Friday, January 11, 2008

Dr. Codman was right then, and he is right now

Please check out this article by Doctors Swensen and Cortese from the Mayo Clinic. An excerpt:

Transparency was an issue for the American medical profession a century ago, and transparency is an issue for the American medical profession today. In 1905, Ernest Codman, MD, first described the "end result idea." The end result idea is simply that doctors should follow up with all patients to assess the results of their treatment and that the outcomes actively be made public. The end result idea was considered heretical at the time, but in retrospect Codman was sagacious and prescient. He was an advocate for transparency, which he believed would promote quality improvement, patient choice, and physician learning. Transparency is best viewed as an opportunity, one that we should fully and enthusiastically embrace. It offers a substantive boost as organizations step up to the moral imperative of improving patient care to the best it can be.

Codman "walked the walk" as well as "talked the talk." He openly admitted his errors in public and in print. In fact, he paid to publish reports so that patients could judge for themselves the quality of his care. He sent copies of his annual reports to major hospitals throughout the country, challenging them to do the same. From 1911 to 1916, he described 337 patients who were dismissed from his hospital. He reported 123 errors. He measured the end results for all. Codman passionately promoted transparency in order to raise standards. Codman said, "Let us remember that the object of having standards is to raise them."

...A century later, the medical profession is still struggling with the same issues as though they were new. Dr. Codman was right then, and he is right now. Fundamental to the quality movement and American medicine in the 21st century are the same peer review, standardization, systems engineering, and outcome measurement issues. Publishing results for public scrutiny remains a controversial topic. We should embrace transparency as a component of our tipping point strategy to ignite the change we all need to transform our organizations and our profession.

2 comments:

Anonymous said...

Once again, I can start on my rant about subscriptions being necessary to view health-related articles, since clicking on your link, Paul, tells me only that I need a subscription to Chest Online to read this. However, I assume this is Dr. Codman of the Codman award, given to institutions demonstrating best practices and successful quality improvement projects.

I think someone should post about the fact that medical journals should make AT LEAST their editorial/quality improvement articles free to the public, in order to help educate both laypeople and other professionals, and improve implementation of best practices.

Paul Levy said...

Oh, I'm so sorry. I didn't know it was protected in that way. I guess our hospital has a subscription, so I was able to read the whole thing. But, you get the main point anyway.