Social Learning Blog

Good Ideas Alone Don’t Change Employee Behavior


Ignaz Semmelweis was obsessed. Giving birth was a dangerous activity in the mid 1800’s. In Europe the mortality rate for new mothers averaged around 10%. At the time no one knew the exact cause of death. Some thought it was caused by particles in the air; others thought each of the mothers had a unique disease. As a recent graduate placed in a maternity ward, Semmelweis wondered if there was a cure for this illness that was killing newborns and their mothers.

With a missionary zeal, Semmelweis decided to find the answer to this mysterious childbed fever. He noticed that the mortality rate was significantly lower among mothers who delivered with midwives than by doctors in hospitals. He began examining every factor between the two methods, analyzing the differences. Then one day he observed a doctor, who had just been working in the autopsy room, delivering a baby.

In the 1840’s, it wasn’t standard practice for doctors to wash their hands before going into surgery. Semmelweis sensed that the doctors were passing the disease from the autopsy room to the delivery room. His findings were confirmed when a doctor, having just been in the autopsy room, accidentally pricked himself with a knife during the delivery process. A few days later, he died of the childbed fever.

doctors in the 1800's

Putting his theory into practice, Semmelweis had the interns in his ward adopt the practice of washing their hands. If they had just performed an autopsy, they needed to use a solution of chlorinated lime before delivering a baby. In 1847 the mortality rate at the hospital was 18.3%. Two months after adopting the practice of hand washing, the mortality rate dropped to under 2%.

Semmelweis took his findings to the head of the department. Unfortunately, he was not effective in communicating his ideas and was not able to make his case. Instead of giving Semmelweis praise, the department head wrote him off as young, inexperienced, and audacious in suggesting that the doctors were responsible for the deaths. When Semmelweis’s contract was up for renewal, it was terminated instead.

After his dismissal, Semmelweis’s attempts at communication only became worse. He put his theory into writings that were charged with anger, going so far as to denounce leading European obstetricians, calling them irresponsible murderers. Eventually, he found himself working in a Budapest hospital where he forced hand washing on the interns with a tyrannical authority.

Semmelweis was able to cut the mortality rate, but he alienated a majority of doctors and nurses. He refused to write proper studies of his theory, which was transmitted only through second-hand reports. The medical community rejected his ideas and came to question whether it was, indeed, his idea of hand washing that had contributed to the drop in mortality rates.

Semmelweis’ supporters had been begging him to publish a book, which he finally did; but it was poorly executed. Instead of a small, concise collection of his arguments, the book was a 600- page rambling mess, full of emotional rants. The book gave his critics something that could be easily dismissed and discredited, while causing his colleagues and students to lose faith in his ability to lead the cause.

There isn’t a happy ending to Semmelweis’ story. He was eventually committed to a mental institution, where he died a few weeks later.

Good ideas are not enough.

Why did doctors reject the idea of washing their hands? History has clearly been proven Semmelweis’ theory to be correct. Why were people so hesitant to acknowledge it?

4 Laws of Communicating an Idea

1. Know the Worldview of the Audience
Semmelweis’ first presented his idea to his department head—a man who was staunchly conservative and followed only traditional medical practices. Semmelweis would have had a greater likelihood of persuading him if his theory had been presented in a way that matched the department head’s worldview. Everyone has a worldview through which they see the world. It’s far easier to adapt your idea to the worldview of the audience than to convince that audience to change the way they see the world.

2. Know What the Audience Values
In 1847 the medical community didn’t have much regard for experiments and theories that hadn’t been proven in actual practice. Semmelweis should have conducted official experiments that would have been respected by this community and given his followers ammunition in support of his cause.

When you are communicating to your audience, you need to consider what they value and address those values in the points you are making. People who buy a Timex watch and people who buy a Rolex value different things. They are both buying a watch, but for different reasons based on what they value.

3. Know the Implications of Your Idea
Imagine that your co-workers told you that one specific task, which you had been performing every single day as part of your job, was causing the unnecessary deaths of people. You would have a very strong desire to believe that they were wrong. Had Semmelweis considered that the medical community would infer his theory labelled them murderers, he could have presented his idea in a way that would have made them heroes instead. He could have modified what he said to convey that if they adopted his theory, they would save countless lives.

4. Seek to Inspire, Not Coerce
Coercion is typically a short-term change. Anyone can be coerced and forced into temporarily changing his or her behavior, but lasting change needs to come from a place of inspiration. In the Budapest hospital, Semmelweis was able to temporarily change the behavior of the interns. Because the change was administered through aggressive force, however, they resented him and his theory. Had he chosen to inspire them instead, the response would have been much different. To quote Simon Sinek in his great TED Talk, ‘People don’t buy what you do; they buy why you do it.”

Change is hard.
With any change inside an organization, such as adopting new software or new processes, whether or not employees are ready to adopt the process is just as important as the technical details. The fact the change makes sense for the organization isn’t enough to motivate the employees to eagerly adopt it. The human element is one of the most neglected aspects of change, yet is also one of the most important.

In Semmelweis’s case, the reduction in mortality rates―when medical doctors washed their hands before going into the maternity ward from the autopsy room―was indisputable. Yet, according to the writing about his legacy in the years after his death, the doctors refused to accept his findings because Semmelweis focused entirely on the theory while ignoring how people would react.

Tech Problems Don't Exist People Problems

Before implementing any change, especially one that requires new behavior, you need to understand your audience. Understanding what they value, what motivates them, what their goals are—all of this is important when implementing change. Then, you need to have a plan that will connect with their head (rational), heart (motivation), and hands (how to execute). If you don’t engage all three, you’ll have a good idea throttled by poor execution.

While many factors created complications for Semmelweis, including cognitive dissonance, if he had been a more strategic communicator, it’s far more likely he would have seen his theory attain substantial adoption within his lifetime, thus saving a significant number of lives, including his own.

To learn more about the tragic life of Ignaz Semmelweis, read his story on Wikipedia or in the books Mistakes Were Made But Not By Me and Mastery.

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Ben Nesvig

Ben is an learning enthusiast, avid reader, and enjoys receiving recommendations on good books to read.
  • Rabin Rai

    good stuff, communication skills is just as important as good ideas

  • Clint Pearman

    Great points. I apply each of the 4 Laws in my work changing health behavior. For example, next week I will be presenting a smoking cessation workshop at a homeless shelter and these 4 Laws are somewhat embedded in the program setup for connecting with the students.

    • Ben Nesvig

      That’s a great example of where the strictly rational approach wouldn’t work. Pretty much everyone knows that smoking is bad for them, but the statistics alone don’t motivate a lot of people to quit.

      In terms of worldview, I remember reading awhile ago about how an anti smoking effort with teens saw dramatic improvements when they framed smoking as tobacco companies controlling the teens behavior. As teens often tend to be anti authority, presenting the message this way was much more successful.

  • Tao Cao

    Thank you for this inspiring story, and insightful points on Laws of Communicating and Idea!

    • Ben Nesvig

      Thanks, Tao.

  • Francoise

    Thanks a lot for this example Ben. The points you bring up are very valuable and true.

    My take is that to enable change Semmelweis first needed to change his own behavior. Something he could do as he didn’t know himself well enough to understand his own behavior and its origin.

    Your description of Semmelweis’ behaviour is one of the best descriptions I have read of the Persister Personality Type under stress as described in the Process Communication Model. Striving for a recognition of his work and values and not receiving it he went out on a “crusade” making it almost impossible for his ideas to be recognized or valued. From there his stress continued to grow until finishing as described. Had he had a better knowledge of himself, he could have understood why not receiving the recognition he needed made it impossible for him to reach his goal.

    This might look like a wild shot when talking about Semmelweis as I only have your description. Nevertheless I found the resemblance striking. In order to implement change understanding his own needs (his own heart) would have enabled him to put your advice into action (hand) and then succeed to bring his research (head) to the world … instead of waiting 200 years for it …