Embracing 'The Museum of NHS Failure'

In Ann Arbor, Michigan, there is a vast museum. It is not open to the public and it holds only one of each displayed item. But this is no ordinary museum, for the tens of thousands of household products on its walls and shelves are all certified failures.

Oliver Burkeman, in his book The Antidote: Happiness for People Who Can’t Stand Positive Thinking, describes them as “products that have been withdrawn from sale after a few weeks or months because nobody wanted to buy them”.

This extraordinary museum is known as the museum of failed products and, according to Burkeman, it is testament to the fact that “most products fail” at an estimated fail rate of 90 per cent. Originally intended to be a collection of all consumer products, it became about failures and a truer reflection of the real world.

The Museum of failure was started by a firm called GFK Custom Research in 1960. Some of its highlights include such forgettables as Clairol’s Touch of Yoghurt shampoo; however, curiosity and amusement are not the aims here. This is a lucrative profit-making business. Product developers who want to revisit past failures in order to avoid repeating them pay for the privilege at this unique museum.

A fascinating insight from Burkeman that should strike a chord with the NHS is that visitors don’t, as you might expect, come to see the past failures of others. Often they come to see failures of the companies they work for. Their own companies, obsessed with success and positivity, do not dwell on the past. Likewise product developers, prefer to forget their failures as they move between companies.

Curating the NHS collection

I began to wonder what an NHS Museum of Failure would look like. In my mind's eye I visualised long corridors stretching into the distance, all packed with exhibits.

The national IT programme would no doubt take pride of place, with an enthusiastic curator highlighting examples of how technology can be over-engineered and suppliers screwed until failure is inevitable.

There would be a whole room for transient organisational acronyms such as PCTs, HAs, SHAs, GPFHs and PCGs.

The Capital Developments section would be piled high:

• The Coastal cardiac centre built without the population to sustain it
• The private finance initiative hospital with too few beds;
• The publicly funded, state of the art, primary care centre generating profits for resident GPs;
• The teaching hospital with some departments at five star hotel standard, while others would shame a third world country.

Glass cases would feature the good intentions of commissioners, admissions avoidance schemes and perhaps a selection of human resource contractual failings: the GP contract, the consultant contract and Agenda for Change.

Space would be reserved for personal and local failings too:

• Failure to turn a bed-bound patient, resulting in pressure sores
• Food left in front of a patient unable to feed themselves
• The junior doctor, so tired from his European Working Time Directive non-compliant shift that he overprescribes a medication tenfold.

The gallery cafe would offer the half-baked ideas of politicians and their whimsical glib and self-interested interference into complex issues. A small selection would include two accident and emergency departments being kept open when there was only enough specialist staff for one, and the PFI hospital, built on two sites although patient numbers justified only one.

Commerciality reversed

In the “real world”, where capitalism largely motors-on without the brakes of excessive bureaucracy, success is rewarded and failure punished. Those at the top in the private sector enjoy impressive runs of success.

In the NHS, however, this natural law fails to be consistent. Across all grades, the wave of incremental progression up the Agenda for Change pay scales continues unfettered by structured and challenging performance management.

‘We need to enthusiastically embrace the breadth, scale and frequency of failure at a national, local and personal level. We need to live and breathe the failure’

The harsh commercial reality of “up or out” is perverted from becoming “up or up”. Where failure occurs at a senior manager or executive level, if the individual is unfortunate enough not to qualify for the holy grail of early retirement, they quickly reappear in some other part of the system. If we could only encourage our people to speak openly of failure and listen it can be our primary source of learning. We could make the NHS’s greatest failings one of our greatest opportunities for success.

In my personal life learning from my past failures is an ever present. Every day I wake with the intention of avoiding mistakes I have made. So why is it not the same in my professional life?

In my former consulting career, an exercise that stands out in the context of fully embracing failure is the pre-mortem − a simple workshop exercise I have carried out with groups about to launch innovative transformation projects. In the sessions we seek to visualise what failure will feel like in the future.

We project ourselves into the future and look back on the failure of an enterprise that has yet to be launched. I have, on occasion, even drawn the figurative cadavers of the project so that we can physically label the past reasons for failure that has not yet occurred (think knees labelled with lack of flexibility, eyes with lack of vision and a heart’s lack of passion).

Positive thinking

For fans of positive thinking, this may seem anathema. Surely we need to think of how successful we are going to be? If we picture failure, we will fail, right? But in practice it doesn’t feel like this. The experience is often a liberating one. People bring their experience and knowledge of past failings, to this exercise unconstrained by the need to confess their role in them.

This exercise will not turn a doomed project into a success (these should be stopped at the first sign of imminent failure regardless of sunk costs − human and financial), but it will give a shared sense of ownership and an opportunity to focus on collectively planning to avoid known pitfalls.

We all know people who are more than willing to relentlessly highlight the failures of others. Indeed the press appears to treat it as a national sport. This is not what our museum is about. It is not an exercise in the kind of sneering and cynicism we are all too familiar with in the NHS. Nor is it a superficial willingness to talk about failure as a shortcut to success.

We need to embrace the breadth, scale and frequency of failure enthusiastically at a national, local and personal level. We need to live and breathe the failure. Only then will we realise the scale of the challenge and the complexity of the environment we work within. Our ambitions and problem solving approaches should be shaped for this new reality.

The museum of failed products demonstrates that it is a good idea to collect and revisit past failures, regardless of whether these are the failures of others or our own. But we need to be cautious; embracing the lessons from these failures does not mean we will tolerate teams or individuals who are destined to fail.

We need to ensure we only employ people and create teams that have the character and competence to embrace failure but deliver success more often than not.

This is a blog-size version of a piece originally published in the Health Service Journal (HSJ).