In the 1840s, hospitals were dangerous places. Mothers who went in to give birth often didn’t make it out. For example, at Vienna General Hospital’s First Obstetrical Clinic, as many as 10% of mothers died of puerperal fever after giving birth. But there was some good news: at the Second Clinic, the number was just 4%. Expectant mothers noticed this — some would get down on their knees and beg to be admitted to the Second Clinic. Others, hearing new patients were being admitted to the First Clinic that day, decided they’d rather give birth in the streets.
Ignaz Semmelweis, an assistant at the First Clinic, couldn’t bear it. He began desperately searching for some kind of explanation for the difference. He tested many things without success. Then, in 1847, Semmelweis’s friend Jakob Kolletschka was performing an autopsy when a student accidentally poked him with a scalpel. It was a minor injury, but Kolletschka got terribly sick and ultimately passed away, with symptoms rather like the ones the mothers had. Which got Semmelweis wondering: was some “deathly material” on the corpses responsible for the deaths?
To test this, he insisted the doctors begin washing their hands with chlorinated lime (which he found best removed the stink of death) before handling the pregnant women. The results were shocking. In April 1847, the mortality rate was 18.3%. Semmelweis instituted handwashing in mid-May and by June the mortality rate had crashed to 2.2%. The next month it was even less and later that year it reached zero — for the first time ever.
You’d think doctors would be thrilled by this incredible discovery. Instead, Semmelweis was ridiculed and attacked. He was fired from the hospital and forced out of Vienna. “In published medical works my teachings are either ignored or attacked,” he complained. “The medical faculty at Würzburg awarded a prize to a monograph written in 1859 in which my teachings were rejected.” Hundreds of mothers continued to die every year.
Semmelweis turned to alcohol and his behaviour became increasingly erratic. It’s believed that he may have developed Alzheimer’s, and in 1865 he was committed to a mental institution. There he was beaten by the guards, placed in a straitjacket, and locked in a dark cell. He died shortly thereafter, at the age of 47, from an infected wound .
Why did doctors so stubbornly reject Semmelweis’ ideas? Well, imagine being told you were responsible for the deaths of thousands of your patients. That you had been killing the people you were supposed to be protecting. That you were so bad at your job that you were actually worse than just giving birth in the street.
People attack new ideas when they have a vested interest in the old ones. They build whole careers on some ideas. When someone claims they're false or obsolete, they feel threatened.
Look at the history of ideas, and especially the history of science, and you'll notice a pattern in how big things start. Someone proposes an idea that sounds crazy, most people dismiss it, and then it gradually takes over the world. Semmelweis is one example, but on a smaller scale, we find companies like Uber, Netflix and AirBnB.
Ideas are the currency of progress. Finding, developing and acting on them is how we move forward. But ideas are fragile; most people don’t even start talking about them at all because they sound silly. How do we create the conditions for crazy ideas to flourish?
How to find good ideas
Ideas improve with iteration and feedback. Very few are good at the start, and like diamonds, they undergo a process of refinement to reveal the ones that are valuable. Crafting an environment for that process to happen is necessary to have good ideas. Here’s how:
- Stay away from people who belittle your ambitions. You want to be around people who don’t make you feel stupid for mentioning a bad idea, and never feel stupid for doing so themselves. You want people that are optimistic about the future and will entertain improbable plans.
- It’s ok to look dumb. It's probably a good thing and might even be necessary. If you don't look dumb somewhere along the way you probably aren't remaining open to the really crazy ideas. The willingness to look dumb is crucial to exploring crazy ideas long enough for them to develop into something worthwhile. The goal isn't to look smart the whole way, it's to look smart at the end.
- Be the first to criticise your ideas. The main reason people don’t tell you what they really think is they’re afraid of your reaction. But people will feel more comfortable telling you the truth if you start by criticising yourself, showing them that it’s OK. Criticising your own ideas will get people discussing them, and that’s how they get stronger. It'll also encourage others to share their own crazy ideas with you.
- Seek conversations with a high rate of idea exchange. The majority of ideas will be bad, but there will be a couple of gems worth exploring. My rate of idea exchange is particularly high with certain people. Whenever I want to talk through ideas I go to them. Find a handful of people that you can do this with.
“He just makes these surprising connections and comes up with these like surprising ideas that are things that I have not thought of... Conversations that are most useful with Paul are when you're thinking about some totally new area or something and you go to Paul and come back with ten ideas that I had not thought. Some of them are really outlandish and terrible ideas and some of them are really good.”