Florence Nightingale - mother of modern healthcare analyticsHealthcare analytics. Data visualization. Population health. Buzz continues to build around these terms as we look ahead to 2018. But looking back, we find a surprising figure at the root of all three: Florence Nightingale.

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Florence Nightingale, the mother of modern nursing, was also arguably the mother of healthcare analytics. She was a trailblazer in using statistics to identify preventable conditions that affect mortality and a master of data visualization. Her story has powerful lessons for today’s analysts. Here are four.

Florence Nightingale’s story

Florence Nightingale was born into the British aristocracy and educated by her father. After Britain sent a military force to Crimea in 1854, Nightingale led a team of 38 nurses to staff a hospital for soldiers in Scutari, Turkey, 300 miles by sea from the battlefront. Nightingale and her team quickly established a reputation for compassionate care. Although, that mostly amounted to comforting the dying. Infections ran rampant amidst overcrowding. Patients died at an alarming rate. The winter was particularly grim, as weather forced nurses to keep all the windows closed.

The high mortality rate during the two-year war became a scandal. 18,000 men had died in a force that was intended to number around 25,000! Essentially, an entire army had been lost. The British government sent a civilian commission to investigate. The group largely blamed military commanders. This investigation produced something pivotal to Nightingale’s life and work – a detailed accounting of the dates, locations, and causes of soldiers’ deaths.

A shock in the data

Nightingale dug into this set of data, working with William Farr, a physician and public health statistician. What they found was shocking: soldiers stood a better chance of survival if they had remained in the hospitals at the front (12.5% mortality) than if they had been transported to the Scutari hospital (37.5% mortality). In Scutari, fumes from backed-up sewers beneath the hospital combined with the complete lack of ventilation in the winter had poisoned patients.

Confronting this reality drove Nightingale into a decade-long state of despair and guilt that so many had died despite her efforts. While confined to her bedroom, she wrote prolifically to campaign for reform. She feared future disasters if the military did not make major changes. Nightingale herself authored an 830-page report on the Crimean deaths, but she worried that Queen Victoria’s – and other readers’ – eyes would glaze over at the vast tables of statistics. So she devised an innovative way to present the data, the now-famous Rose Chart.

 

 

Also known as a polar area chart, Nightingale’s graphic allowed multiple comparisons on one diagram. It showed death month-by-month from disease, wounds, and other causes.  This vividly communicated that more men had died from disease than from their wounds, especially in winter, and spotlighted the need for reform.

Saving lives through statistics

The Rose Chart is just one of the colorful graphics Nightingale used to disseminate information and persuade others to make changes to reduce mortality. She corresponded with hundreds of medical and scientific experts, public health administrators, and government and military officials. She used statistical evidence to lobby for sanitation in military and civilian hospitals as well as homes and neighborhoods in both England and India. The public health practices she helped establish in the 19th century ultimately saved millions of lives around the world.

Lessons for today’s analysts

No doubt Nightingale would be thrilled that today’s healthcare professionals are continuing her work using quantitative data to improve patient care and outcomes. Here are some of the things we can learn from her work.

  • Numeracy is as important as literacy. Nightingale did not rely on hunches or anecdotes about why soldiers were dying. She used math, data, and logic – the foundations of numeracy. “We do not want impressions, we want fact,” Farr reminded her in preparing their report on military deaths.
  • Stay curious. Nightingale had a drive to understand things that were not obvious, such as what killed British soldiers at the Scutari hospital and other settings. She dug deep into the data to find the truth, even when it was painful for her.
  • Creative visualization is persuasive. More than 150 years before “infographics,” Nightingale created beautiful data visualization. The Rose Chart creatively and powerfully underscored the underlying message of the mortality statistics.
  • Collaborate: Nightingale had an enduring humility and willingness to work with and learn from others, including Farr, British ministers, and civilian commissioners. Even when it threatened her reputation, Nightingale still worked with others to understand and publicize what happened in Scutari for the greater good.

With more than a century of hindsight, we can see how Florence Nightingale laid the foundations for healthcare analytics – with techniques that do not even require a computer! She was an analyst with an open mind, powerful ideas, and the curiosity and passion to put them into action.

Note: This blog is part of my Practical Analysis series, in which I explore three topics integral to understanding information: analysis, interpretation, and communication. You can find earlier posts here.

Source: Florence Nightingale: Avenging Angel by Hugh Small

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