Planning for Failure in Healthcare

Hashtag Fail - SpryBlog post by Colin Hung

Nothing ever goes as planned.

Has there ever been a more true statement? In healthcare as in life, the best laid plans always seem to go awry. EHR implementations never go as smoothly as anticipated. Acceptance of new patient protocols is never as easy as hoped. Resistance to change in healthcare is always stronger than expected.

With all this potential for healthcare projects to off-the-rails, could they or should they not be planned for?

Planning for failure may seem counter-intuitive, but it can lead to tremendous success. Fast Company recently published an article on this very topic: “How Planning to Fail Can Help You Succeed”. The article talks about the principle of implementation intentions, which means clearly defining potential failure points (veering off course) ahead of time and knowing exactly what you will do when it happens.

The theory behind “implementation intentions” takes it one step further than just having a “quit plan.” You also need to establish the “if-then” response you’ll have when you encounter tough conditions. Research among children has found that imagining both the obstacles to their goals and their “if-then responses” improved students’ grades, attendance, and in-class conduct. And separate studies have found that implementation intentions can strongly and consistently improve time management.

I believe that healthcare needs to plan more for failure – especially when it comes to large-scale projects like EHR implementations, Health Information Exchanges (HIEs) and wholesale changes to reimbursement models. Without going through the exercise of defining failure points, healthcare will continue to pour precious resources into project that really shouldn’t be continued.

In business they call this “Sunk Cost Bias” – a mental trap where you factor in the cost of prior investments into the decision of whether to continue an activity. Lee Crumbaugh describes this bias succinctly in his blog “Sunk cost fallacy: Throwing good money after bad

In economics, a sunk cost is any cost that has already been paid and cannot be recovered. The sunk cost fallacy is a mistake in reasoning in which the sunk costs of an activity – instead of the future costs and benefits – are considered when deciding whether to continue the activity.  The sunk cost fallacy makes it more likely that a person or an organization continues with an activity in which they have already invested money, time, or effort, even if they would not start the activity had they not already invested in it. The greater the size of the sunk investment, the more people tend to invest further, even when the return on added investment appears not to be worthwhile.

I think anyone who works in healthcare or who follows the industry can easily point to one or more instances of Sunk Cost Bias. Ill-advised building expansions, investments in new workflows that don’t actually improve patient care, continuing to work with bad technologies when better options are available…the list goes on and on.

Healthcare IT is especially susceptible to Sunk Cost Bias. I personally have been involved with many projects that, in hindsight, should have been shut down. One such project was the development of a brand new “next generation” product. At the two year mark the team showed their work to a group of actual end-users and the feedback was middling. There were some positive comments on the user interface, but everything else elicited “blah” comments. Several end-users pointed to other products already on the market with superior features. The team focused on the positive comments and did not think twice about the middle-of-the-road evaluation scores.

At the same time an audit of the project expenses revealed that it was running 2x over budget and a year behind schedule. The culprit – ever changing requirements – something that kept happening because newer technologies/features kept entering the market from smaller solution providers.

If the project team has spent time planning for failure, I believe we would have pursued a whole new product path rather than continue to pour $Millions into the product the team was building. If we had had “quit milestones” related to low end-user scores, high budget overruns and established competitors with more functionality – we might have stopped the project in time to pivot to something else.

In the end the product was launched, but it was a complete disappointment. It was clunky to implement, horribly confusing to use and worst of all it failed to catch on with end-users. Even though this project happened years ago, the dollars wasted still haunts me. Those $Millions could have been used to do so much more.

Perhaps it is healthcare’s never-give-up-on-a-patient attitude that makes it so easy to fall into the Sunk Cost Bias trap. Perhaps it is the fear of admitting failure. Or perhaps it is simply a failure of leadership. No matter the cause, I truly believe that we need to inject more failure planning into healthcare projects. We should dedicate time in project meetings to go through scenario planning where what-ifs are considered. Most importantly healthcare teams need to build “quit milestones” that if met, would spell the end of the project.

Join the #hcldr community on Tuesday April 5th at 8:30pm EDT (for your local time click here) where we will discuss planning for failure in healthcare:

  • T1 Do you think healthcare is more susceptible to Sunk-Cost-Bias than other industries? Why or why not?
  • T2 If you were running a healthcare project, what would your quit criteria be? What would make you stop the project?
  • T3 Is there a healthcare project (in your organization or in general) that you would stop right now?
  • T4 How would you advise someone who believes their healthcare project is headed for failure? How do they alert leaders?

Resources

“How Planning To Fail Can Help You Succeed”, Benjamin Hardy, Fast Company, March 31 2016, http://www.fastcompany.com/3058418/how-to-be-a-success-at-everything/how-planning-to-fail-can-help-you-succeed, accessed April 3 2016

“Sunk Cost Fallacy: Throwing Good Money After Bad”, Lee Crumbaugh, March 21 2015, http://leepublish.typepad.com/strategicthinking/2015/03/sunk-cost-fallacy.html, accessed April 3 2016

“Assessment of the sunk-cost effect in clinical decision-making”, Braveman and Blumenthal-Barby, Social Science and Medicine, July 2012, http://www.ncbi.nlm.nih.gov/pubmed/22503839, accessed April 3 2016

“Falling Prey to the Sunk Cost Bias: A Potential Harm of Patient Radiation Dose Histories”, Eisenberg et al, Radiology, June 2012, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359514/, accessed April 3 2016

“Cutting Your Losses: How to Avoid the Sunk Cost Trap”, Michael Roberto, Ivey Business Journal, November 2009, http://iveybusinessjournal.com/publication/cutting-your-losses-how-to-avoid-the-sunk-cost-trap/, accessed April 3 2016

“How to Walk Away. The Psychology of Lost Causes”, Heidi Grant Halvorson, The Atlantic, May 14 2013, http://www.theatlantic.com/health/archive/2013/05/how-to-walk-away/275833/, accessed April 3 2016

“The Upside of Quitting”, Stephen J Dubner, Freakonomics, September 30 2011, http://freakonomics.com/podcast/new-freakonomics-radio-podcast-the-upside-of-quitting/, accessed April 3 2016

“Why the VA Couldn’t Keep Up with IT”, Nicole Torres, Harvard Business Review, June 24 2014, https://hbr.org/2014/06/why-the-va-couldnt-keep-up-with-it, accessed April 3 2016

“Why Bad Projects Are So Hard to Kill”, Isabelle Royer, Harvard Business Review, February 2003, https://hbr.org/2003/02/why-bad-projects-are-so-hard-to-kill, accessed April 3 2016

Image Credit

#Fail – Spry https://flic.kr/p/9AMkCS

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