Our attempts to improve safety and quality in healthcare have tended to focus on learning from error. Intuitively, this seems like a good idea: if we make a mistake, we would like to learn why it happened and how to stop it happening again. But errors only occur in a minority of clinical encounters, so our focus is quite narrow. We may be missing learning opportunities from the episodes when things have gone very well. Furthermore, by focussing entirely on learning from adverse events, we run the risk of creating a culture of negativity, fear and avoidance. In this presentation, I will challenge the deficit-based approach to learning (i.e. learning from error) as the sole instrument to improve quality. I will also introduce the following concepts: our innate negativity bias - why we can't help spotting errors, and why tend to overvalue their significance; the second victim phenomenon; Safety-2; intrinsic vs. extrinsic motivation; and Appreciative Inquiry. I will describe a complementary approach to learning in healthcare: Learning from Excellence, and how our team established an Excellence Reporting system in our intensive care unit. www.learningfromexcellence.com @adrianplunkett