Failure not an option

On this very day, 43 years ago, an urgent call was issued from the crew of Apollo 13: “Houston, we have a problem.”

  

In response, unprecedented activity began. NASA’s ground crew scurried into solution-development mode with a sobering deadline and two severe limitations in coming up with a solution: Only materials already in the space module could be used and, because this was a first-ever occurrence, the answer would have to be inferred or extrapolated from known scientific principles. The solution would have to be innovated on the “edge of knowledge.”

Failure to correct the space module’s malfunction would have dire consequences for the Apollo 13 crew and for America. Left uncorrected, the environment in the module would become so toxic it would not sustain human life, and the mission would be lost. Despite a situation that initially seemed to the NASA crew hopelessly futile, the commander proclaimed, “Failure is not an option!” With considerable ingenuity and working under extreme time and emotional pressures, the team successfully mounted the challenging task.

In this second day of the Creating Healthy Work Environments (CHWE) conference, I am struck by the similarities between the malfunctions of Apollo 13 and our work environments. The stakes are comparable and the challenges facing us analogous. Although our work environments are worlds apart from the confinement of the Apollo 13 space module, our situations are much the same: 1) Toxic environmental factors must be corrected to prevent harm to those aboard and those invested in the mission. 2) The well-being of health professionals, patients, and health care organizations depend on the actions we take.

Fortunately, the HWE initiative has an advantage over Apollo 13. We have the opportunity to draw knowledge, research, and practice-based evidence from the CHWE conference. To size up the status of our knowledge, a synthesis of the conference content seemed in order, at least to the “scientist” in me. The conference program contained 66 poster and podium presentations, along with three symposia, based on submitted abstracts. Realizing that knowledge begins with exploration and moves to intervention testing, I classified the projects into a) those that described the HWE issue and b) those that were doing something about it.

Roughly 60 percent of the projects fell into the first category. These projects defined concepts and showed relationships or developed useful metrics to quantify concepts. The projects reflected excellent work in identifying core HWE concepts, such as horizontal violence, moral distress, and organizational cynicism. The remaining 40 percent of the projects fell into the second category—solutions being tested. These projects evaluated initiatives, programs, and strategies to answer, “What strategies work to change the situation?” For example, projects tested new solutions and interventions to manage bullying, improve emotional work environments, evaluate collaborative care councils, build leadership, and increase conflict-resolution competence. This far-less-than-fully-scientific approach suggested to me that we are rapidly growing our understanding of “how” to solve the issues and achieve healthy work environments.

In creating these environments, we can learn from the ingredients that contributed to Apollo 13’s dramatic success: 1) Experts were willing to risk, to go beyond what had been tested. 2) Teamwork was used to co-create an effective solution. 3) Once a “fix” was devised, it was implemented through exquisite communication between ground and flight crews. 4) Courage flipped the switch to what was an untested solution. 5) Full devotion was given to saving the astronauts’ lives and the mission. In the end, the Apollo 13 malfunctions were corrected, the crew brought home safely, and the mission saved.*

For us, as with Apollo 13, FAILURE IS NOT AN OPTION! We must continue to invent, test, and put in place work-environment “fixes” that assure every nurse, every health care professional, every manager, and every person experiences joy in work—the joy that drew each of us into our careers. We must reduce into nonexistence the toxicities and hassles of our work environments so that we, our legacies, and the future workforce thrive and excel.

Nurses are at the head of the crew that will innovate and put in place the strategies, programs, and culture that create healthy work environments. In fact, from the interactions I enjoyed today, I conclude we already have begun!

*For an account of these events, see Charlie and Dottie Duke’s autobiography, Moonwalker (1990, Thomas Nelson, Inc.) and Charlie Duke’s website. He will present “Innovating on the Edge of Knowledge: A Walk on the Moon” on 11 July 2013 at the Summer Institutes on Quality Improvement.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.