On the early history of quality management in healthcare: Pirogov, Nightingale and Codman

Abstract

The quality of healthcare organisations is often described with the model of Donabedian structure-process-outcome. But the foundation of the model were laid by earlier thinkers about medical and healthcare quality of the 19th and early 20th centuries. This article focuses on two surgeons, Pirogov and Codman, and one nurse manager, Nightingale who occupied themselves with the management and organisation of hospitals. They started with nothing to rely on, as they were pioneers in the field of quality management. Even the concepts of quality and management were not present at the time, as were many other areas, such as an adequate understanding of the causation of hospital infections, scientific thinking in medicine and nursing, and statistical and methodological tools to study and improve healthcare. We will show that although their thoughts were original, they were also embedded in the belief systems of their time. Following their development, we will understand how thinking about quality management evolved in their time. Their experiences have led to very significant improvements we nowadays take for granted.