Channeling Nightingale in the time of COVID-19


This month we celebrated International Nurses Day at a time when nurses and other health care professionals have never been so needed. This important day also fell on what would have been Florence Nightingale’s 200th birthday. Most people know Florence Nightingale as the famous nurse who saved hundreds of lives during the Crimean War. What many don’t know is that she was also one of the very first women to use analytics in health care.

Nightingale, like so many of today’s brave nurses, was called to nursing to serve humankind. When she arrived in Turkey to attend to the British military hospitals in 1854, the mortality rate was staggering. Nightingale pored over the hospital’s statistical records and collected data from the patients and staff. Her research led her to the conclusion that insufficient sanitary practices – not the severity of battle wounds themselves – were the main reason for the deaths occurring in the hospitals.

Using statistical research, she began to establish new standards – requiring better food, regular clothing, dressings for wounds and bathing for soldiers and staff. She painstakingly changed years of hospital practices to create a safer and healthier environment. Her work to apply statistics to effect change in the health care system saved lives and earned her reputation as a heroic historical figure.

An expert in communicating data

Nightingale not only worked with statistics – she also was an infographic expert. Her notes and records are full of diagrams and tables; most notably, the “coxcomb,” which we still use in many forms today. In the coxcomb chart, which is similar to a pie chart but more complex, the first layer of data is represented by the length of the “pie slices” rather than the size of the slice. This new diagram allowed her to showcase much more information in a small space than a pie chart would allow. The chart was divided into 12 slices – one for each month of the year. Her color-coded shading represented the cause of death in each specific area of the coxcomb. She did not just rely on traditional medical disciplines, but used quantitative data to decrease the number of military deaths.

Today we appreciate the role of not just medicine, but of data and analytics, to help fight disease. Where Nightingale relied on statistics to help combat death due to wounds inflicted by an obvious and visible enemy, today’s medical professionals are using data to combat an invisible – but still deadly – enemy. The use of predictive modeling has assisted government officials and health authorities to make tough decisions about which public health measures to suggest and which to mandate.

Data-driven health care during a pandemic

As a health care practitioner myself, I currently oversee dozens of health care practitioners in our corporate on-site health care center that serves thousands of SAS employees and their families. I know first-hand that the care we give patients is always driven by data; the questions we ask, exams we perform, vital signs we collect and tests we order are data points that assist us on the way to formulating a diagnosis.

  • What are the common conditions that cause a patient’s symptoms and physical findings?
  • What are the odds that their family history, personal health history and/or medical history play a role?

As evidence-based health care providers in the current pandemic, we follow evolving COVID-19 guidance from the Centers for Disease Control and Prevention. This guidance is fluid, evolving in sync with new knowledge from observational and bench research plus trends in patient symptomatology, testing, acuity, morbidity/mortality and recovery.

Because we have reliable data about how the virus is spread, how long it takes to incubate, how long communicability lasts and what symptoms are most suggestive of infection, we’ve changed almost all our everyday procedures. Everything from our front door signage, to the arrangement of lobby furniture, to wearing masks, to having patients with illness symptoms wait in their cars instead of the lobby until we call them for check-in – all are changes we have made based on evolving evidence and COVID-inspired clinical best practices.

Saving lives with data

During this time of pandemic, we – and all health care practitioners – continue to channel two other important qualities that led Florence Nightingale to become such an enduring hero: curiosity and passion.

Nightingale was determined to understand why soldiers were dying at an alarming rate. She undertook years of research and sought out data she could use to uncover the truth and save lives. She was driven to help others by first understanding the problem, and then sharing her findings. Just like Nightingale, nurses today care about each patient that comes through our doors. That’s why we study available data and evolve our processes to provide the best care to all patients we serve.

As a nurse who happens to work for the organization that founded the field of analytics over 40 years ago, I’m humbled and proud to see how the quiet work of one observant nurse on a battlefield has transformed into a sophisticated analytics-led counterattack against COVID-19. I think Florence Nightingale would be proud, too.

Fuel your curiosity and passion | Visit the COVID-19 resource hub

About Author

Gale Adcock

Chief Health Officer

Gale Adcock was formerly the SAS Chief Health Officer. A nurse practitioner with 30+ years of health care experience, she helped evolve the SAS Health Care Center to a 55 staff member, full-service primary care center seeing an average of 170 patients a day and saving SAS in excess of $8 million a year in avoided health insurance expenditures and employee time savings. She retired in 2021.


    • Alison Bolen

      Thanks for reading, Candy, and for sending this correction. We've made the change in the post and appreciate your taking the time to leave a comment.
      -Alison Bolen (blog editor)

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