Why It Matters
Florence Nightingale learned many lessons about health care quality and safety that are relevant today.
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Why Florence Nightingale’s Improvement Lessons Still Matter Today

By Patricia McGaffigan | Thursday, May 2, 2019

Florence Nightingale monument photo by Eamon Curry | flickr

National Nurses Week, May 6–12, is timed to conclude on Florence Nightingale’s birthday. While Nightingale is often recognized for transforming nursing from a service to a profession, far too few recognize her as one of the first safety and quality leaders in health care.

It is fitting that IHI honors Nightingale with a meeting room named for her because so many of her lessons learned remain relevant to us today:

  • Everyone in the health care system contributes to quality and safety — From those who deliver frontline care to educators and hospital administrators, Nightingale asserted that the entire health care team should be held accountable for safe, high-quality care — what we at IHI call total systems safety.
  • Using the right improvement tools and methods matters — Nightingale used diagrams to help understand problems, set aims, assign metrics for improvement, and translate evidence into practice. She developed and implemented action plans to improve sanitary conditions and made handwashing, bathing, and other principles of asepsis and infection control mandatory. During the Crimean War, she and her team applied these techniques and reduced their hospital’s death rate by two-thirds.
  • Improving quality means addressing what matters to patients — Nightingale’s calling to reduce human suffering helped set standards for compassionate, patient-centered care that addresses the needs and preferences of patients. She championed innovations designed to treat patients with dignity and respect. These included creating a kitchen to make appetizing meals, establishing a library and classroom for entertainment and intellectual stimulation, and starting a laundry to provide clean sheets.
  • Culture and outcomes are linked — Nightingale noted “how very little can be done under the spirit of fear.” Her courage in speaking up and challenging the traditional medical authority was instrumental in advancing collaborative, high-quality care, and defining necessary elements for cultures of safety.
  • Nurses are high-impact leaders — Nightingale set the vision for nursing as a profession. She established principles and priorities for nursing education. She was an early proponent of evidence-based care. She recognized the privilege of nurses to view, understand, and transform health care systems. She was committed to interprofessional learning systems to continually improve health care and health. She believed that hospital leaders must ensure patient and workforce safety as core values.
  • Understanding data is essential for improvement — Nightingale called statistics “the most important science in the world.” She broke new ground with her use of data to understand the current state, evaluate priorities, and assess progress in improving patient outcomes. For example, her version of root cause analysis revealed that British soldiers were more likely to die because of typhoid, cholera, and dysentery spread through unsanitary conditions and practices than from injuries they had sustained in battle.

More than 200 years after her birth, “the lady with the lamp” continues to light our path forward and inspires nurses and all health care professionals to continually improve, never settling for the status quo. During Nurses Week and throughout the year, IHI honors her and extends our appreciation to nurses around the globe.

Patricia McGaffigan, RN, MS, CPPS, is IHI's Vice President, Patient Safety Programs.

You may also be interested in:

LEARN MORE: IHI Patient Safety Congress

Why Nurses Are Meant to Be Improvers

Dear IHI: What Advice Would You Give to a Nurse Who Wants to Be in a Leadership Position?

History.com — Florence Nightingale

American Statistical Association — Florence Nightingale: The Lady with the Data

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