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By David A. Shore, Ph.D., Harvard University and University of Monterrey (Mexico), Business School
W
hen it comes to change, is it for healthcare professionals today to
people reflexively fear the embrace innovations where the evidence
new. However, the ratio- is far less clear, the ROI is far less certain, Key Board Takeaways
nales for this fear vary in and the potential adverse consequences far Higher-performing hospitals and health systems
healthcare delivery organizations.1 More more personal? all have one thing in common: the ability to ignite
often than not a leading argument is some Dr. Semmelweis worked at the generally innovation. Too often leaders fear what is new
manifestation of the NIH (“not invented well-respected Vienna General Hospital. and different and end up dismissing or pushing
here”) syndrome, which is a recurring However, the mortality rate among women off innovative ideas. Healthcare delivery organiza-
affliction and a cause of fatigue in ignit- on his ward was one in 10. Its reputation tions need people in leadership positions to be
ing innovation. Another familiar refrain was so bad that many women preferred to agents of change, capable of igniting innovation
when a change initiative is proposed is to give birth on the street and then go to the and realizing benefits from these efforts. Boards
take a “not now” approach. Rather than hospital. It is estimated that 2,000 women should evaluate their own organization’s toler-
decide whether or not to invest, leaders died each year in Vienna alone from ance and capability for change:
and governing boards take on a “wait and Puerperal fever. Patients at Vienna General •• Do we have the capacity and infrastructure
see” attitude. I know of no better ways to Hospital pleaded to be transferred off of to ignite innovation?
extinguish ideas for future innovations Dr. Semmelweis’s ward and onto a second •• Are leaders effectively managing organiza-
than these two responses. In today’s ever- section of the maternity ward where the tional change?
changing environment, healthcare leaders mortality rate was (only) one in 50. •• Is innovation encouraged at all levels of the
need to be open to new ideas and create a Dr. Semmelweis became consumed organization?
culture where innovation is cultivated. by the disparity on the two wards and •• What can we do to stimulate and sustain a
attempted to control all factors (i.e., birth- culture of change?
The Semmelweis Reflex ing positions, ventilation, diet, venue for
An exploration into the challenge of change laundry). He noticed there was one glaring
in healthcare and the consequences of not distinction between the two sections. His later that his discovery was accepted after
changing would not be complete without section was attended by physicians, while Louis Pasteur revealed the presence of
exploring the Semmelweis Reflex case. The the other section was attended by mid- Streptococcus in the blood of women with
Semmelweis Reflex (or Semmelweis Effect) wives. As a teaching and research hospital, child fever.2
is a metaphor for the reflex-like tendency to physicians split their day between research
reject new evidence or knowledge because on cadavers in the morning and treatment Being Right Isn’t Good Enough
it contradicts established norms, beliefs, of patients in the afternoon. Midwives were The Semmelweis case reminds us of Vol-
or paradigms. This was named after Ignaz neither required nor allowed to perform taire’s warning, “It is dangerous to be right
Semmelweis, a 19th century Hungarian autopsies. Dr. Semmelweis concluded in matters on which the established author-
obstetrician whose perfectly reasonable that “particles” from cadavers and other ities are wrong.” It further reminds us that
hand-washing recommendations were diseased patients were being transmitted to the human mind often treats a new idea the
ridiculed and rejected by his contempo- healthy patients by the hands of physicians. same way the body treats a strange protein,
raries. As you read the following story, I He experimented with various cleansing it rejects it and often tries to destroy it.
invite you to reflect on this question: If agents and eventually instituted a policy Had Dr. Semmelweis received training
physicians found it so difficult to grasp as requiring all physicians to wash their hands in “soft” or non-cognitive skills his efforts
intuitive and straightforward a prophylactic thoroughly in a chlorine and lime solution to introduce change might have met with
practice as hand washing, how challenging before examining any patient. The death a more positive response. Indeed, with
rate precipitously fell to one in 100. regard to the selection of healthcare lead-
In 1848, the mortality rate in Dr. Sem- ers (both clinical and non-clinical) there
melweis’s division went from 18.27 percent is currently a tradition of measuring these
to 1.27 percent. Yet, the doctor was not non-cognitive factors in an effort to predict
rewarded for his discovery and changes
in protocol. In fact, the following year, he
was dropped from his post at the clinic
2 The Semmelweis story is drawn from multiple
and turned down for a teaching position. sources including: The Arbinger Institute,
In 1861, he published a book; however, his Leadership and Self-Deception: Getting Out of the
doctrine continued to be roundly rejected Box, San Francisco: Berrett-Koehler, 2002; Ignaz
1 David A. Shore, Launching and Leading Change by the medical community. A few years Semmelweis (translated by K. Codell Carter),
Initiatives in Health Care Organizations: Managing The Etiology, Concept, and Prophylaxis of Childbed
Successful Projects, San Francisco: Jossey-Bass, later, he suffered a nervous breakdown and Fever, Madison: University of Wisconsin Press,
2014; David A. Shore and Eric D. Kupferberg, was admitted to a mental hospital, where 1983; K. Codell Carter and Barbara R. Carter,
“Preparing People and Organizations for the he was routinely beaten by asylum person- Childbed Fever: A Scientific Biography of Ignaz
Challenge of Change,” Journal of Health Commu- Semmelweis, Westport: Greenwood Publishing
nication, Vol. 19, No. 3, 2014, pp. 275–281.
nel and died at the age of 47. It was 14 years Group, 1994.