“Forgive and remember”

File this under “lessons about failure that the nonprofit sector can learn from medical sociology.”

Forgive and Remember: Managing Medical Failure, by Charles Bosk, is a classic of medical sociology, an analysis of how coping with failure is built into the training that surgeons receive in hospital rounds, mobidity and mortality conferences, and other settings.

Please note that I am not claiming that surgeons themselves have a lot to teach us about dealing with failure, because my experience is that while their sub-culture does have rituals and protocols that they enact privately, they still have a way to go in transparency and accountability to others.

This has been my experience in three instances of major surgery:

1. Surgeon did not follow instructions given by the specialist physician managing my condition.  Acknowledgement: Partial.  Apology: No.
2. Surgeon did not inform me that the tumor to be removed might be malignant and require addition surgery until I was under anesthesia. Acknowledgement: Yes, after I complained. Apology: Yes, after I complained.
3. Surgeon did not respect my request regarding administration of anesthesia:  Acknowledgement: Yes, after I complained. Apology: No.

Not that I am bitter.

But let’s face it:  most of us are highly invested in showing the world that we are skillful, trustworthy, and deserving of whatever prestige is ascribed to us.  As a patient, I naturally blamed the surgeons, not only for their errors in judgement, but for the instances in which they failed to acknowledge or apologize for their mistakes.  As a fellow human being, I completely empathize with their reluctance.  I imagine that that reluctance is more acute among professionals who have to cut people open.  Their work is obscenely invasive but often lifesaving,  and therefore must maintain an impeccably trustworthy reputation.

That’s why Brent James is one of my heroes, along with surgeons and physicians like him who are putting it on the line for evidence-based practice.  There will be no accountability, transparency, or improvement in health care unless successes and failures are accurately documented.  Those results must then be carefully analyzed, made available to the public in appropriate ways, and used to improve their efforts.

As with medicine, so with other mission-based organizations.  We need to track outcomes, acknowledge failures, and then do better.  If it takes a pink feather boa and an amusing ritual for nonprofits to get there, I’m all for it, though I’m not expecting surgeons to adopt the feather boa.

As for the slogan, “forgive and remember,” I think of it as both a spiritual and a practical precept.  We not only need to forgive ourselves and others when we have failed – we also need to bear the lessons of failure in mind.  Both individuals and organizations not only need to keep learning, but to take appropriate action to protect those who are at risk.

I used to work in violence prevention, and for me, one of the most heart-rending aspects of it was the well-documented difficulty in stopping offenders from repeatedly battering their loved ones.  In some cases, they simply didn’t see their behavior as abusive, or their loved ones didn’t see any alternative to accepting abuse.

As I reflect on that today, it drives home very painfully the lesson that we cannot always change others, or even control a specific behavior of theirs.  The old cliche that they “have to really want to change” is true, and it’s also true that not everyone who wants to change can do so. This is the really difficult side of facing failure for nonprofit organizations – in some cases, there may be no alternative to severing ties with individuals or organizations, if the organization is going to face its failure and move on.  It’s going to take more than a pink feather boa, a “joyful funeral,” or a FailFaire to get past that.  When the well-being of vulnerable people is on the line, there are cases where forgiving and remembering is crucial, but it isn’t enough.

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Bonus item:

Q:  How many psychotherapists does it take to change a lightbulb?

A:  Only one, but the light bulb really has to want to change.

Tagged: abuse, abusive behavior, accountability, accuracy, acknowledgement, analyzing failure, apology, appropriate action, at risk, battering, behavior, best practices, bitterness, bonus item, brent james, change, charles bosk, competence, documentation, domestic violence, empathy, error, evidence-based medicine, evidence-based practice, fail, failfaire, failure, forgive and remember, forgiveness, fun, health care, human nature, improvement, intermountain healthcare, invasive procedure, joyful funeral, judgement, learning, life-saving, managing medical failure, medical culture, medical sociology, mission-based organizations, mobidity and mortality, moving on, nonprofit, nonprofit management, outcomes, outcomes management, physicians, pink feather boa, protocol, remembrance, reputation, respect, ritual, rounds, severing ties, skill, spirituality, sub-culture, success, surgeons, surgery, the learning organization, transparency, trust, trustworthiness, violence prevention, vulnerability, worst practices