ABSTRACT
Performance monitoring of healthcare is not a new idea. Back in Babylonia in around 1700 BC, King Hammurabi adapted existing cuneiform edicts into his Codex that had several important concepts we would recognise today: physician fees for treatments such as general surgery, eye surgery and setting fractures; objective outcome measurement standards to ensure quality of care; and, as the other side of pay-for-performance, punishments for failure. As an account of the Codex in Managed Care puts it, his edicts left no margin for error: healthcare providers had to be flawless or lucky (Spiegel 1997). §218 of the Codex states that
Hammurabi’s system also included a data collection mechanism for the patient’s ailments, treatments and outcomes. We’ve moved on from his clay tablets, with the great nineteenth-century nursing reformer and epidemiologist Florence Nightingale who argued for a standardised collection of hospital
mortality data. Such data would ensure that subscribers’ money was being put to good and not, in her words, “mischief”. Although best known for her nursing endeavours during and following the Crimean War, in 1858, Nightingale became the first female member of the Royal Statistical Society in the same year as publishing her seminal “Notes on matters affecting the health, efficiency and hospital administration of the British Army” (Nightingale 1858). In 1863, she published her “Note on Hospitals”, where she stated that uniform hospital statistics might “… enable us to ascertain the relative mortality of different hospitals as well as of different diseases and injuries at the same and at different ages, the relative frequency of different diseases and injuries among the classes which enter hospitals in different countries, and in different districts of the same country”. In fact, annual hospital mortality statistics were published in the Journal of the Statistical Society of London as early as 1862 for some London and provincial institutions.
