How about time? Make the player have a time to complete the things he/she is supposed to do, thus having lose time in both doing the action and 'dying'. Making it so the time is plentiful if you don't make mistakes, should also allow for another way to tweak the challenge. (Have less time in some situations).
If time runs out, the level would fail.
This is probably the most flexible of these I'm writing about. X time before a sandstorm arrives in a desert. X time before you freeze to death at a glacier etc.
Or you could think of mentality of the character. Failing could make him a little bit more mad. Success make him a tad more sane. This, like time, could work on a game-wide scale. Probably works best if the game is about the character him/herself.
Or something you're about to rescue. Probably best, if you're not shy about giving gruesome ideas to the player. I was about to point out that this wouldn't be such an awesome idea in a 'happyhappy' game, but I realized it could actually give a nice contrast that something is dying as you go. (Then again, I'm curious about emotional confusion in games
)
Or the love of a beloved. This one's been used a bit on other games I think. Similar mechanic to sanity.
I'd have to know more about the setting the game is in to be able to give accurate descriptions on how these could work. And for some more accurate ideas.