•Errors (synonymous with mistakes): as unintended deviations from prespecified standards, such as procedures, rules, or policies •Violations: occur when an individual intentionally deviates from the rules https://app.heptabase.com/w/f081e5ccde7d627fb7d304000be42324587b43abdea017a1e97297771114a09e
the science of failing well • It allows people to ask for help when they’re in over their heads, which helps eliminate preventable failures • It helps them report—and hence catch and correct—errors to avoid worse outcomes, and it makes it possible to experiment in thoughtful ways to generate new discoveries • *Psychological safety is an emergent property of a group, not a personality difference. • When a group is higher in psychological safety, it’s likely to be more innovative, do higher-quality work, and enjoy better performance, compared to a group that is low in psychological safety • **Psychological safety in a team is virtually synonymous with a learning environment in a team. https://app.heptabase.com/w/f081e5ccde7d627fb7d304000be42324587b43abdea017a1e97297771114a09e
are those that bring us valuable new information that simply could not have been gained any other way. • Bad Failure, Good Failure: • First, failure is not always bad. • Second, learning from failure is not nearly as easy as it sounds. Nonetheless, we can learn how to do it well. • Every kind of failure brings opportunities for learning and improvement. To avoid squandering these opportunities, we need a mix of emotional, cognitive, and interpersonal skills https://app.heptabase.com/w/f081e5ccde7d627fb7d304000be42324587b43abdea017a1e97297771114a09e
one cause, none of which created the failure on its own. External factors: In complex failures, an external or uncontrollable factor often enters the mix. Warning signs: Complex failures are generally preceded by small warning signs that get missed, ignored, or downplayed https://app.heptabase.com/w/f081e5ccde7d627fb7d304000be42324587b43abdea017a1e97297771114a09e
produce unwanted outcomes Unique and novel combinations of events that give rise to unwanted outcomes Novel forays into new territory that lead to unwanted outcomes Common Causes Behavior, skill, lack of attention Complexity and variability Uncertainty, experimentation and risk taking Failure Archetypes
improvement • System redesign • Sanctions, if repeated or otherwise blameworthy actions are found • Failure analysis from diverse perspectives • Identification of risk factors to address • System improvement • Failure parties • Failure awards • Thoughtful analysis of result to figure out implications • Brainstorming of new hypotheses • Design of next steps or additional experiments Productive Response to Failure
Perrow’s core idea that interactive complexity and tight coupling, such as are found in nuclear power plants, create a danger zone. • Perrow used railroads to illustrate the combination of tight coupling and linear interactions in what I call the control zone. • A typical manufacturing plant presents loose coupling and linear interactions. Because classic management works extremely well in such contexts, I refer to this as the managed zone. • Complex interactions combine with loose coupling in a university, with its ongoing negotiations to keep things organized and functioning, giving rise to what I call the negotiated zone.
refers to an instinctive emotional response to failure. • Why are we so sensitive to negative information and criticism? Well, it seems to have offered a survival advantage for early humans, when the threat of rejection from the tribe could mean death. This left us disproportionately sensitive to threats, even the merely interpersonal threat of looking bad in the eyes of others. • We also suffer from what Daniel Kahneman calls “loss aversion”—a tendency to overweigh losses (of money, possessions, or even social status) compared to equivalent wins. https://app.heptabase.com/w/f081e5ccde7d627fb7d304000be42324587b43abdea017a1e97297771114a09e
arises when we lack access to a simple, practical framework for distinguishing failure types. • Our confusion about failure gives rise to illogical policies and practices. https://app.heptabase.com/w/f081e5ccde7d627fb7d304000be42324587b43abdea017a1e97297771114a09e
comes from the social stigma of failure. Adding to our emotional aversion and cognitive confusion is a deep-rooted fear of looking bad in the eyes of others • The fear response, designed to be protective, can be counterproductive in the modern world when it keeps us from taking the small interpersonal risks that are essential to speaking up or trying new things. • First, fear inhibits learning. • Second, fear impedes talking about our failures. https://app.heptabase.com/w/f081e5ccde7d627fb7d304000be42324587b43abdea017a1e97297771114a09e
excellence and tolerance of failure seem to be in tension. • At one end we find misconduct or sabotage (say, breaking a law or violating a safety procedure); at the other, we find a thoughtful experiment that fails (as scientists endure daily). It becomes clear that not all failures are caused by blameworthy acts. Some are downright praiseworthy.
to work and look ignorant, incompetent, or disruptive. These are called interpersonal risks, and they are what nearly everyone seeks to avoid, not always consciously” - Amy Edmondson
physiologic resources, diverting them from parts of the brain that manage working memory and process new information. This impairs analytical thinking, creative insight, and problem solving.” Managing with the Brain in Mind (D. Rock).
environment that focuses on learning, and they must set high standards for people to aspire too. The high standards should, however, be accompanied by true leadership. A desire to help the employee improve.
they have to communicate is important. For some it’s a sense of futility, in others it’s a fear of being viewed in a negative light or damaging relationships at work.
unwanted outcomes Unique and novel combinations of events that give rise to unwanted outcomes Novel forays into new territory that lead to unwanted outcomes Common Causes Behavior, skill, lack of attention Complexity and variability Uncertainty, experimentation and risk taking Failure Archetypes
• System redesign • Sanctions, if repeated or otherwise blameworthy actions are found • Failure analysis from diverse perspectives • Identification of risk factors to address • System improvement • Failure parties • Failure awards • Thoughtful analysis of result to figure out implications • Brainstorming of new hypotheses • Design of next steps or additional experiments Productive Response to Failure
to a blameworthy act. Most people are thoughtful enough to recognize and appreciate it when people violate rules or repeatedly take risky shortcuts, they are putting themselves and their organization at risk.
as if you have it already. See what happens. The chances are you will be creating a safer and more energized environment for those around you as well. Exercising a small act of leadership. What can you do?
safety in the workplace for learning, innovation, and growth. John Wiley & Sons Edmondson, A. C. (2023). Right Kind of Wrong: The Science of Failing Well. Simon and Schuster. Rock, D., & Page, L. J. (2009). Coaching with the brain in mind: Foundations for practice. John Wiley & Sons.