As Service Designers, we are often asked by clients to come on-board to solve seemingly impossible problems. After years of practice, changing how companies conceptualize their product, how employees deliver service and how customers adjust to change, can be insurmountable. We face pushbacks and blockages at every turn and can sometimes question our own abilities. However, by looking at how medical innovations were rolled out over the ages, we can learn much about creating less resistance.

Dr. Ignaz Semmelweis — Wikipedia

The year was 1846 and the doctor was Ignaz Semmelweis. He was the first physician to make the link between hand washing hygiene and reduced infection rates. However, you may never have heard of him because sadly, his hygiene recommendations weren’t taken up during his lifetime.

Semmelweis was a young Doctor at a maternity hospital in Vienna who had noticed one striking difference between the doctor and medical student side of the hospital and the midwives clinic. The death rate for new mothers on the doctor’s side was nearly five times higher than that in the midwives’ clinic. Semmelweis set about discovering why this was.

Now, around this time, the mark of a good doctor was still a bloodied coat and instruments. Although it may seem unbelievable to us today, patients liked to know the doctor and his tools had performed numerous operations.The midwives, however, cleaned their space thoroughly as it was expected that a woman’s area should be clean. So to a modern mind, the cause of the infections on the doctor’s side is now obvious.

“At the time, diseases were thought to be caused by an imbalance of bad air or evil spirits. So Semmelweis’ tiny molecules-of-corpse was revolutionary.”

To Semmelweis, the solution was not so clear but following the death of a physician who pricked his finger during an autopsy, he landed on a cross-contamination theory. Particles of the corpse had killed the doctor by entering his blood. What if these same corpse particles were finding their way into the women’s blood? At the time, diseases were thought to be caused by an imbalance of bad air or evil spirits. So Semmelweis’ tiny molecules-of-corpse was revolutionary. On the back of his new understanding, he recommended routine hand washing for the doctors and argued the midwives, who washed their hands and clothes frequently, were the example to follow.

You can probably imagine how these learned men of science felt about being told to replicate the lowly midwives’ practice. They pushed back. However, Semmelweis fought hard until a new rule was introduced forcing all doctors to regularly clean their tools and hands with chlorine.

“He made them responsible for every death in the hospital when they were working around the clock to save lives.”

But as is often the case with innovation, it’s not known if the doctors adhered to this rule at all. One thing was for sure, Semmelweis became infamous for stalking the corridors trying to enforce the rule. He publicly berated doctors who disagreed with him and his colleagues eventually had him committed to an insane asylum where he was beaten to death. Simply put, the doctors were upset because Semmelweis’ hypothesis framed the problem as being one of their own making. He made them responsible for every death in the hospital when they were working around the clock to save lives. They cared a great deal about the deaths of the women and they did not want to hear it was all-their-fault. That’s natural. But just think for a moment, how differently Semmelweis could have presented his theory to improve buy-in and uptake… and save lives.

Sir Joseph Lister — Wikipedia

We don’t have to imagine it, however, because we have an example in Louis Pasteur. At the same time as Semmelweis was having a hard time with his doctors, Pasteur was framing ‘germ theory’ as the presence of other living things which could kill us and which needed to be overpowered by knowledge and science. Understandably, this approach put doctors back in the position of power and respect and the effect was wide acceptance. While Pasteur is now most famous for pasteurized milk and wine, and vaccinations, he’s also responsible for generating widespread acceptance of Semmelweis’ practice years after the latter’s death.

Following this, the British surgeon Joseph Lister essentially found fame with an upgrade of Semmelweis’ theory of hand washing. Like Semmelweis, Lister promoted hand washing and cleaning tools with carbolic acid, but he floated it on the back of Pasteur’s germ theory and made the doctor’s the champions of change.

“…we must consider who the partners, performers and stakeholders are in this new solution, and how they will respond to the solution.”

In short, while Semmelweis developed a true and accurate solution to combat the transmission of disease, his method for promoting new behaviors was so flawed that it caused resistance for many years come. This is a reminder to us, as Service Designers to think of the big picture. When a solution to a problem is found we must consider who the partners, performers and stakeholders are in this new solution, and how they will respond to the solution. How can we frame our solution to guarantee maximum buy-in? After all, a solution is only as good as our ability to take it through to implementation.

Remember that knowledge isn’t power, application of knowledge is power

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