Learning from failure

BMJ 2011; 343 doi: (Published 12 August 2011) Cite this as: BMJ 2011;343:d5152
  1. Tom Downes, consultant physician and geriatrician, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  1. Tom.Downes{at}

Last year I had the humbling privilege of experiencing a year’s fellowship at the Institute for Healthcare Improvement (IHI) in Boston in the United States.

Early in my fellowship year I received a visit from a long time medical friend, an internationally renowned rheumatologist from the UK. The same day I had attended an IHI course on executive leadership. I had heard a speaker, by coincidence also a rheumatologist and former hospital chief executive, recount how standardisation of methotrexate initiation has the potential to improve safety and efficiency. Full of enthusiasm, I repeated this to my visitor over dinner anticipating a positive reception.

“Why would …

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