Failure to Rescue

Scientists have given a new name to the deaths that occur in surgery after something goes wrong—whether it is an infection or some bizarre twist of the stomach. They call them a “failure to rescue.” More than anything, this is what distinguished the great from the mediocre. They didn’t fail less. They rescued more. Atul Gawande

Suppose you are faced with surgery and need to choose between two different hospitals. Both have the same death rate following surgery. But they differ in terms of surgical complications. The first has fewer complications, while the second has more, but is better at rescuing patients from them.

Which hospital would you choose? Normally you’d prefer the first, hoping at all cost to avoid any complication. That’s what Atul Gawande, an eminent surgeon and staff writer at the New Yorker, said he would have chosen during his talk at the New Yorker Festival last weekend.

But he admitted he was wrong. You would have been better off having surgery in the second hospital. He said this was crazy and counter intuitive. He pointed out, however, that problems during surgery depend on many unknown and complex circumstances—chance, how poor the patients are, their health, etc., that you really want the hospital that has a better record of rescuing patients from any unforeseen difficulty.

In his lecture, Gawande cited some of the medical studies supporting this idea and explored their implications. He pointed to the British Petroleum oil disaster in the Gulf of Mexico two years ago. According to the official investigation, there were many signs that the drill pipe was having problems, but the companies involved did nothing about them before the night of the explosions and the crew testing the well the day after did not take immediate action once they recognized how serious the situation had become.

When something goes wrong or a mistake is made, more often than not, we tend to ignore it or diminish its importance and hope it won’t happen again. Less often do we acknowledge the problem and then plan carefully what to do if and when it happens again. The BP crew did not have such a plan ready to employ once they were aware something was wrong.

The hospitals that had a better rescue rate did have in place a well-prepared set of scenarios about what to do once something went wrong. The surgical teams had practiced it, talked about it, and each member of the team knew what to do in the event of an emergency.

Gawande also mentioned the widely discussed case of the US Airways flight that crashed in the icy waters of the Hudson River a few years ago. While most everyone praised the skill of the Pilot, Chesley Sullenberger, even he acknowledged that had little to do with avoiding any casualties. That depended far more on his crew, the plane’s attendants, the proximity of the ferryboats that rushed over to the plane, and above all the well-rehearsed plan they had for responding to emergency situations.

Gawande’s discussion of this issue suggests a general strategy for anyone who wants to deal effectively with unforeseen errors, accidents, and mistakes: Have a plan, practice it, and prepare for as many possible difficulties as possible.

He spoke about this topic in his recent Commencement address to the graduating students at Williams College, concluding:

So you will take risks, and you will have failures. But it’s what happens afterward that is defining. A failure often does not have to be a failure at all. However, you have to be ready for it—will you admit when things go wrong? Will you take steps to set them right?—because the difference between triumph and defeat, you’ll find, isn’t about willingness to take risks. It’s about mastery of rescue.