Process Design and Human Nature

Mothers were dying

In 1840’s Vienna they were dying of “childbed fever”.  In one hospital the death rate was alarming, roughly 1 in 10 mothers perished after childbirth, some months this statistic climbed to a horrific  30%.

A young doctor, Ignaz Semmelweis, working in the maternity hospital noticed that in a neighbouring hospital death rates were a far lower 2% to 7.5%.  Deeply disturbed by the poor performance of his hospital Semmelweis set out to find out what was causing it, he wanted to save lives.

Investigating the deaths

Semmelweis drew a blank.  He found that:

  • Both hospitals used the same procedures
  • Both hospitals had the same suppliers
  • Both hospitals served the same population

The only obvious difference was that the hospital with the lower mortality rate was a midwife led hospital, the one he worked in was a teaching hospital for doctors, but Semmelweis couldn’t understand why that would cause such a vast difference.  After all, you would expect the best from a teaching hospital.

Tragedy leads to success

A tragic breakthrough happened when one of Semmelweis’ friends was accidentally poked by a student’s scalpel during an autopsy, this caused an infection and the friend died with similar symptoms to childbed fever.

Semmelweis guessed that doctors who performed autopsies and deliveries were infecting the mothers with “cadaverous material” which they carried on their hands.  This seems obvious to us now with our understanding of infection and microbiology, but in the 1840’s it was a revolutionary idea.

Semmelweis tested his theory by asking physicians leaving the morgue to wash their hands in a chlorinated lime solution.  The results were immediate and dramatic.  Deaths from childbed fever dropped from over 10% down to 2%.

Human nature results in failure

Now you would expect a happy ending, Semmelweis becomes a hero, doctors worldwide adopt his practices and thousands of mothers live to see their babies.  Unfortunately not.  The medical community reacted to Semmelweis’ findings with skepticism and outright hostility.

Semmelweis failed, not because his solution didn’t work, but because it didn’t take account of human nature.

Some doctors couldn’t look past the prevailing medical wisdom.

Far worse still, he offended many doctors with the idea that they were the source of disease-producing dirt.  After all they were well-educated professionals of high social standing.  How could they possibly be killing people?

A natural reaction. But the deaths continued.

It was only after Semmelweis’ death that Louis Pasteur succeeded in persuading the world that micro-organisms exist.

From the sublime to the ridiculous:

Now I have a second story, a change of tack.  Before I go any further I apologise to any women reading this post.

One of the potential hazards of being a gentleman in the modern world is “splash back”.  When we visit a urinal it is possible that the stream of urine bounces back at us when it hits the porcelain, causing some anguish and unpleasant odours.  This is particularly distressing for those of us who wear light coloured trousers.

As in the previous story clever people have found a solution to the problem.  In this case altering the curvature of the urinal so it minimises “splash back”.

This is brilliant process design but there is a problem, the “sweet spot” is not obvious, and as men aren’t known for their attention to detail the problem remained.

Human nature to the rescue

A Dutch maintenance engineer at Schipol airport, Jos Van Bedoff, solved the problem.

He drew a fly on the target point.

Every male has an inner boy and to a man we aim instinctively at the “fly”, trying to give it a good drenching.  This not only prevents splash back but also reduces spillage by 80%.  (How this was measured I can’t begin to contemplate.)

In this case, human nature worked to solve the problem.

Using human nature to your advantage

We are all different, but fundamentally we have very similar wants:

  • We want an easy life
  • We want to have fun
  • We want respect

If you have found a marvellous new way of doing things and you want people to change their behaviour then you have to appeal to their human nature, as part of the solution.  Otherwise you will be sadly, possibly tragically, disappointed.

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  1. Hello James

    Great post – throughly enjoyed reading it and got value out of it. From where I stand you make the fundamental point when it comes to organisational behaviour, organisational change and performance improvement. Work with the grain of human nature rather than against it.

    Yet be mindful that there is no such thing as human nature – as in a a universal. As Pascal so brilliantly noticed and stated “Custom is our nature”.

    And if we want to get that feel for the richness of the being of human beings then there is, in my view, none better than Fyodor Dostoyevsky. Some say his novel The Brothers Karamazov is packed with insight into ‘human nature’. I have read it and agree wholeheartedly.

    All the best

  2. Hi James,
    Great couple of stories. One thing I have learnt about human ‘nature’ or custom, as Maz calls it, is that we also want to be right or not wrong. I think this was a central barrier in the first story and should be a consideration in all cases where we need to change something and that is: even when you are making someone wrong give them an opportunity to be right too. A bit like making your manager think that it was their great idea.


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