A study in hospital efficiency

n.p.: n.p., 1916. FIRST EDITION. With a folding chart in a pocket on the rear board. Publisher’s cloth, author and title in gilt on spine. Laid in is a printed card stating: “This book is sent to you as an officer of the Massachusetts General Hospital, in fulfillment of a special request made by Dr. Codman shortly before his death on November 23rd, 1940.”. First edition, privately printed. The Hospital Standardization Movement founded by the American College of Surgeons supported the concept that hospital staffs should follow each and every patient they treat long enough to determine whether or not the treatment was successful, then learn from any failures. Referred to as “The Idea,” it was a controversial program which ultimately was included as part of the platform of the Joint Commission on Accreditation of Hospitals.

The author of this work, Dr. Ernest Amory Codman (1869-19400), was an influential proponent of The Idea. He was an advocate of hospital reform and is the acknowledged founder of what today is known as outcomes management in patient care. Codman was the first American doctor to follow the progress of patients through their recoveries in a systematic manner. He kept track of his patients via “End Result Cards” which contained basic demographic data on every patient treated, along with the diagnosis, the treatment rendered, and the outcome of each case. A one-year follow-up on each patient was made to observe long-term outcomes. It was his lifelong pursuit to establish an “end results system” to track the outcomes of patient treatments as an opportunity to identify clinical errors and to serve as the foundation for improving the care of future patients. He also believed that all of this information should be made public so that patients could be guided in their choices of physicians and hospitals.

Codman graduated from Harvard Medical School in 1895 and joined the surgical staff at Massachusetts General Hospital. In 1914, the hospital refused his plan for evaluating surgeon competence. He eventually established his own hospital to pursue those performance measurement and improvement objectives. To support his end results theory, Codman made public the end results of his own hospital in a privately published book, A study in hospital efficiency. Of the 337 patients discharged between 1911 and 1916, Dr. Codman recorded and published 123 errors. The folding chart contains an index of cases combined with statistical tables using anatomic and pathologic classification of diseases and operations.