As dental professionals, one of the most challenging aspects of our careers is how we navigate our relationship with failure. Traditionally, failure has been viewed as an outcome that is unacceptable and to be avoided at all costs. In this article for Colgate Palmolive, I explore a different perspective on failure to allow you to reframe failure from a growth mindset point of view and allow you to thrive even in the midst of a failure.
Failure in dentistry has long been seen as a fatalistic outcome to be avoided simply due to the fact that we are dealing with the health of another human being. More importantly, the outcome of failure in dentistry is seen as the opposite of a successful outcome for us and our patients. The biggest fallacy of this mindset is that if failure cannot be avoided, then it is best we don’t try at all. This is what I would classify as true failure. If you consider the fact that no skill in life, from walking to riding a bicycle, was ever mastered successfully without failure, then the same mindset applies that failure is simply the precursor to success. Most importantly, failure is an event, not an outcome. Unlike our medical and medical surgeon colleagues, in dentistry we are fortunate that the majority of our procedures rarely involve a patient’s mortality. This should be coupled with the fact that with more evidence-based prosthetic tooth replacement solutions such as dental implants, almost any tooth that is lost can now have a prosthetic replacement.
Interestingly, in the medical surgery world, the term ‘failure’ is never used. Instead the term ‘revision surgery’ is used, with a consented and fully informed understanding from both doctors and patients. Both parties understand the suggested treatment may not yield the desired outcome, requiring a second revision surgery at the patient’s own expense.1 The problem that exists in dentistry currently is that patients see dental treatments as a commoditised service whereby when a filling debonds and comes off the tooth, most patients would say “your filling failed”. In the private practice sector, most dentists usually are pressured to replace this for free for fear of losing the patient and this concept of ‘goodwill’ and ‘guaranteed work’.
Carol Dweck’s famous book Mindset: The New Psychology of Success explores the differences between a fixed and growth mindset. She postulates that a fixed mindset believes that intelligence and talents are innate and unchangeable, while a growth mindset believes that intelligence and talents can be developed through effort and practice. Individuals with a fixed mindset may avoid challenges or give up easily when faced with setbacks, while those with a growth mindset embrace challenges and see setbacks as opportunities to learn and improve.2 Perfectionism is a mindset that naturally exists amongst the majority of dentists and this mindset suggests if something is not done perfectly, it is deemed unacceptable. The fallacy of this fixed mindset however is that it builds upon the habit of focussing on flaws, as opposed to adopting a growth mindset of progression, which understands that deviations from desired outcomes contain a lesson to improve for the future.
GR Lee and YM Gil explored this in a qualitative study, investigating different coping mechanisms that experienced dentists, with greater than five years of practice, used to overcome failure. The seven themes he found were:
Reflecting - characteristically a fixed minded dentist is stuck in the habits of their original methods of doing things. When a procedure fails, the ability to think through processes, sometimes with written notes, often reveals the cause(s) of the problem.
Learning - attending continuous professional development, through self-study, online or in person, enabled analysis of the causes of failure and discovering tips to overcome the problem.
Correcting - modifying procedures are introduced, thus changing behaviours. For example, one dentist shared that they now carefully check the radiograph in advance before an extraction procedure.
Asking a colleague - in particular, experienced colleagues whom they trust, with a view to acquiring information and gaining a variety of different perspectives on the problem.
Referring to a colleague - particularly when dentists judged the solution was beyond their competence, but sometimes because self-confidence had been lost and there was fear of further failures.
Communicating - not meeting the patient’s expectations of treatment outcomes was perceived as a cause of failure. Explaining later is viewed by patients as an excuse, whereas advising in advance is an explanation.
Adopting - new pieces of kit, particularly in cases of endodontic failure, were frequently the solution. Ultrasonics, a microscope, cone beam tomography and using newer materials such as MTA were all examples given by the interviewees.3
From a systems level, dentistry is not unique in the opportunity that learning from failure provides. High Reliability Organisations (HRO) are organisations that have a preoccupation with failure who have succeeded in avoiding catastrophes despite a high level of risk and complexity. Minor errors in HROs such as airlines or nuclear plants could have widespread, catastrophic consequences, and yet although they are likely to happen, these errors rarely do. Whilst impacts to a single patient are not of the same scale of nuclear plants or airlines, our patients entrust us with their health and we have a code of ethics to do no harm. HROs have influenced the safety and culture of many hospitals around the world, and in dentistry we can learn from the five characteristics of high reliability: a preoccupation with failure, a reluctance to simplify, a sensitivity to operations, a deference to expertise, and a commitment to resilience.4
A great mindset to develop as a dental practitioner is a “fail forward” mindset. This means viewing failures as learning opportunities and stepping stones to success rather than setbacks. Instead of being paralyzed by mistakes, individuals with this mindset embrace them, analyze what went wrong, and use that knowledge to refine their approach and move forward. It's about understanding that failure is an inevitable part of the journey to achieving goals and is ultimately a catalyst for growth and innovation.5
The next time you fail, consider whether maybe it taught you:
The courage to try again
What truly matters to you
What doesn’t align with your values
To separate your worth from your achievements
How to pivot
To recognise your limits
To ask for help and lean on others
Success doesn’t look the way you imagined
The power of starting over
