Evaluation of healthcare quality: a tale of three giants.

Although the concept of quality of care goes as far back as King Hammurabi in 1700 bc, and many have worked on improving the quality of care in medicine since, 3 individuals receive credit for laying down the foundation for the evaluation and measurement of quality of care in modern surgery: Ernest Amory Codman, Avedis Donabedian, and Shukri Khuri. Donabedian was not a surgeon, but his concepts in systems of care provided the basis for the modern engineering design of surgical care delivery. Without crossing paths, each of those giants built on the contributions of their predecessors. They shared the traits of tremendous determination in the face of many challenges and adversities and a sense of enthusiasm in a belief that resulted in improved and safer care.