The Semmelweis Reflex and selective attention

I read an article recently where a leader offered that there are no more rabbits to pull out of a hat. My first reaction was that isn't accurate. It assumes you only have a hat with one rabbit when innovation and transformation is thinking you have a closet full of hats and a fluffle of rabbits to find. But then the leader also said the current environment "will force the need for real and rapid change in how we do things." Now, the challenge many organizations have is the lack of a process for rapid change. That isn't being critical of anyone; it's just my commentary based on experience in working for many large organizations. When rapid change can't happen with your internal processes, it is time to look to the outside for things you can change, which are often the root of why startup organizations exist.

Even while looking outside, those organizations will have to avoid what is known as the Semmelweis reflex. That term is used to describe the human tendency to reject new information or evidence that contradicts established beliefs, norms, or paradigms—especially when that new information challenges authority or conventional wisdom. Ironically, the term was named after Ignaz Semmelweis. He was a 19th-century Hungarian physician who discovered that handwashing with chlorinated lime significantly reduced deaths from puerperal (childbed) fever in hospitals. Despite his clear and reproducible results, his ideas were widely dismissed by the medical community at the time because they conflicted with prevailing beliefs about disease causation. The irony for me is that it seems we continue to deal with this in medicine today.

A great example of that resistance is Sepsis protocols and early warning systems (like MEWS or qSOFA) that were developed to detect deterioration earlier and reduce sepsis mortality. Assumptions on why it was resisted are that clinicians often rejected these systems as "cookbook medicine," feeling they overrode clinical judgment or produced too many false alarms. It also seems that cultural resistance still hampers consistent use—even when evidence shows benefit. So are their remaining rabbits to pull out of a hat? Yes, there are.

I think of what David Banks recently shared. David shared this story: "Morning, boys. How’s the water?” That’s what an older fish says as he swims past two younger fish. A few moments later, one of them turns to the other and asks, “What’s water?” It’s a simple story from the late writer and professor David Foster Wallace, and it stayed with me. Because the environments we move through every day – including our workplace culture – can become so familiar, we stop noticing them." I offer that because the processes and solutions we use today become so familiar that we stop noticing them or just accept that that's all there is. 

This reminds me of the selective attention test seen here that many of us know about and that the article image references: https://www.youtube.com/watch?v=vJG698U2Mvo

When I think about what David shared and the video, I can't help but think about how long we have used a gravity-fed catheter for managing fluid outputs. The gravity-fed Foley catheter was patented in 1936 in the name of Dr. Foley. We also use a serum creatinine test that research has proven is a lagging indicator of kidney distress. It does not detect deterioration early; it is a lagging indicator.  I asked ChatGPT Pro to tell me when the serum creatinine test was invented, and it offered "So, while the Jaffé reaction dates to 1904, the serum creatinine test as a clinical diagnostic tool came into routine use by the 1920s." Imagine that we continue to use a simple draining tube and collection bag and blood test for assessing kidney function and condition with solutions that were invented approximately 100 years ago.

So have we missed the "rabbit in the hat" or the water because we have the Semmelweis Reflex? Transformation and innovation are driven by empathy and curiosity. Would it ignite empathy if we remember that ~3.1 million people each year get an AKI, and that is based on a Serum Creatinine score that research proves is a lagging indicator of kidney insult and can miss 50% plus AKIs?  Would it further ignite patient and provider empathy to know that a significant percentage of patients who receive an AKI diagnosis develop Chronic Kidney Disease? A condition that never goes away?  Not one of us would want that for our loved one.  I admire how Ruben Mesa, MD calls us to deliver care to "The Loved One" standard.  Would a more profound sense of empathy and curiosity push us past the Semmelweis Reflex? I believe it would.

We can no longer have the Semmelweis Reflex in our organizations if we want to do no harm and transform our organizations for the now and future. As a note, CMS has declared Acute Kidney Injury as a hospital harm. https://ecqi.healthit.gov/ecqm/hosp-inpt/2025/cms0832v2?qt-tabs_measure=measure-information. We must slow down and notice what is no longer working by relentlessly remaining curious and empathetic to the incredibly complex and hard work our clinical teams commit their lives to doing. Patients expect perfect care, and clinicians want to deliver it. Take a walk into an operating room or intensive care unit and observe the gravity-fed catheter and contrast that to the devices and solutions used to digitize the heart and lungs.