Fail fast and learn faster

The national new care models programme brings together local health and care systems as ‘vanguards’ to radically redesign care for the local populations they serve. Professor Don Berwick was appointed in 2015 to support the vanguards learn from international best practice and visits the UK this week to see how the vanguards are progressing and to share his insight and knowledge with them. In this blog, Samantha Jones, Director of the New Care Models Programme, reflects on the theme of an event Professor Berwick will be hosting for the vanguards as part of his visit – ‘fail fast and learn faster’ and explains how important this idea is in the context of developing new models of care.

Being brave enough to say we haven’t got something right, we did this wrong or actually we could have done something better is often quite easy to say but hard to do in practice.

By the very nature of the new care models that are being developed by vanguards, we expect things to not work as well as they need to and we expect people to not get it as right as they could have done. As a result, they will need to learn from what hasn’t worked well so they can make improvements.

This notion might sound bold – but it is the whole principle of our programme that we learn from failures and make sure that we share that learning, both good and bad with people wider, so that we can prevent and support people from making the same mistakes.  We cannot only share the good stuff.

What’s interesting is that people can be very reluctant to talk about their failures. We spend a lot of time encouraging people to share, and share again, and share a little bit more, but it can be hard enough to get people to talk about the things that they have done well, let alone the things that haven’t done so well.

I’ve often found that when this does happen, it’s usually been over a cup of coffee and something that is said very quietly.

I have a few examples, including people saying they underestimated the size of the challenge or that they underestimated the amount of time it takes for the relationships to be solid enough to totally challenge the way things are done.

I think people would say that our ability to really let go and start with a blank sheet of paper is perhaps not as easy as they thought – for them as individuals and also for the people they are working with, which is very much the human side of learning from fast failures.

Before I started writing this, I went through a list of things I’ve learned as a result of failure and there are a couple of stand-out moments for me. I’m not afraid of holding my hands up when I make mistakes.

The first one is making an error while I was a student nurse, six months before qualifying. Even now, over 25 years later, I still remember that feeling as a result of what happened and subsequently going to see the senior staff nurse. The biggest learning for me was that she wasn’t as honest as she could have been and I ended up going to see the nursing officer to explain the mistake as well because I was so worried.

I have to say that everything was fine but I learned a massive amount, taking time, understanding the fear associated with making a mistake and understanding the judgement call that I personally had to make and crucially being brave enough to go and talk to someone more senior about it. That early experience in my career has really defined the way I work.

My second example is from a leadership perspective, and a mistake that I make – and that is to not always trust my instinct. You should always listen to people, always take different views from people who come to the table with different experiences but at the end of the day, the times when I have made some of my biggest mistakes and not learned as fast as I could have done is when I haven’t listened to my instinct.

The vanguards meeting with Professor Berwick today have been asked a few key questions during registration. They’ve been asked how confident they feel to take managed risks in their work and developing the new care models, and to put that on a scale of one-ten, with ten being high.

In my old role where I was leading an organisation and we were dealing with some significantly difficult things then I would say it was high. This role is different because the very need to be able to do things differently and take safe risks is at the heart of what we are doing in the new care models programme and within vanguards.

Measured risk is really important. I once worked for somebody who taught me early in my career that there were two rules – one is to make it safe and make it legal and the second rule was that we are right behind you, irrespective of what happens. I think that those two fundamental principles are the things that most people need to know to take a calculated, sensible and safe risk and would hope that is the case for people throughout the new care models programme.

Professor Berwick’s visit also coincides with this year’s Fab Change Day, which is a great opportunity for people to learn from their mistakes and make a difference by pledging to make one simple change. This year I have made my pledge in the video below (web team to embed) and you can see how others across the new care models and vanguards have pledged to make a positive difference by searching #fabchangeday and #futureNHS on social media.

Samantha Jones

Samantha Jones is NHS England’s Director for New Models of Care.

Samantha Jones was appointed as NHS England’s New Care Models Programme Director in January 2015 leading the implementation of new models of care as outlined in the NHS Five Year Forward View.

She started her NHS career as a paediatric and general nurse and was a national management trainee. Having worked in a variety of operational management roles, and in the national clinical governance support team, she became the Chief Executive of Epsom and St Helier Hospitals NHS Trust.

Following this, Samantha worked in the independent sector before she was appointed Chief Executive of West Hertfordshire Hospitals NHS Trust in February 2013.

In 2014 she was awarded Health Service Journal Chief Executive of the Year and the trust’s “Onion” was highly commended in the patient safety award.