1. Section Editor(s): Powell, Suzanne K. RN, MBA, CCM, CPHQ


As the new health care laws and regulations are defined and quickly changing, we must be nimble, allow our colleagues to attempt new ways of solving old problems, make mistakes if necessary, observe, take note, and discover the new best practices.


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Freedom isn't worth having if it doesn't include the freedom to make mistakes.


Mahatma Gandhi


It is early January and another year is changing shape. This is a time where those around me are making "resolutions" to better themselves and I am no different. But this year I pledge to move from being a "recovering perfectionist" to one who is not afraid of making mistakes. In fact, I plan to actively strive to make a mistake here and there. Now I don't plan on being reckless, let's just call it "creative." After all, it is difficult to conceive of case managers keeping up with all the multiple changes in healthcare using the same tools we have always done. Let's be bold! And try new things!


No ... making mistakes is a road I always chose not to travel ... until I gave it more thought. First, I determined what perfectionism looked like to me. I found a picture that symbolized perfectionism: a ground-level photographic face-shot of a man trimming his lawn by hand-with a pair of scissors. He was obviously concentrating on getting each blade of grass to be exactly the length as the one next to it. This picture is an ideal reminder for me about the folly of perfectionism. First, the time it would take would steal time for more important endeavors such as living life and connecting with people and nature. Second, it is not that important. Third, it leaves no room to learn and grow.


I remember when, at age 6, I whole-heartedly wanted to ride a two-wheeler. At first I fell over-many times. Next (and without knowing principles of momentum) I realized that if I pedaled as fast as I could, I would not fall over. But there was a problem-how to stop? So I took my Huffy to the back alley and pedaled and pedaled until I hit the garage door at the end of the alley-many times-at which time I fell off-many times. Finally, I put it all together, learned to slow down so I could stop the bike (Did I even think of using any brakes? Did I have brakes?!). But I was free; I learned by making mistakes ... but I learned. The silliness of that story is embarrassing to this adult, but as a young child, it was not an issue. I did what I had to do to get to the outcome I wanted (to ride a two-wheeler).


It is a small leap to say there is a correlation between perfectionism and fear of making mistakes. It starts early. As children we make mistakes while being taught proper manners; righting of those mistakes usually incorporates some element of shame. In the early school years, making mistakes lowers our grades, makes us less attractive to certain universities, and "stays on your permanent record." During the working years, mistakes can lead to ridicule or pink slips. We hang our heads believing a mistake (the grand faux pas) will be seen as incompetence. We feel that "success" is defined by our image as experts. We are measured in terms of numbers such as reduction in readmissions or lower length of stays. (Note: In am not talking about the types of "mistakes" in health care known as adverse medical events. There are some life-threatening tasks that may have zero tolerance for failure.)


So, if there is a correlation between perfectionism and fear of making mistakes, there is yet another correlation that stands in the evolutionary path of a "recovering perfectionist," and that is the correlation between making "mistakes" and discovery of something new and better: serendipity! In the universities we strived for as children, where we got good grades and avoided anything negative on our permanent records-we also learned that people often stumble upon great inventions.


One well-known serendipitous event occurred during an improbable chain of events that led Alexander Fleming to discover penicillin in 1928. Fleming was a Scottish research scientist with a bit of a reputation for being sloppy. He left a culture plate smeared with Staphylococcus bacteria on his laboratory bench and went on a 2-week vacation. Upon return, he noticed a clear halo surrounding the yellow-green growth of a mold that had accidentally contaminated the plate; Penicillium notatum had drifted in from a mycology laboratory one floor below. Fleming decided not to store his culture in a warm incubator, and through a bit of luck, London was hit by a cold spell, giving the mold a chance to grow. Later, as the temperature rose, the Staphylococcus bacteria grew rapidly, covering the entire plate-except for the area surrounding the moldy contaminant. Fleming's "Eureka" moment was the realization that the mold that had been growing was Penicillium, or bread mold. He set about culturing mold on any bread he could lay his hands on, including the sandwiches and buns that belonged to his laboratory staff. He correctly deduced that the mold released a substance that inhibited the growth of the bacteria. The rest is history and forever altered the treatment of bacterial infections (Ho, 1999).


Pfizer Pharmaceuticals became the recipient of another serendipitous "mistake" of enormous proportions, started as a grave disappointment. For years their researchers worked on sildenafil, an inhibitor of the PDE5 enzyme, which they hoped would be effective in relaxing coronary arteries and relieving chest pain. By 1992, researchers glumly terminated the trial and requested that the participants return the unused drugs. Many men refused to return it and hoarded it like gold. Researchers gave the behavior little thought until they heard rumors about the drug's side effects on sex life and, more important, read a paper on the role of PDE5 in the chemical pathway of erection. Gloom evaporated and with new clinical tests, Pfizer stumbled on Viagra.


In these instances, serendipity, or the knack of making fortunate discoveries by accident, has been bettered mankind: sulfur drugs, penicillin, chloroform, vitamins, tranquilizer, and cancer drugs. Microbiologist and historian Alexander Kohn observed: "Nearly all the great discoveries in chemotherapy have been made as a result of a false hypothesis or due to a so-called chance observation" (Auyang, 2011, p. 1).


You can't have these outcomes unless you are also sometimes willing to be "wrong." Actively striving to make mistakes as a New Year's resolution may seem like a foolhardy undertaking, but only time will tell. And there are some things should not change: patient advocacy, collaboration, critical thinking, to name a few. These are sacred cows for case management and must never be compromised. But there is growing evidence to suggest that allowing innovation (i.e., the space to make mistakes) is an important characteristic in flourishing cultures. What serendipitous events may happen if we encourage and invite innovation in this time when all the health care rules are changing, and many things you practiced to become perfect are less useful? As the new health care laws and regulations are defined, we must be nimble, allow our colleagues to attempt new ways of solving old problems, make mistakes if necessary, observe, take note, and discover the new best practices. Finally, publish your innovative thinking, your way of handling the challenges in our changing health care world. I am waiting to hear from you.


Wishing all an (im)perfect 2012!




Auyang S. Y. (2011). Chance and the prepared mind in drug discovery. Retrieved September 17, 2011, from[Context Link]


Ho D. (1999). Bacteriologist Alexander Fleming. Time Magazine March 29, 1999. Retrieved September 17, 2011, from,9171,990612,00.html[Context Link]