Outcomes pioneer memorialized nearly 74 years after his death

The grave of a Boston surgeon considered by many to be a pioneering advocate for tracking patient outcomes and acknowledging medical errors was memorialized Tuesday by the American College of Surgeons.

Dr. Ernest Codman, criticized by colleagues of his time for wanting to increase transparency, died in 1940, and his grave in a Cambridge, Mass., cemetery remained unmarked for nearly 74 years. More than a century after he introduced new concepts to drive improvements in healthcare outcomes, patient-safety experts say there's still a long way to go.

Codman began encouraging colleagues in the early 1900s to adopt what he called an “end results” system—a radical idea for encouraging transparency through reporting on healthcare-associated outcomes that was not readily accepted by his counterparts. When the hospital where he was working did not adopt the philosophy, he established his own hospital in 1911, where physicians meticulously tracked more than 300 patients and kept track of physician-related errors.

“Every hospital should trace each patient with the object of ascertaining whether the maximum benefit has been obtained and to find out if not, why not,” Codman argued in a 1924 publication (PDF) on establishing criteria for bone cancer diagnosis. He encouraged hospitals to be conscious of their shortcomings and constantly on the watch to improve equipment and methods.

“This will be a contrast to the present condition,” he said, “where the trustees expect neither study nor care and shut their eyes to even indifference and neglect, and take no inventory of their product.”

Codman was an early leader who contributed immensely to hospital standardization activities, Dr. David Hoyt, executive director of the ACS, said in a statement.

“I think he would be proud to see how his advocacy for tracking patients' outcomes contributed to the development of robust surgical data registries, one of the most valuable tools surgeons use to improve the quality of patient care today.”

Indeed ahead of his time, Codman's ideas have been woven into the foundations of patient-centered, quality-based care, and have been promoted in various quality and safety standards and guidelines.

However, more than 100 years after Codman introduced his end results system, patient safety leaders say the problem of patients dying or being harmed because of preventable medical errors in U.S. hospitals is still not getting the attention needed to drive widespread change.

The healthcare transparency movement was reinvigorated in 1999, when the eye-opening Institute of Medicine report “To Err is Human” drew attention to the issue. Efforts to reduce errors have been a major focus for U.S. hospitals, which now can face financial penalties or lose accreditation for not making improvements, according to the American Hospital Association.

But overall progress has been sporadic and inconsistent, advocates told Sen. Bernie Sanders, chairman of the Senate Subcommittee on Primary Health and Aging, last week during a hearing. The need for reliable data, metrics and monitoring systems that can consistently provide accurate comparisons on outcomes still does not exist, they said.

When he died of melanoma in 1940, Codman's family reportedly did not have the money for a headstone, so the ACS recognized him Tuesday with a memorial crafted by Boston-based sculptor Daniel Altshuler. The epitaph reads, “Father of outcomes assessment and quality measurement: It may take 100 years for my ideas to be accepted.”

Follow Sabriya Rice on Twitter: @MHSRice