What is the most important innovation ever?

I’ve argued before that it is hand-washing in hospitals. This innovation was a major driver in the improved health outcomes that have increased our life expectancies from less than 60 years at birth to nearly 80 in most developed countries.

It’s such a simple idea, and so easy to do, that it must have spread quickly, right?

Well, not really.

Oliver Wendell Holmes in the 1840s was one of the first people to suggest that hand-washing could reduce infections. Not many people paid attention.

One who did was Ignaz Semmelweis. He collected data in maternity wards in the 1850s which showed that hand washing reduced infection rates from nearly 15% to less than 1%. What more proof would you need than that to start doing it yourself?

A lot, apparently. Semmelweis was ridiculed for his suggestion that hand washing reduced infections. Why? Because he couldn’t explain why it worked, he could only prove that it did. He was hounded out of two different jobs for promoting his views on hand washing, and he died in an asylum of, ironically, a serious infection.

It took more than twenty years to clearly identify the mechanism that Semmelweis needed – germs. The work of John Snow, Louis Pasteur and Richard Koch established the germ theory of disease by the late 1860s.

So now that we had a theory to support Semmelweis’ data it should be clear sailing, right? Guess again.

Joseph Lister built on Pasteur’s work in particular to develop techniques for aseptic surgery in the 1870s.

His approach was widely adopted….. fifty years later.

There was about a seventy year gap between Semmelweis proving that hand washing saves lives until the practice was widely accepted. Even today, in many hospitals less than half of the health care practitioners follow the right procedures for hand washing.

What makes it so hard to wash your hands before touching a patient?

The big challenge is that hand washing requires people to change their behaviour. Worse, it requires people to break their habits – something that Charles Duhigg talks about in his excellent new book The Power of Habit: Why We Do What We Do in Life and Business.

Duhigg explains how habits work:

Hand washing was resisted for many reasons. One is that it suggests that doctors and nurses are the cause of infections and harm – and this doesn’t fit with how they view their jobs at all. Another is that it takes time, and time is often in extremely short supply in hospitals. A third is that it just seemed too simple. Medicine is complex, it requires years of training to practice effectively, and significant expertise to practice well. It’s built for complexity, not simplicity.

Consequently, hand washing can be tough sell, even though everyone knows now that it works, and why.

There are some important innovation lessons in the story of the slow adoption of hand washing:

• Innovations are often ideas, not things. The breakthrough here was the idea – the germ theory of disease, and then the application of the idea in practice. We tend to think of breakthroughs as things – the first car, a rocket that takes people to the moon, or an iPhone. But as Hugh MacLeod says:
  

  Products are idea amplifiers. The molecules and/or bytes are secondary.

• Ideas spread much more slowly than we expect. Innovators tend to be pretty smart, and one of the most common mistakes that smart people make is to expect great ideas to be self-evidently good. This is never true. It wasn’t enough to show that hand washing saves lives. It took seventy years of effort to get people to adopt the practice. As Howard Aiken said:
  

  Don’t worry about people stealing an idea. If it’s original, you will have to ram it down their throats.

• Innovation is always about changing behaviour. If you’re selling a new widget, you have to get people to switch from their old widgets. If you have a new way of doing things, you have to get people to abandon the old ways. If you have a new idea, you often have to kill off an old way of thinking. You have to break connections to get your ideas to spread. In all cases, this requires people to change the way that they act.

This is why Duhigg’s work on habits is so important. He has a great set of steps to follow in this pdf excerpt from the book on rules for changing habits. He also has many examples of how firms have gotten their customers to change their habits.

If you are innovating, you must think about this. During an analysis of a recent project, we concluded that the fundamental problem in the organisation was political. We went in thinking our task was to come up with a new business model for one of the units in the firm. But really, it was to come up with a new business model, and also a way to sell it.

Because the innovative idea is worthless if it doesn’t change the way that people act.

We re-learned Ignaz Semmelweis’s big lesson – innovation always requires a change in behaviour.