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Nightingale also astutely recognized the importance of collecting and using data to assess the quality of health care. She employed coxcomb diagrams to present visual images of the number of preventable deaths during the Crimean war (Figure 2.1) and then later in London hospitals.

FIGURE 2.1 Florence Nightingale's coxcomb diagram of the causes of mortality in the army in the East.

Source: Florence Nightingale (1820–1910). [Public domain].

Today, data is collected through patient records, surveys, and administrative systems. From these, reports are developed, such as To Err is Human (IOM, 1999); the CDC National Vital Statistics Reports (Martin, Hamilton, Sutton, & Ventura, 2006); and The National Healthcare Disparities Report (NHDR) (Agency for Healthcare Research and Quality (AHRQ), 2005). These reports provide invaluable information, and data is displayed with charts and pictures to emphasize the successes and failures of health care throughout our nation. Evidence of significant disparities and low quality continue to demonstrate the need for significant health care improvement.