NHS doesn’t need to fail less: it needs to learn more

Three leaders walk into a bar and do something rare: they got brutally honest about their biggest mistakes. And what happened after Caroline Clarke, Matthew Trainer and Louise Ansari had finished was even more remarkable: the audience joined in.

The responses were refreshingly human. One person admitted to being “a very controlling junior manager” who thought they had all the answers. Another confessed to not developing leadership skills sooner, leaving colleagues to “play catch up.”

Someone else shared the painful lesson of trying to protect a culture change plan so much that it got “kicked into the long grass.”

This was Kaleidoscope’s failure night, part of our fringe festival at NHS ConfedExpo. What struck me wasn’t just the honesty, but how different these failures were from the sanitised “learning experiences” we usually hear about. These were messy, human stories about ego, timing, and the uncomfortable reality that good intentions don’t always lead to good outcomes.

The failure paradox

We have a curious relationship with failure in the NHS. We know it’s essential for learning, but we’re terrible at talking about it. We have incident reporting systems, mortality reviews, and serious incident investigations. We’ve professionalised the analysis of what goes wrong.

But how often do you hear leaders say, “I got this completely wrong, and here’s what I learned”?

The workshop responses revealed something fascinating. When asked about their greatest failures, leaders didn’t talk about clinical incidents or system breakdowns. They talked about personal misjudgements, relationship failures, and moments when they realised they weren’t as smart as they thought.

One response stood out: “I didn’t get a role that I really wanted, but got a better role. I learnt that everything happens for a reason and that perspective is really important.”

This isn’t about accepting failure – but, as my wise colleague Shane Carmichael puts it, learning to recognise that ‘we don’t move on from history, we move on with it’. Our failures are part of us, so why not reflect on them consciously?

The vulnerability gap

The research is clear: psychological safety is fundamental to high-performing teams. Yet our workshop revealed a troubling contradiction. While leaders strongly agreed that they want colleagues to show vulnerability with them (scoring 4.6 out of 5), they were much less comfortable showing vulnerability to those same colleagues themselves (3.3 out of 5).

We want others to be open with us about their mistakes and uncertainties, but we struggle to model that openness ourselves. It creates a vulnerability stand-off where everyone waits for someone else to go first.

When senior leaders can’t model vulnerability, it creates a culture where admitting mistakes becomes career-limiting rather than career-enhancing. The result? We end up with an NHS that’s brilliant at managing failure after it happens, but struggles to prevent it because we can’t talk honestly about the small failures that precede the big ones.

Actions to change the conversation

Based on what we heard and our experience supporting teams to develop psychological safety, here are three steps:

1. Create safe spaces for honest conversation

This isn’t about formal incident reporting or governance meetings. It’s about creating regular opportunities for leaders to share what’s not working. One workshop suggestion was simple: “Always ask ‘what am I noticing?'” This shifts conversation from blame to curiosity. In our work with teams, this structured reflection time – what we call a culture of continuous improvement – becomes the foundation for everything else.

2. Model vulnerability at the top

The workshop showed that senior leaders recognise the importance of vulnerability but struggle to show it. This connects directly to psychological safety – it starts with leadership. The solution isn’t to manufacture authenticity – it’s to find genuine moments to share learning from mistakes. When leaders model this vulnerability, it creates conditions for dependability – where team members can count on each other to act in the team’s best interests.

3. Separate learning from accountability

This is the hardest challenge, but it’s fundamental to creating meaning and impact in people’s work. We need a space where people can admit mistakes without triggering accountability processes. This doesn’t mean abandoning accountability – it means recognising that if every admission of error leads to investigation, people will stop admitting errors. The learning conversation and accountability conversation need to be distinct.

The ripple effect

What became clear from our session is that failure isn’t the problem – our inability to talk about it openly is. When leaders can model the honest reflection we heard from Matthew, Caroline, and Louise, it gives permission for everyone else to do the same.

Learning requires the honest, vulnerable conversation that happened in a side room at ConfedExpo but rarely happens in boardrooms. Maybe that’s where real change starts: not with new policies or frameworks, but with three simple words that are harder to say than they should be: “I got this wrong.”