4 The Problem beneath Other Problems

“Have you ever heard of Ignaz Semmelweis?” Bud asked. (He pronounced it “Ignawts Semelvice.”)

“No, I don’t think so. Is it a sickness or something?”

“No, no,” he said with a chuckle. “But close. Semmelweis was a European doctor, an obstetrician, in the mid-1800s. He worked at the Vienna General Hospital, an important research hospital, where he tried to get to the bottom of a horrendous mortality rate among women in the maternity ward. In the section of the ward where Semmelweis practiced, the mortality rate was 1 in 10. Think of it. One in every 10 women giving birth there died! Can you imagine?”

“I wouldn’t have let my wife near the place,” I said.

“You wouldn’t have been alone. Vienna General had such a frightening reputation that some women actually gave birth on the street and then went to the hospital.”

“I don’t blame them,” I said.

“The collection of symptoms associated with these deaths,” Bud continued, “became known as ‘childbed fever.’ Conventional medical science at the time called for separate treatment for each symptom. Inflammation meant that excess blood was causing swelling — so they bled the patient or applied leeches. They treated fever the same way. Trouble breathing meant the air was bad — so they improved ventilation. And so on. But nothing worked. More than half of the women who contracted the disease died within days.

“The terrible risk was well known. Semmelweis reported that patients were frequently seen ‘kneeling and wringing their hands,’ begging to be moved to a second section of the maternity ward, where the mortality rate was 1 in 50 — still horrific, but far better than the 1-in-10 rate in Semmelweis’s section.

“Semmelweis gradually became obsessed with the problem — in particular with discovering why the mortality rate in one section of the maternity ward was so much higher than the rate in the other. The only obvious difference between the sections was that Semmelweis’s section — the section that performed the worst — was attended by doctors, while the other section was attended by midwives. He couldn’t see why that would explain the difference, so he tried to equalize every other factor among the maternity patients. He standardized everything from birthing positions to ventilation and diet. He even standardized the way the laundry was done. He looked at every possibility but could find no answer. Nothing he tried made any measurable difference in the mortality rates.

“But then something happened. He took a four-month leave to visit another hospital, and upon his return he discovered that the death rate had fallen significantly in his section of the ward in his absence.”

“Really?”

“Yes. He didn’t know why, but it had definitely fallen. He dug in to find the reason. Gradually, his inquiry led him to think about the possible significance of research done by the doctors on cadavers.”

“Cadavers?”

“Yes,” he answered. “Remember, Vienna General was a teaching and research hospital. Many of the doctors split their time between research on cadavers and treatment of live patients. They hadn’t seen any problem with that practice because there was as yet no understanding of germs. All they knew were symptoms. And in examining his own work practices compared with the practices of those who had worked for him in his absence, Semmelweis discovered that the only significant difference was that he, Semmelweis, spent far more time doing research on the cadavers.

“From these observations, he developed a theory of childbed fever, a theory that became the precursor to germ theory. He concluded that ‘particles’ from cadavers and other diseased patients were being transmitted to healthy patients on the hands of the physicians. So he immediately instituted a policy requiring physicians to wash their hands thoroughly in a chlorine-and-lime solution before examining any patient. And you know what happened?”

I shook my head. “What?”

“The death rate immediately fell to 1 in 100.”

“So he was right,” I said, almost under my breath. “The doctors were the carriers.”

“Yes. In fact, Semmelweis once sadly remarked, ‘Only God knows the number of patients who went prematurely to their graves because of me.’ Imagine living with that. The doctors were doing the best they knew how, but they were carrying a disease they knew nothing about. It caused a multitude of debilitating symptoms, all of which could be prevented by a single act once the common cause of the symptoms was discovered—what was later identified as a germ.”

Bud stopped. He put his hands on the table and leaned toward me. “There is a similar germ that is spread in organizations — a germ we all carry to one extent or another, a germ that kills leadership effectiveness and teamwork, a germ that causes a multitude of ‘people problems,’ a germ that can be isolated and neutralized.”

“What is it?” I asked.

“Just what we’ve been talking about,” Bud replied. “Self-deception — ‘the box.’ Or, more precisely, self-deception is the disease. What we’re going to learn about is the germ that causes it.

“What I’m suggesting, Tom, is that, like the discovery of the cause of childbed fever, the discovery of the cause of self-deception amounts to the revelation of a sort of unifying theory, an explanation that shows how the apparently disparate collection of symptoms we call ‘people problems’ — from problems in leadership to problems in motivation and everything in between — are all caused by the same thing. With this knowledge, people problems can be solved with an efficiency that has never been possible before. There is a clear way to attack and solve them — not one by one but in one disciplined stroke.”

“That’s quite a claim,” I said.

“Indeed,” Bud responded. “And it’s quite a discovery. But I don’t intend for you to take my word for it. I’m going to attempt to help you discover it for yourself. We need you to understand it because you need to make sure the strategies that follow from it are implemented in your division.”

“Okay,” I said.

“To begin with,” he said, “Let me tell you about one of my first experiences at Zagrum.”