Musings on Strategic Investigation, Performance Improvement, and Rhetoric

Florence Nightingale - A Case Study in Excellence




If I were to choose a list of great people who embody what it takes to be excellent, Florence Nightingale would rank above every single living person I can think of.

The commonly-held view of her is romantic, the archetypal nurturing carer; someone "called upon by God" in her own words to spend her life in nursing despite expectations of feminine nobility.  But beneath this velvet glove, there was a tough and practical nature; which supplemented her passionate side to make her a case study in excellence.

I'll describe her less recognised side in terms of the attributes of high performance I’ve introduced previously.

Constant feedback and measurement of progress

Nightingale was absolutely systematic and rigorous in using measurement to track improvement.  In addition to being a nurse, she was an accomplished statistician, and in her time pioneered graphical representation of information.  She is credited with developing the polar area diagram, which she used to analyse progression of Crimean War conditions.  Examples of these elegant and insightful charts are shown here:



She later used a statistical study of sanitation in India to recommend improvements in public health, and was invited to become the first female member of the Royal Statistical Society.

Honest diagnosis of what is and isn't working, what works best and what to change

When Nightingale first arrived in the Crimea, she was convinced that high hospital death rates - ten times greater than death rates from combat - were caused by poor nutrition and supplies, and by over-working.  In the first year of her presence, despite her efforts, mortality went up to the highest level of any hospital in the region.  Only after analysing evidence that indicated the benefits of sanitation did she turn her focus to this, subsequently pioneering sanitary living conditions in the army and then other hospitals.  Compared to the improved survival rates from Nightingale-inspired changes, the benefits of modern drug developments are a rounding error.

Pursuit of challenging boundaries, constantly reviewing them to be just right versus capabilities

Nightingale started as a nurse with the challenge of cleaning hospitals in the Crimea, but stretched her boundaries consistently over time.  After Crimea, she founded the first school of nursing; she then wrote the first textbook on nursing, then introduced trained nurses into the workhouse system, and then launched trained nursing to the US through her mentorship of Linda Richards, ultimately founding the nursing profession in both the UK and US.

In clarifying her thoughts on the profession, she wrote what would be a seminal work in the progression of feminism.  In applying them, she undertook to statistical studies and lobbied for sanitary reform that supported a quartering of the British Army death rate in India.

Focus only on relevant actions and outcomes that are within your control

She couldn't do much about the Crimean war that caused men to be hospitalised, or the medicines available, but could she sort out the sewers.  Following the Sanitary Commission’s work, death rates fell from 42% to 2%.

She couldn’t do much about the insanitary living conditions of the British poor, but she could send nurses to the workhouses, a precursor to the National Health Service.

De-cluttering of everything else that distracts, and creating support systems to allow such dedication

Nightingale was as single-mindedly dedicated to nursing as Hannibal was to toppling Rome, or as Wylie Coyote still is to catching Road Runner.

She rejected her first high profile marriage suitor, with an explanation that marriage would interfere with her calling to nursing, and rebuffed other approaches regularly through her life.  She had the education, privileges, opportunity and backing to take up legion other causes, particularly the growing feminism movement of which she was in a position to be a leading light; but she chose to focus her time and attention on nursing and the improvement of the conditions of the sick.

She was also fortunate to have support systems that allowed this commitment.  She was from a wealthy background, and her allowance from her family was large enough that she was not distracted by worry about making ends meet.

Relentless continual mindful application for hours and hours and hours

Nightingale was “called by God” to nursing at 17.  She used her time before she could become a nurse to study hospitals, producing her first work on treatment of the sick at 21.  She announced her decision to enter nursing when she could, at 24, which was then the focus of her attention for the rest of her life.

It is hard to think of a more intensive, unremitting, immersion in any profession than the Scutari military hospital of the Crimea where Nightingale made her name in 1854, as far from society as could be conceived, and where 4,077 soldiers died in her first winter.  Her obsession with hospital conditions was relentless throughout her life; even when bedridden with severe brucellosis, she did pioneering work on hospital design that was implemented around the world.

I wouldn’t invite her to my ideal party, because she wouldn’t turn up to anything that wasn’t about improving the conditions of the sick.  But that doesn’t make her less of an inspiration.

To many people, she’s the magical, caring lady-with-the-lamp.  To me, she’s the intrepid, forensic, challenging, realistic, relentless, hard-as-nails, make-it-so Flo.  Today’s performance gurus couldn’t hold a candle to her.

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