The effect of failure on performance over time: The case of cardiac surgery operations

• Author: Ioannis Fragkos,Bilal Gokpinar,Emmanouil Avgerinos
• Date: 01 June 2020
• Published date: 01 June 2020
• DOI: http://doi.org/10.1002/joom.1068

RESEARCH ARTICLE

The effect of failure on performance over time: The case

of cardiac surgery operations

Emmanouil Avgerinos

1

| Bilal Gokpinar

2

| Ioannis Fragkos

3

1

IE Business School, IE University,

Operations and Technology, Madrid, Spain

2

UCL School of Management, University

College London, London, UK

3

Technology and Operations Management,

Rotterdam School of Management,

Rottredam, Netherlands

Correspondence

Emmanouil Avgerinos, IE Business School,

IE University, Operations and Technology,

Maria de Molina 12, Madrid, Spain, 28006.

Email: emmanouil.avgerinos@ie.edu

Handling Editor: Anand Nair

Abstract

Failure is a common occurrence in many operational contexts involving knowledge

work. Concentrating on highly critical cardiac surgery operations, we investigate

how failure affects subsequent performance over time. In addressing our research

questions, we draw on the sensemaking perspective and incorporate behavioral

aspects of failure that are often overlooked. We develop three hypotheses on the

effects of failure (i.e., in-hospital mortality of a patient) and test them with a unique

data set of 4,306 cardiac surgery operations from a large European hospital, span-

ning five years. Our findings show that while failure promotes learning over time

and improves task execution quality (as measured by patients' reduced length of

stay) in the long term, its effect is the opposite in the short term. Our work also

unravels how relational dynamics (i.e., familiarity) may reduce the short-term

effects of failure. We find evidence that team familiarity mitigates the detrimental

effects of recent failures. This implies that certain team assignment strategies after

failure (e.g., putting individuals into familiar teams) may be preferable than others.

We explore and illustrate this by conducting a policy simulation based on our data.

This article provides new insights into how operations managers can support their

employees in moving forward after failure.

KEYWORDS

failure, healthcare operations, quality, sensemaking, team familiarity

1|INTRODUCTION

From academics submitting grant proposals or research

papers to lawyers representing clients before a court, an

unsuccessful outcome or failure is a common occurrence in

many operational contexts involving knowledge work. This

is more so in healthcare settings where individuals

(e.g., surgeons) perform many critical tasks with often

uncertain outcomes (e.g., surgeries). While failure may facil-

itate individual and organizational learning and improve

future performance (Cannon & Edmondson, 2005; KC,

Staats, & Gino, 2013) by stimulating the development of

new ways of approaching existing problems and the adop-

tion of new strategies (Baum & Dahlin, 2007), it may also

induce negative reactions involving anxiety, anger or shame,

and be detrimental to performance (Carmeli & Gittel, 2009;

Zhao, 2011).

This study examines the behavioral and learning dynam-

ics that are likely to take place after failure and the conse-

quences this can have on individuals' subsequent execution

of tasks and seeks to answer the following two research

questions: How does failure affect subsequent performance

over time? Does team familiarity affect the relationship

between recent failure and subsequent performance and if

so, to what extent? While recent studies have investigated

the effect of failure on individuals (KC et al., 2013), the

mechanism by which this effect unfolds over time has

received little attention. We focus on the consequences of

Received: 16 July 2018 Revised: 29 July 2019 Accepted: 28 September 2019

DOI: 10.1002/joom.1068

J Oper Manag. 2020;66:441–463. wileyonlinelibrary.com/journal/joom © 2019 Association for Supply Chain Management, Inc. 441

failure based on temporal dynamics and investigate both its

long-term and short-term impacts. Exploring the link

between failure and subsequent performance is interesting

from a theoretical perspective, but it is also of significant

practical importance for operations managers who have to

make team allocation decisions in the aftermath of a recent

failure and also need to support their employees in moving

forward after failure.

Learning from failure seldom takes place in isolation but

involves interpersonal activities and dynamic interactions

among organizational members (Elkjaer, 2003; Kozlowski &

Ilgen, 2006). We consider the relational aspects associated

with learning from failure and the recent work, which high-

lights the importance of shared work experience (i.e., team

familiarity) on learning and task performance (Avgerinos &

Gokpinar, 2017; Huckman, Staats, & Upton, 2009; Reagans,

Argote, & Brooks, 2005). Consequently, our second

research question addresses whether and to what extent team

familiarity affects the relationship between recent failure and

subsequent performance.

In addressing our research questions and examining the

performance implications of failure in the short and long

term, we draw on the rich and growing literature on sen-

semaking (Maitlis & Christianson, 2014; Schabram &

Maitlis, 2017; Weick, 1995; Weick, Sutcliffe, & Obstfeld,

2005). Sensemaking is the process by which individuals

work to understand and react to uncertain events or occur-

rences around them through continuous interpretation and

action (Christianson & Sutcliffe, 2009; Thomas, Clark, &

Gioia, 1993). A key feature of sensemaking is the active

nature of understanding, as individuals play a role in creat-

ing the actual situations they try to understand in retrospect

(Cornelissen, 2012; Sutcliffe, 2013; Weick et al., 2005).

Research has shown how past failures can promote sen-

semaking among individuals, leading to learning and

improved performance (Colville, Hennestad, & Thoner,

2013; Gephart, 1993; Maitlis & Christianson, 2014;

Thomas, Sussman, & Henderson, 2001; Weick, 1988, 1990,

1993). Similarly, we argue that sensemaking is a key process

through which individuals learn from failure (Catino & Pat-

riotta, 2013; Christianson, Farkas, Sutcliffe, & Weick, 2009)

in our setting. Moreover, we propose that failure is likely to

trigger negative emotions (Shepherd & Cardon, 2009; Zhao,

2011), which in turn may hinder the process of sensemaking

and learning from the failure experience (Byrne & Shepherd,

2015; Shepherd, 2009). Emotions are increasingly consid-

ered to be part of the sensemaking process (Maitlis &

Christianson, 2014), with emerging research connecting neg-

ative emotions with superficial sensemaking (Liu & Maitlis,

2014). Finally, we examine how past shared experiences

interact with recent failure by arguing that highly familiar

individuals share greater levels of information, which leads

to the creation of shared mental models that help them to

create cognitive maps of their situation (Weick, 1995) and

therefore promote the process of sensemaking (Akgun,

Keskin, Lynn, & Dogan, 2012).

We address our research questions using a highly detailed

data set of all cardiac surgeries conducted in a private hospi-

tal in Europe over five years. Patients' in-hospital mortality

has been commonly characterized as a failure in the

healthcare operations literature (KC et al., 2013; KC & Ter-

wiesch, 2011) and has been found to be a highly negative

experience for hospital employees (Gerber & Workman,

1995; Lenart, Bauer, Brighton, Johnson, & Stringer, 1998).

Throughout our study, we use failure as meaning “lack of

success”(Oxford English Dictionary, 2018), which is differ-

ent than an “error”. Our setting involving cardiac operations

is ideal to address our research questions for several reasons.

First, the longitudinal nature of our sample allows us to

observe the effects of failure over time. Second, in cardiac

surgery, failure is well defined. In-hospital mortality is

widely accepted as a measure of failure for cardiac opera-

tions (KC et al., 2013; KC & Terwiesch, 2011). Thirdly,

epitomizing today's dynamic, high pressure, and high uncer-

tainty knowledge work environment, cardiac surgery opera-

tions have significant ramifications (Edmondson, 1999;

Nembhard & Edmondson, 2006; Tucker & Edmondson,

2003), whereby behavioral dynamics are likely to be at play

alongside learning. In a cardiac surgery setting, individuals

are assembled to work on a specific operation in fluid teams.

After the operation, the team is dissolved and individuals

become part of another team to perform a different opera-

tion. That is, individuals develop familiarity with each other

over time through their shared work experience in the same

teams. Our sample in this study includes 4,306 cardiac oper-

ations of the following types: Coronary artery bypass

grafting (CABG), valve replacement/repair, tumor removal,

heart failure, congenital heart surgery, routine cardiac sur-

gery, other normal surgeries, which do not belong in any of

the aforementioned groups, double surgeries which include

two cardiac surgeries of the previous groups and triple sur-

geries. Finally, our performance measure for a cardiac opera-

tion (i.e., task execution quality) is a patient's hospital length

of stay (LOS) after an operation, a widely accepted quality

measure for cardiac surgeries (Guru et al., 2005; Hannan,

Stone, Biddle, & DeBuono, 1997; KC & Terwiesch, 2009;

KC & Terwiesch, 2011; Schneider & Epstein, 1996).

This article offers a number of important contributions to

operations and healthcare management literatures. First, it

provides a more nuanced understanding of the effects of fail-

ure by distinguishing between its long-term and its short-

term effects. Drawing on the sensemaking perspective and

incorporating often overlooked emotional aspects associated

with failure, we hypothesize and find that while failure

442 AVGERINOS ET AL.