'Lessons must be learned'

'Lessons must be learned'. How many times have you heard that on the news? Deepwater Horizon, Columbine High School, Leicester City winning the soccer Premiership League Cup  - there is no shortage of lessons learned, but a tragedy and waste that so little of that learning is applied. 

Hang on, 'Leicester City winning the League Cup'? It may seem strange to mention this together with high profile failures, but what they have in common is the potential to effect change. I suspect that Leicester's success, in the context of 5000-1 odds, owes much to them applying what Sky's Tour de France team had pioneered. Sky's cumulative micro-improvement policy had never been done before on that scale, but is now acknowledged as a game-changer (as Leicester proved), and not just in sport. Wouldn't it be great if we heard the mantra 'lessons must be learned' in connection with successes.

The reasons for lessons being identified, but not applied, are a combination of behavioural economics and poor business processes. All can be fixed, but not simply by spouting 'lessons must be learned'. What needs fixing?

1. Blame! 

'The Blame Game' is a fascinating 30 minute BBC Radio 4 programme with former head of MI5, Eliza Manningham-Buller, on how counter-productive a blame culture is in applying lessons. The contrast between the airline safety industry's and government in this regard is stark, but this programme shows how a blame culture can be changed. 

2. Tolerance of failure.

One of my favourite quotations is (allegedly) from Einstein; 'Anyone who has never made a mistake has never tried anything new'. There is often a marked dissonance between an organisation's desire for innovation and their tolerance for failure. See HBR article on the Failure-Tolerant Leader. Truly innovative organisations such as  Tesla or Google look at failure as an inevitable consequence of innovation (Google+, Google Glass, Wave?). The key is to look for what can be taken from the experience and not to make the same mistake twice. If your organisation has an innovation strategy or framework, does it include a defined tolerance for, or expectation of failure? If not, why not, and is it really going to learn from the inevitable failures along the way?

3. What's changed? '

'Capturing' (by which we usually mean documenting) the outcome of a poor activity or project, in no way means it won't happen again. Same as basking in a success doesn't mean it will be repeated. Unless... something fundamental that universally defines how the work is done, changes for good. A while back I did some work for a large engineering company that had suffered an extremely high-profile and costly disaster. This was mainly a result of failing to change their Standard Operating Procedures (SOP) following a series of apparently disconnected previous incidents. To their credit, there was a safety-first culture and the SOPs had always been rigorously adhered-to by operators. None of the minor incidents had resulted in loss of life or plant, and every one of these incidents was 'captured'.  The problem was that their SOPs were not subsequently changed and calamity resulted. For every 'lesson learned' you have to ask the question - what's changed? What's your organisation's equivalent to the SOP and how confident are you in the linkage between operational reporting and change?

4. Leadership

What do leaders mean when they talk of 'being a learning organisation'? When it comes to 'learning lessons' there are some extremely practical things those giving direction can do, other than repeat the mantra 'lessons must be learned'. Next time there is a review of a major project, they have a responsibility to ensure the ball is played, not the man; what happened and why, not who did what.  They must be open and deliberate about their tolerance for failure and act accordingly. As IBM's Thomas J Watson said "The fastest way to succeed, is to double your failure rate.”  

Lastly, let's not forget that 'lessons' can be drawn and improvements made from positive experiences as well as failures. As Jack Welch asked whenever presented with a successful project "...and who have you shared that with".