Failure in medicine

Medicine doesn’t take failure well. In high-risk areas of patient care and safety, when the cost of failure is a life, that obviously makes sense. But do failures necessarily have to be that large?

I’ve spent a lot of time over the past few months talking to people at Penn’s Innovation Center. Their job is, as you might expect, to bring innovation into the UPenn health system. Here’s what I’ve learned. Medicine has long been thought of a field entrenched in its own traditions, one that has a lot of institutional memory. Changes are slow and incremental to be proposed, let alone adapted. I was immersed in an entrepreneurial ecosystem in college where I learned to rapidly iterate and learn from mistakes, and then just iterate again. I learned to think at the scope of microchanges, so no one mistake cripples me, but over time the sum of these microchanges would completely change the outcome. With this particular way of thinking, failure never seemed all that scary. From what I’ve seen, this doesn’t happen too often in medicine. I’ve asked those far more powerful than I, and they agree. Some of them take it a step further and say it’s not feasible, and this is where I disagree. From a policy level, I’ve noticed the prevailing opinion is that the healthcare system is so broken that nothing short of an overhaul will be acceptable. From EHR to universal access, all of the issues in the current healthcare system are purported to be too complicated and intertwined for any one measure to solve. This might explain why the Affordable Care Act (ACA) seemed so disparate and overwhelming (read into what the actual articles of the ACA are – very few deal with access to healthcare). Even in medical education, medical schools very rarely change their curricula – we’re still effectively using a model developed decades ago despite the field’s rapid evolution.

At my vantage point, two things have to happen: those who have been in the field for decades have to be willing to test new ideas, and healthcare needs to accept failure. The former means that doctors, nurses, staff, etc. have to buy into the idea that small changes can be impactful and are worth making. Not every issue is going to be fixed with one catch-all solution. The latter means that in areas where medicine can afford to innovate, it should. Failure will always be a statistically necessary byproduct of frequent iteration, but if the iteration is done with intention and care, there’s no reason to be afraid of it. The Innovation Center is doing exactly that – looking at implementing projects that doctors and staff want to see happen and helping them navigate the red tape. (One of the most frequent answers I’ve received in response to a question about implementing something new is red tape. Red tape is entirely the invention of a bureaucracy, and if the very institutions that complain about it simply choose to ignore it, the red tape magically vanishes). It’s a good start, but I don’t think it’s enough. There’s still this institutionally ingrained hesitation when it comes to trying new things.

I have a hard time believing iterating with microchanges wouldn’t work – it’s especially because healthcare often has to avoid large failures that the start-up way of thinking ­should work. There is great evidence of this already with the Intermountain Healthcare System in Utah and Idaho. But it’s not enough. Those of the philosophy that healthcare is vast and complicated and failing grossly are all correct – but I see that not as a paralytic, but as a call to action. I want to get in the habit of thinking like an innovator now, when the risk is relatively low (all I really do right now is a bit of armchair-philosophizing). But on a larger scale, more hospitals, more schools, more companies have to start innovating to disrupt within the confines of the medical system. It doesn’t have to be large. A new checklist here, a new curricular initiative there, and we might be able to (slowly, but surely) create a new medical system someday.