Where is that delicate sweet spot where breakthroughs occur? Organizations spend a good deal of time and treasure; trying to zero in, but often fail. Is it strategy? Execution? Sprints? Scrums? All of these can be factors of, but not the location to the sweet spot. We can learn where it is from a 19th century physician, trying desperately to solve a problem.
Ignaz Semmelweis was a Hungarian obstetrician. Most people have no idea who he is, but our understanding of health and cleanliness stemmed from a discovery of his while trying to solve a problem impacting the clinics he was responsible for. In the mid-nineteenth century, Semmelweis was what we would today would consider a chief resident at the Obstetrics Clinic at Vienna General Hospital.
At this same time there were many maternity clinics established throughout Europe. These were charitable institutions intended to address the problems associated with illegitimate children and their underprivileged mothers. However, there was a quid pro quo to the arrangement. The obstetrics patients would be subjects for physicians and midwives that were in training.
At Vienna General Hospital there were two such clinics. One had an average patient mortality rate 2 ½ times greater than the other, at 10%. Women birthing at the first clinic were dying at a rate of 1 out of every 10. Morbidity was attributed to puerperal fever, although a cause had not yet been determined. The problem was extremely vexing to Semmelweis.
Underprivileged women in the community aware of this would give birth “enroute” to the clinic, avoiding death as from delivering in the clinics, still qualifying for care after childbirth. Some women were described as begging on their knees not to deliver in the clinic in the first clinic.
Semmelweis struggled and studied this issue with great intensity for a good while. He eliminated overcrowding as a factor. The second clinic with the lower average mortality rate (4%), was much more crowded than the first clinic with the higher mortality rate. He also eliminated climate as a factor since both clinics had the same climate.
It was not until the death of a good friend and colleague, Jakob Kolletschka – the result of an accidental puncture wound from a student’s scalpel curing a post mortem examination – that Semmelweis began to realize the cause of the maternal mortality rate of the first clinic. During the autopsy of his friend, similar pathologies to the women having died in the first clinic were evident. He immediately suggested a connection between the contamination from cadavers and puerperal fever.
The factor determined to be the cause was that students from the medical school having examined cadavers as part of their medical training, were not washing or disinfecting their hands after their studies in gross anatomy and then assisting with childbirth in the first clinic. Student midwives in the second clinic had no such training with cadavers. Semmelweis mandated the practice of medical students washing their hands with calcium hypochlorite (similar to bleach) between work doing autopsies in the medical school and delivering babies in the clinic. The mortality rate in the first clinic declined by 90% after institutionalizing this policy.
In business, particularly during this challenging time of unrest, we often don’t know what we don’t know. Until Semmelweis began to investigate with an open mind – much to the consternation of his peers in the current medical establishment who thought they knew better – was he able to find the solution to the problem.
There are two Shingo Guiding Principles at play here for Semmelweis and for us today. They are the foundation, called “Cultural Enablers,” of the dimensions of the Shingo Model. First is Guiding Principle is “Respect Every Individual.” Semmelweis, as a physician, had respect for the significantly less fortunate mothers he was caring for and had responsibility over. Much different than the condescending treatment of the medical establishment at the time, who were certain that the mortality rate must be associated with the indigent situation of the patients in the first clinic.
Second is “Lead With Humility.” Semmelweis had the humility to realize something was amiss which his current base of knowledge could not inform. He opened his mind to the idea that conventional wisdom of the time may well not have had the answer, encouraging him to embark on a journey of discovery until an answer was found.
Business leaders often find themselves in situations where there are inexplicable problems. We often assume our base of knowledge must have the answer we seek. In short, we believe conventional wisdom will get us through. There are a number of epitaphs to such wisdom in Sears and Blockbuster Video, to name just two.
Years ago, I was assigned as lead investigator for a significant non-conformance that shut down production of a much-needed lifesaving medicine. I was pulled aside by the executive sponsor and told the problem was a specific supplier. The leader had been in contention with the supplier over another matter, which could be related, but was not yet determined. As lead investigator, I respectfully held my ground, asserting we would allow the investigation to take us where it led.
After creating a sprint team to focus heavily, we considered all the what-ifs and turned over every stone we could think of. In an interview with an operator, we found that a well-meaning maintenance person had created a “shim” to resolve a problem the operator was experiencing. Upon examination of the shim, we learned that the cause of the failure was internal and had nothing to do with the supplier we were asked to “go after.”
There is a phrase often used in various contexts, that I like to use myself, and which was mentioned previously: “You don’t know, what you don’t know.” Such was the case with Semmelweis. Such was the case regarding the conventional wisdom of leadership in the investigation I led.
If you Respect Every Individual, you recognize that they often have far more to give than what is expected. They will give their hearts and minds. If you Lead With Humility you recognize that you truly don’t know what you don’t know. You are open to the idea that others – whom you respect – may have knowledge, insights, or ideas out of your own range of perception and knowledge.
This is the delicate sweet spot where breakthroughs occur.
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