![]() ![]() Jocelyn Keith described the proposal as “the first model for the systematic collection of hospital data using a uniform classification of diseases and operations that was to form the basis of the ICD code used today.” 3 Nightingale sent a proposal for improved statistics of surgical operations to the International Statistical Congress held at Berlin in 1863, which took the analysis a step further. 2 The delegates took up her proposal, adopted a resolution to that effect, and forms were duly drawn up. She sent a letter advocating the uniform collection of hospital statistics, so that outcomes could be compared by hospital, region, and country. Nightingale found another opportunity to achieve reforms during the 1860 International Statistical Congress, which was held in London and presided over by the eminent Belgian statistician, Adolphe Quetelet. 1 One recommendation was for the creation of a statistical department to track rates of disease and mortality and to identify problems so that they could be dealt with promptly. The royal commission report that was eventually produced showed Nightingale's work from its conception, terms of reference, choice of members, and analysis of data to its recommendations for change. She worked with a team of “sanitary experts,” including William Farr, who was Britain's leading social statistician at the time. She pressed for the creation of a royal commission to investigate the causes of the high mortality (eg, for every 1 soldier that died from his wounds, 7 died from disease). Nightingale returned from the Crimean War with a conviction that the desperate loss of life she witnessed should never occur again. Nightingale was keen not only to get the science right but also to make it comprehensible to lay people, especially the politicians and senior civil servants who made and administered the laws. At a time when research reports were only beginning to include tables, Nightingale was using bar and pie charts, which were colour coded to highlight key points (eg, high mortality rates under certain conditions). She was also a pioneer in the graphical presentation of data. ![]() She herself was a pioneer developer of survey instruments, always vetted by other experts and pretested on appropriate cases. Nightingale's leadership style was very much knowledge based. For Nightingale, this entailed the best possible research, access to the best available government statistics and expertise, and the collection of new material where the existing stock was inadequate. Let's begin by looking at Nightingale as a systemic thinker and a “passionate statistician.” Her work in nursing and social reform was informed by a religious faith or philosophy that favoured a systemic approach: God made the world and runs it by laws, which we can discover by research in both the biophysical and social spheres. ![]()
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