actually, the person who’s talking the podcast said that the really helpful thing would have been if someone came to them and said, what has happened to me, that has happened to me in the past, I’ve done exactly the same or, or similar. I’ve made mistakes just like that.

That was the one thing that would have made her feel better. And felt like it’s not even a dreadful person. It’s just one of those things that happens. Taj, what do you think? How do you help people facilitate learning as opposed to just blaming themselves?

Taj: This is so tough, because we’re all busy. And we don’t invest time in channels of communication around how we share our mistakes. And so, you know, in hospitals, it’s great. If you think something gone wrong, you can do something punitive and put in a Datex. Again, specialty x and that makes you feel better, because you think you’re improving the system.

When in fact you’re really getting back at specialty x and, and so finding ways to regularly gather, you know, things that have gone wrong, and finding good facilitators, to be able to share those experiences is really, really important. We on the other end of the spectrum, the extreme spectrum in the emergency department in the resource room, we tried to do some hot debriefs when things you know, when a patient has died, especially young life or a child and it’s very distressing.

People, some of the people there will think they’ve made a tragic mistake and whether it was delay in assessment, delay in therapy, and you can’t unbundle out at the time, but you can give them a sense that actually there was so much that we gained, right. And so I think that’s an acute end of the spectrum, but the other thing, it’s really important, whether you’re a clinical director or a medical director, or chief exec, that you find ways to give people time to share error and and how the organisation is trying to handle it.

Because I think the people on the shop floor in the midst of everything, just don’t see. Don’t see enough of that good organisations have executive leaders that you know, that are tangibly there and sharing and communicating in corridors and that’s powerful because people learn to feel valued. But once you feel valued you get through the day, or you just want to deliver the best possible care based on it.

Rachel: Taj, how do you think we make this just a PART part of training, a part of learning, a part of working? Because in the startup world, when you create a product, what you do is you create products, which you can fail fast at. I need to fail first, so we know, we know how not to do that. And it’s all about how can I fail first? How can I fail first?

You’re looking for opportunities to fail in order to improve now, obviously, [incorrigible], we don’t want to be looking for opportunities to fail when it causes patient harm. But how do we transfer that sort of mindset into our practices, as leaders.

Taj: I think getting people to focus much more around validated quality improvement strategies, because actually, you know, PDSA cycles are ways to fail fast, and you keep going until you get better. And I think organisations again, that have invested in training their people on validated quality improvement, that those are really good ways. In the old days, once upon a time, we get these terrible things called audits. And I hated audit, and I hated my bosses for making me do audit. And when I became a consultant, I promised myself I would never ever make any of my juniors do audits, but I would help them do good quality improvement.

I think that’s really important. That’s a really good way to fail faster and feel that you’re incrementally shifting the needle, which, of course, is what we’re trying to do.

Rachel: Thank you, Claire. Sally, have you got any, any suggestions?

Sally: I think all of us could do with learning, just to say, till colleague students, isn’t it? Are you okay? Are you really okay, about what happened? What you did the really, okay. Do you want a coffee and talk about this? And I think all of that. And you know what, that’s a gift. That’s a gift, you’d be able to a colleague, and maybe one day somebody will give you that gift back.And tell you just put in the chat. You [incorrigible] yourself several times,

Claire: I think there was some discussion about your comment about data specialty apps, because they’ve annoyed you. But I’ve definitely dated myself when I inadvertently discharged a patient that had had a flu swab and the consultant and me didn’t check that result before discharging the patient. And they sat in the discharge lounge and exposed, vital lots of people to flu.

Likewise, with antibiotic prescribing era where you know, that [incorrigible], the patient had come in with a sibling rather than their parent, and they’ve not disclosed allergy. Fortunately, didn’t turn out to be actually an allergy. But yeah, data, it’s myself. And I think the importance of the data system is reading that feedback email that does sometimes take six, eight weeks to come back. But it shows that it’s been reviewed, and hopefully some reflections have been made by all parties.

Rachel: Data says you’re just for those people don’t know, it’s the reporting system in hospitals, isn’t it? With adverse incidents. Someone told me recently the word AFOG, which stands for “Another Flipping Opportunities for Growth.”

I’m like, “There’s another flippin opportunity for growth.” And like, okay, I feel dreadful about this, but what growth? Can I get out of this? What growth can I get out of that, and that has really helped me but you know, you have to say AFOG, again, quite hacked off manner. Then you can get over and think like, Okay, this isn’t failure unless I fail to learn from it. It’s only true failure if I fail to change what I’m doing or else then.

We’ve got a couple of minutes left. And there’s a question in the chat about what do we do about when we’re failing through the system time and time again, and it’s repeating repeated? We can put a tick, then what do we do when we just see that happening again, and again? And again, maybe it’s the final thought from each one of us? Are we finished?

Taj: I’m just gonna add to AFOG and say My father used to say, these are all CBEs, a CBE is a “character building exercise”. And so I’ve always got I’ve had my character built humongously over the years. So I think working in systems that are failing that, you know, let’s be honest, that’s our NHS at the moment. You know, I think even system leaders, even NHS ei executives, are saying our NHS is on its knees is really struggling.

What you have to do is just accept the fact that things may well go wrong. But the heart of it is what I said earlier, so I’m sorry, if I’m going to repeat myself is caring for yourself and your team. We cannot afford to have good people go down because the next person next to them didn’t realise they weren’t very well because of a bad incident.

So you have to care for the team. And the executives responsibility is to channel their communication really well to show people on the shop floor, that they are valued. And that’s really important. and that will then allow us to take care of the people who are really ill. And that’s our core job, do people who desperately need our support, and everybody else, for the time being is going to have to wait.

Sally: I would say, just be very consciously aware that you have the four T’s at your disposal, this is from a risk management, take it, treat it, transfer it or terminate it. And I think that you can be consciously in control of any of those four decisions. I’ve certainly left jobs because I felt I couldn’t fix the system.

Rachel: Thank you. Thanks, Sally. So difficult choices to be made. Finally, Claire, you get the last word.

Claire: Someone had taught me sort of “self, team, then others.” I guess that’s seconding Taj just said, and you can’t look after everyone else if you’re not looking after yourself.

Rachel: Yeah, thank you. First of all, thank you so much, Taj, Sally and Claire for being with us. I hope that that has helped convince maybe some people that fail is not a nasty four letter word. It is actually a four letter acronym, which stands for “First Attempt In Learning” that failure is just the flip side of success.

You can’t actually have success unless you have failed and learn from that. We just need to get some strategies around dealing with it and not be scared to do the hard stuff as leaders because that’s why we need it to do the hard thing.

So thank you so much for being here. Thanks, everyone who’s been listening. Thanks so much, FLMM for having us as Leaders in Healthcare. So check out the rest of the podcast episodes we haven’t you’re not probably done a whole full podcast series on failure. So you might want to check that out as well. But thanks everyone.

Thanks for listening. If you’ve enjoyed this episode, then please share it with your friends and colleagues. Please subscribe to my You Are Not A Frog email list and subscribe to the podcast. And if you have enjoyed it, then please leave me a rating wherever you listen to your podcasts. So keep well everyone. You’re doing a great job. You got this.