Priya Agrawal, BMBCh, MA, MPH, DFSRH
Merck for Mothers
Dr. Priya Agrawal is an obstetrician/gynecologist, women’s health expert and executive director of Merck Mothers – Merck’s 10-year, $500 million initiative to reduce maternal mortality.
One of the biggest surprises at the Global Maternal Newborn Health Conference in last fall was the popularity of a session on the power of learning from failure. More than 600 maternal and newborn health experts attended to learn how speaking candidly about what doesn’t work can fuel learning and drive innovation. I was delighted to be a panelist, representing the private sector. The provocative discussion launched a broader conversation on how learning from failure can reinvigorate the maternal and newborn health field by truly valuing learning and innovation in the quest to save more lives.
Learning from and embracing failure are not new concepts. In fact, Thomas Edison famously said “I failed my way to success.” But today it is a business imperative for many companies, especially those like Merck that are dependent on innovation to sustain their business. Every day a company continues to invest in a “failing” product or idea, it diverts precious resources from prospects with greater potential. This reality drives companies to be vigilant for early signs of failure as well as train and reward employees for addressing failures in a timely manner.
Yet when it comes to maternal and newborn health, we are often loath to share information about “failed” efforts. That’s not just a shame and a poor use of precious dollars, but a dangerous precedent that needs to be changed. As Lancet editor Richard Horton argued, our unwillingness to talk about what doesn’t work has created a “disabling culture” and is “perhaps the biggest barrier we’ve got” to saving more lives.
But it doesn’t have to be this way.
On the panel, Sharad Agarwal, CEO of the Hindustan Latex Family Planning Promotion Trust, gave a terrific example from his work in India, where what seemed like a savvy approach – recruiting informal health providers to become referral agents to more qualified, franchised private providers – turned out to be a failure. The informal providers continued to offer care, and the poor quality damaged the value of the franchise brand. Recognizing the negative consequences on both women’s health and his business, Sharad “owned” the failure and went directly to his donor for help in course correcting. Sharad’s decision was the smart one, both for mothers and the business.
Without a strong business motive forcing the conversation, however, it can be hard to broach the subject of failure, in spite of the impact on health. As women’s health expert France Donnay noted, relationships, reputations and livelihoods are often at stake. Leaders who embrace failure need to create a supportive organizational environment that encourages all employees – not just those at the top – to speak up; otherwise, fear can stymie critical learning and innovation. India’s Tata Group and ad agency Grey New York, for example, have developed awards for intelligent, creative failures, to embolden employees to dream big and take risks. Perhaps we need something similar in maternal and newborn health to help overcome the stigma of failure.
We can also reduce the stigma by lowering the stakes. As Margaret Kruk, an evaluation expert from Harvard’s T.H. Chan School of Public Health, pointed out, evaluations can help detect failure at an early stage and course correct. Merck approaches research this way: early indicators of failure are defined at the outset, and then we use interim evaluations and adaptive trial methodology to support course correction. All the data are scrutinized and shared widely so we can make difficult decisions and stay true to the end goal of addressing unmet need and going to market. We can do the same in maternal and newborn health.
Breaking our silence on what hasn’t worked in order to learn from failure will not be easy. At the same time, the stakes are too high not to try. We were wowed by the number of creative ideas our audience suggested to start building a learning culture, especially these three:
- Develop a knowledge bank of failed interventions – A publicly available catalogue of projects that didn’t work and why would be invaluable when designing new projects – making it easier to learn from earlier failures and increasing the likelihood of future success.
- Include risk analyses and early indicators of failures in proposals – In many businesses, small controlled failures are built in as tests along the way to help learn, correct course, and mitigate risk for later, larger tests. Funding proposals could include something similar so that implementers and donors could be transparent about potential risks and how to recognize them early.
- Recognize people and organizations with the courage to learn from failure – To help incentivize the culture shift to learn from failure, why not establish some kind of forum – an award or website – that recognizes those who have had the courage to look failure in the face and learn from what went wrong?
These ideas are just a starting point for self-reflection on how the maternal and newborn health field should evolve. As the panelists and audience members affirmed, we need a culture shift that recognizes that failure is our “first attempt in learning,” and that those learnings can help save women’s and newborns’ lives.
I invite you to send along your ideas about how our community can harness the power of learning from failure. We cannot wait any longer if we are to succeed in completing the unfinished maternal and newborn health agenda.