ABSTRACT
Among the pioneers of methodical assessment was Florence Nightingale, that scourge of those ultimately responsible for low standards of medical care in the army. Her devastating exposure of Crimean hospitals as death traps was based on showing that a key determinant of regimental mortality was distance from hospital. Another impressive figure in the annals of quality assessment is Dr E A Codman of Boston, who instituted a one year follow up of all his surgical patients. Each patient was recalled a year after discharge and his health state assessed in terms of the original objectives of the operation. Codman sought to determine whether his diagnosis had been correct, whether the operation had been a technical success, whether the patient had benefited, and whether there had been harmful side effects. Paradoxically, American doctors are far more subject to systematic examination of their clinical work than are their British equivalents in bureaucratic health care system.
