If you asked most people if they value "creativity" in their doctor or surgeon, I'm guessing most people would say “NO.” (Tell me where I'm wrong.) I used to think that there were certain professions – like medicine - where creativity is actually not a valuable attribute. I'm beginning to wonder if that's really true.
Are mistakes always bad?
Most of us think that medical mistakes are all bad. That the last thing we want is for our doctor to "make a mistake". Well, I'm beginning to think that by making mistakes "bad" we are limiting the creative thinking that we really need from doctors. Especially now.
One of the big walls in my mind that was completely blasted away during my year of training as a life coach and certification in sound healing was the idea that all mistakes are “bad”. First, I heard story after story from real people describing how the biggest “mistakes” in life often turn out to yield unimaginably rich treasures later on (an assertion confirmed recently by Conan O’Brien at his visit to Google). Then, when I began making improvisational music, I realized that some of the most expressive sounds come from playing the “wrong” notes. I slowly began to see how just that thought – “Mistakes are bad” – leads us to hide the things we don’t know, be afraid of asking for help, and remain closed to new ways of doing things.
Medical training doesn’t encourage creative thinking
What I never saw encouraged in the first two years of medical school was any kind of creative thinking. The selection process to get into medical school, and the evaluations throughout the process, rely heavily on multiple-choice tests and promote the belief that physicians always need to be "right".
But I always knew intuitively that clinical medicine is an art. I wondered at what point in the training this shift from "being right" to "practicing an art" would be instilled in us.
Maybe I didn't stick around long enough in medicine to see for myself, but when I looked at the residents and fellows in training around me - the ones who were supposed to be my mentors – many of them walked around like the living dead. They appeared to divide their time between trying to look good to the person just above them on the hierarchy of authority, and trying to get home from the hospital at a decent time each day. In their spare time, if their eyes were actually open, they would look pityingly at us medical students, occasionally sharing a story or two about how someday we would also have the starry-eyed hope beaten out of us.
When I think back on those days, I wonder how they might have been different if the training culture (starting in medical school) had treated the idea of "mistakes" in a different way.
What if…?
What if people, at every stage of their training and practice of medicine, were expected to make mistakes? What if the number and type of mistakes you made (and shared openly with others) were a measure of the quality of your learning? What if you had to make your mistakes publicly, and everyone in the room was invited to give feedback? What if everyone – from student to resident to fellow to attending -- had to do this?
I’m borrowing this model from a source that may surprise you – the internal practices of Pixar Animation Studio. Ed Catmull, President of Pixar, wrote a Harvard Business Review paper and recently gave a talk I attended at Stanford University on the elements of success at Pixar. How is it that the studio has managed to produce such a steady string of consistently blockbuster movies (Toy Story, Toy Story 2, Monsters, Inc., Finding Nemo, The Incredibles, Cars, Ratatouille, WALL-E, and Up), each with an original storyline developed in-house?
The answer surprised me.
Catmull described a culture in which each of the “What if…?” questions I asked above was answered with “Yes.” Contrast these attributes of Pixar's culture with the typical training environment for a physician.
- Expect to make mistakes. Everyone at Pixar is taught to expect things (using Catmull’s language) to “suck” at first. Everyone also learns early on that the path to “not sucking” (ie, being good) always starts with “sucking”. Young doctors live in perpetual fear, clinging to the notion of needing to be “right” all the time. The training environment should reassure them that the more wrong they are willing to be at first, the better chances they have at improving over time.
- Fail publicly…early and often. It is an accepted part of the culture at Pixar to show your unfinished work to peers on a daily basis to receive feedback…even when it sucks. These gatherings are called “dailies”. Everyone does this, so that inhibitions about “being the only one who sucks” are let go, and trust is built. Doctors-in-training are constantly playing a game of “looking good” in front of the more senior person on the totem pole. There is little to no value placed on peer feedback, even though the daily patient rounds are a perfect setting for this to occur.
- Open communication. At Pixar, the film’s director has final decision-making authority; however, everyone in the room is encouraged to give feedback during dailies. “Brain trusts” of senior members on other teams are convened when one team needs help on a particular problem. In medicine, it is rare for a student to directly address an attending physician. There is a clear hierarchy of roles, which usually mirrors access and communication.
Catmull admitted to a challenge now that certain Pixar executives have achieved “legendary” status. When it’s observed that feedback is being held back because of the presence of certain “legends in the room”, the meetings are scaled back to two or three people, in order to create a safe environment for feedback to flow….even when it sucks.
“Going to Hell in a Handbasket”
Asking what might happen if the medical training culture began to place a greater value on creativity, making mistakes, and learning through open communication, probably induces in some the kind of fear associated with the apocalypse. That’s because it would mean the end of one way of thinking. It would threaten the age-old structures that have governed our assumptions, expectations, and ways of measuring outcomes. It would surely induce some people to say, “We’re going to hell in a handbasket!” But aren’t we already saying that about our health care system?
Learning versus Performing
The “learning” environment in medical training is actually a performance environment, even though we call it the "practice" of medicine. As a medical student, real practice and learning is expected to be done in private - reading and memorizing - while the actions of “being a doctor” are presented as "show time" - when you try to impress the person above you with how much you already know.
So back to my list of “What if…?”s. The whole list can be boiled down just to this: What if doctors were trained to be more creative? I can imagine some simple steps that any clinical team could implement tomorrow on morning rounds.
- Start by acknowledging that all doctors are humans. No one - not even that surgeon who acts like he owns the hospital (and maybe he does) - is going to get it "right" all the time. This is a hard one, I know, but you'll never get to the other steps without swallowing this pill, so do it now.
- Mistakes are not inherently bad. It's how we handle our mistakes that develops our creativity and leadership potential. So stop fearing and start making mistakes. And then...
- Talk openly about what went wrong, without blame or judgment. Show your work, explain what you see, and ask for feedback. What information was missing or misinterpreted? Who could be called in for additional help? What step in the process could have been handled better? Get everyone at every level involved in this process. No one is immune to making mistakes, and medicine desperately needs open engagement among all levels of professionals and staff.
- Repeat this process daily. Someone wise once said, “If you have behaved yourself into a situation, you must behave yourself out of it!” Just as the existing culture wasn't created in one day, implementing this into the daily routine will take some time and practice. But with this small shift in attitude, every day is an opportunity to build your creativity muscles.
If medical judgment could be cultivated merely by performing "perfectly" in front of your superiors for a number of years, then how do we explain the high levels of physician burnout, patient dissatisfaction, and medical errors in our health care system today?
The culture of performance needs to be balanced by a culture of learning and creativity.
If medical training began valuing creativity from doctors, we might have more vibrant and collaborative health care teams whose focus was the patient, and whose willingness to learn would produce better health over time…one mistake at a time.