Communication: Semmelweis vs Florence Nightingale

A comparison of two intriguing nineteenth century change agents.

The lady with the lamp: Florence Nightingale, founder of modern nursing, demonstrated the effectiveness of hospital design and administration.

The saviour of mothers: Ignaz Semmelweis, demonstrated statistically that puerperal fever could be reduced by hand washing and implemented hand hygiene at the point of care.

The one was acclaimed during her lifetime; the other died an outcast of medical society in a mental institution at the age of 47.

Similarities

Semmelweis (DOB 1818) and Nightingale (DOB 1820) lived in the same era of health care development.

Both had novel ideas that challenged the existing status quo.

Both used statistics to demonstrate their findings (not commonly used at the time).

They made their world-changing discoveries roughly at the same time (1847 and 1854)

Their discoveries were in the same branch of medicine: spread of disease.

Neither one was completely right.  Semmelweis failed to realize that puerperal fever is an airborne and contact disease.  Nightingale lacked “scientific” insight into the spread of disease.

Brief backgrounds

Nightingale was a lady from the upper class in the Victorian era of British history; women had no legal rights and a Victorian lady’s world was strictly confined to home and family.  Florence’s father held progressive views on the education of women and she was well-educated.  However it remained a radical concept that a privileged lady would want to have a career, especially as a nurse!  Nursing was considered a job for untrained, uneducated women with no other prospects and of poor social standing.

Semmelweis was born in Hungary, the 5th child out of ten in an affluent family from German ascent. He was a physician and worked in a large training hospital in Vienna.  There must’ve been a degree of underlying tension for the Hungarian physician working in Austria due to the European political framework of the time.

How did they communicate their findings?

Florence Nightingale consistently communicated and consulted widely, publishing approximately 200 books and 12 000 letters.   Nightingale was strategic in her allegiances.  She attracted talented and powerful collaborators, connecting with a variety of influential people.  She networked across boundaries, even internationally.  Her collaborative efforts with Sidney Herbert are well-known and demonstrate her ability to influence the right people.  Sidney Herbert carried weight in social circles, he had an influential position and enough access to the Queen to make promise Florence prior to Crimea “unlimited power of drawing on the government for whatever you think requisite for the success of your mission.”

Semmelweis was a reluctant communicator and words used to describe his style includes dogmatic, arrogant and ego-driven.  He displayed a tendency to describe his peers using words such as irresponsible murderers, criminals, adversaries and partners in the massacre.

With the implementation of Semmelweis’s hand washing at point of care idea the mortality rate dropped from 18 – 1%.  For reasons unknown he refused to communicate his reasoning and findings to the learned circles. Only fourteen years after the experiments and after he has left Vienna did he publish a book.  The book was poorly received as it was reportedly poorly written and hard to follow.  Semmelweis responded to the reviews by writing public letters, which did little to win support within the scientific community. He died four years after the publication in a mental institution.  His admission to a mental institution is filled with myth.  He’s reasoning was only accepted 20 years after his death with the further discoveries on the germ theory of disease (Louis Pasteur) and antiseptic techniques (Joseph Lister).

Could Semmelweis have had a greater impact if he could communicate differently? I think yes…

The power to influence

Obtain buy in.  Most of us view ourselves as individuals making independent decisions based on facts, however the behaviour of similar others (our peers) have an influence on our decisions, not to mention our preconceived notions.  When the way that we interpret facts are questioned it threatens our truth and the way we see the world resulting in self-defensive behaviour. The gentlemen doctors in the nineteenth century did not believe that their hands carried germs.  For fourteen years Semmelweis declined to share why he was so forcefully challenging this status quo and insulting his peers.  Semmelweis behaviour made it easier for his peers to shun him than to challenge their own beliefs and buy into his message.

Don’t force your opinion (even if it’s right). Semmelweis felt passionately about his message and his statistics proved that he was “right”.  So he forced his message and when it didn’t work, instead of reviewing and adjusting, he raised the tone, making it more aggressive.  He kept pushing, refusing to consider other’s inputs and views.  It’s not only about the facts; it’s also how we go about communicating and adapting our message that counts.

Use a consistent message in different ways. Nightingale used various ways to communicate the same message.  She wrote letters, books, presented statistics, comparing English and French outcomes and collaborated widely.  She wrote in simple English and innovated difficult statistics into easier visuals ensuring that her message was clearly articulated and understood.

Apply some charm. In addition to our bias, we are more likely to follow the lead of people that we like.  This makes charisma an important leadership and change agent trait. Charismatic people are skilled communicators communicating using just the right amount of emotional appeal to lend credibility to their message.

Nightingale’s background prepared her to be an intuitive and skilful communicator.  She innovated to clarify her message (statistically); she used her influential collaborators and she was persistently persuasive. The power to influence people and get them to work with you or even on your behalf is and advanced form of social interaction. I think Nightingale was a clever strategist and communicated with intent.

Summary

There is a Chinese proverb that states that he who threads softly goes far.

Communicating is a skill. When challenging the status quo we need to be intentional, adapting our personal style yet remaining true to ourselves and our truth.

Footnote:  Semmelweiss was able to make his deductions after comparing a nurse driven clinic (low mortality rates) and a doctor driven clinic (high mortality rates), Nightingale made her deductions from nursing experience.  Both cases illustrate the important role of nurses in improving and advancing health care.

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