The following was delivered as the commencement address at Williams College on Sunday, June 3rd.
...
When I was nearing the end of medical school, I decided to go into surgery. I had become enthralled by surgeons, especially by their competence. The source of their success, I believed, was their physical skill—their hand-eye coördination and fine-motor control. But it wasn’t, I learned in residency training. Getting the physical skills is important, and they take some time to practice and master, but they turn out to be no more difficult to learn than those that Mrs. C. mastered as a seamstress. Instead, the critical skills of the best surgeons I saw involved the ability to handle complexity and uncertainty. They had developed judgment, mastery of teamwork, and willingness to accept responsibility for the consequences of their choices. In this respect, I realized, surgery turns out to be no different than a life in teaching, public service, business, or almost anything you may decide to pursue. We all face complexity and uncertainty no matter where our path takes us. That means we all face the risk of failure. So along the way, we all are forced to develop these critical capacities—of judgment, teamwork, and acceptance of responsibility.
In commencement addresses like this, people admonish us: take risks; be willing to fail. But this has always puzzled me. Do you want a surgeon whose motto is “I like taking risks”? We do in fact want people to take risks, to strive for difficult goals even when the possibility of failure looms. Progress cannot happen otherwise. But how they do it is what seems to matter. The key to reducing death after surgery was the introduction of ways to reduce the risk of things going wrong—through specialization, better planning, and technology...
...
Researchers at the University of Michigan discovered the answer recently, and it has a twist I didn’t expect. I thought that the best places simply did a better job at controlling and minimizing risks—that they did a better job of preventing things from going wrong. But, to my surprise, they didn’t. Their complication rates after surgery were almost the same as others. Instead, what they proved to be really great at was rescuing people when they had a complication, preventing failures from becoming a catastrophe.
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.
This may in fact be the real story of human and societal improvement. We talk a lot about “risk management”—a nice hygienic phrase. But in the end, risk is necessary. Things can and will go wrong. Yet some have a better capacity to prepare for the possibility, to limit the damage, and to sometimes even retrieve success from failure.
When things go wrong, there seem to be three main pitfalls to avoid, three ways to fail to rescue. You could choose a wrong plan, an inadequate plan, or no plan at all. Say you’re cooking and you inadvertently set a grease pan on fire. Throwing gasoline on the fire would be a completely wrong plan. Trying to blow the fire out would be inadequate. And ignoring it—“Fire? What fire?”—would be no plan at all.
...
There was, as I said, every type of error. But the key one was the delay in accepting that something serious was wrong. We see this in national policy, too. All policies court failure—our war in Iraq, for instance, or the effort to stimulate our struggling economy. But when you refuse to even acknowledge that things aren’t going as expected, failure can become a humanitarian disaster. The sooner you’re able to see clearly that your best hopes and intentions have gone awry, the better. You have more room to pivot and adjust. You have more of a chance to rescue.
But recognizing that your expectations are proving wrong—accepting that you need a new plan—is commonly the hardest thing to do. We have this problem called confidence. To take a risk, you must have confidence in yourself. In surgery, you learn early how essential that is. You are imperfect. Your knowledge is never complete. The science is never certain. Your skills are never infallible. Yet you must act. You cannot let yourself become paralyzed by fear.
Yet you cannot blind yourself to failure, either. Indeed, you must prepare for it. For, strangely enough, only then is success possible.
...
Nothing went exactly perfectly. There was still a good deal of fumbling around as they tried to sort out what was really going on and what would need to be done. For a time, they hoped for a small, short procedure, using just a scope and avoiding a big operation. It would have been an inadequate plan—perhaps even the completely wrong one. But they avoided the worst mistake—which was to have no plan at all. They’d acted early enough to buy themselves time for trial and error, to figure out all the steps required to get her through this calamity. They gave her and themselves the chance to rescue success from failure.
...
As you embark on your path from here, you are going to take chances—on a relationship, a job, a new line of study. You will have great hopes. But things won’t always go right.
When I graduated from college, I went abroad to study philosophy. I hoped to become a philosopher, but I proved to be profoundly mediocre in the field. I tried starting a rock band. You don’t want to know how awful the songs I wrote were. I wrote one song, for example, comparing my love for a girl to the decline of Marxism. After this, I worked in government on health-care legislation that not only went nowhere, it set the prospect of health reform back almost two decades.
But the only failure is the failure to rescue something. I took away ideas and experiences and relationships with people that profoundly changed what I was able to do when I finally found the place that was for me, which was in medicine.
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.
...
When I was nearing the end of medical school, I decided to go into surgery. I had become enthralled by surgeons, especially by their competence. The source of their success, I believed, was their physical skill—their hand-eye coördination and fine-motor control. But it wasn’t, I learned in residency training. Getting the physical skills is important, and they take some time to practice and master, but they turn out to be no more difficult to learn than those that Mrs. C. mastered as a seamstress. Instead, the critical skills of the best surgeons I saw involved the ability to handle complexity and uncertainty. They had developed judgment, mastery of teamwork, and willingness to accept responsibility for the consequences of their choices. In this respect, I realized, surgery turns out to be no different than a life in teaching, public service, business, or almost anything you may decide to pursue. We all face complexity and uncertainty no matter where our path takes us. That means we all face the risk of failure. So along the way, we all are forced to develop these critical capacities—of judgment, teamwork, and acceptance of responsibility.
In commencement addresses like this, people admonish us: take risks; be willing to fail. But this has always puzzled me. Do you want a surgeon whose motto is “I like taking risks”? We do in fact want people to take risks, to strive for difficult goals even when the possibility of failure looms. Progress cannot happen otherwise. But how they do it is what seems to matter. The key to reducing death after surgery was the introduction of ways to reduce the risk of things going wrong—through specialization, better planning, and technology...
...
Researchers at the University of Michigan discovered the answer recently, and it has a twist I didn’t expect. I thought that the best places simply did a better job at controlling and minimizing risks—that they did a better job of preventing things from going wrong. But, to my surprise, they didn’t. Their complication rates after surgery were almost the same as others. Instead, what they proved to be really great at was rescuing people when they had a complication, preventing failures from becoming a catastrophe.
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.
This may in fact be the real story of human and societal improvement. We talk a lot about “risk management”—a nice hygienic phrase. But in the end, risk is necessary. Things can and will go wrong. Yet some have a better capacity to prepare for the possibility, to limit the damage, and to sometimes even retrieve success from failure.
When things go wrong, there seem to be three main pitfalls to avoid, three ways to fail to rescue. You could choose a wrong plan, an inadequate plan, or no plan at all. Say you’re cooking and you inadvertently set a grease pan on fire. Throwing gasoline on the fire would be a completely wrong plan. Trying to blow the fire out would be inadequate. And ignoring it—“Fire? What fire?”—would be no plan at all.
...
There was, as I said, every type of error. But the key one was the delay in accepting that something serious was wrong. We see this in national policy, too. All policies court failure—our war in Iraq, for instance, or the effort to stimulate our struggling economy. But when you refuse to even acknowledge that things aren’t going as expected, failure can become a humanitarian disaster. The sooner you’re able to see clearly that your best hopes and intentions have gone awry, the better. You have more room to pivot and adjust. You have more of a chance to rescue.
But recognizing that your expectations are proving wrong—accepting that you need a new plan—is commonly the hardest thing to do. We have this problem called confidence. To take a risk, you must have confidence in yourself. In surgery, you learn early how essential that is. You are imperfect. Your knowledge is never complete. The science is never certain. Your skills are never infallible. Yet you must act. You cannot let yourself become paralyzed by fear.
Yet you cannot blind yourself to failure, either. Indeed, you must prepare for it. For, strangely enough, only then is success possible.
...
Nothing went exactly perfectly. There was still a good deal of fumbling around as they tried to sort out what was really going on and what would need to be done. For a time, they hoped for a small, short procedure, using just a scope and avoiding a big operation. It would have been an inadequate plan—perhaps even the completely wrong one. But they avoided the worst mistake—which was to have no plan at all. They’d acted early enough to buy themselves time for trial and error, to figure out all the steps required to get her through this calamity. They gave her and themselves the chance to rescue success from failure.
...
As you embark on your path from here, you are going to take chances—on a relationship, a job, a new line of study. You will have great hopes. But things won’t always go right.
When I graduated from college, I went abroad to study philosophy. I hoped to become a philosopher, but I proved to be profoundly mediocre in the field. I tried starting a rock band. You don’t want to know how awful the songs I wrote were. I wrote one song, for example, comparing my love for a girl to the decline of Marxism. After this, I worked in government on health-care legislation that not only went nowhere, it set the prospect of health reform back almost two decades.
But the only failure is the failure to rescue something. I took away ideas and experiences and relationships with people that profoundly changed what I was able to do when I finally found the place that was for me, which was in medicine.
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.
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