The American College of Surgeons and medicine itself owe a great deal to the life work of Ernest Amory Codman, MD, FACS, who is known more than anything else for his advocacy of the “End Result Idea.” The “Idea” was simply the premise that hospital staffs would follow every patient they treat long enough to determine whether or not the treatment was successful, then learn from any failures, and how to avoid those situations in the future.
Surprisingly controversial at the time, the “Idea” was the basis for the Hospital Standardization movement founded by the American College of Surgeons, and the precursor to the Joint Commission on Accreditation of Hospitals (JCAH) formed in 1951. Today, known as The Joint Commission (TJC), the organization and the whole issue of quality assurance and control remains very timely and vital in American and worldwide health care systems.
Born to a highly respected Boston family and educated in its private schools, Dr. Codman graduated from Harvard Medical School in 1895 after spending a year visiting outstanding medical centers in Europe. While in Vienna, he encountered the problem of disease of the subdeltoid bursa and became fascinated with the shoulder joint. Throughout all his many pursuits and accomplishments, this subject remained of deep interest to him, culminating in his 1934 book The Shoulder. His interest in bone sarcomas also was directly responsible for the development of the Registry of Bone Sarcoma of the American College of Surgeons, established in 1920. But both of these interests served him to promote the main passion of his life, the End Result Idea.
Dr. Codman served at Massachusetts General Hospital (MGH) as Surgeon to outpatients in 1899, and from 1902 to 1914 was an assistant visiting surgeon at the hospital. He held the post of Lecturer at the Harvard Medical School from 1913 to 1915. He collaborated with Harvey Cushing, MD, FACS, in some of his early activities such as clinical application of diagnostic x-rays and studying results of treatments using anesthesia, but Dr. Codman became discouraged by the hospital administrators’ lack of interest in his end result ideas. The administration continued its system of seniority system of promotion, which Dr. Codman believed was absolutely incompatible with the End Result Idea, so resigned from MGH, establishing his own small hospital.
Later, during World War I, Dr. Codman served with his hospital staff in the military taking his end results cards to test efficiency of medical procedures.
A member of many other surgical associations such as the American Surgical Association, the Society of Clinical Surgery, and Massachusetts medical societies, Dr. Codman is credited in some sources as being crucial to the founding of the American College of Surgeons. He formed a friendship with Edward Martin, MD, FACS, whom he convinced of the value of the End Result Idea, and by 1910, when Dr. Martin was president of the Clinical Congress of North America, he appointed his colleague Dr. Codman to a new Committee on Hospital Standardization. The work of this Committee was a major reason for the birth of the American College of Surgeons in 1913 and has continued as a major cornerstone of ACS activities today.
In retrospect, Dr. Codman was a crusader whose ideas were not entirely appreciated during his lifetime, but whose ideas have become the basis of patient –centered quality based surgery in the College standards and in that of current day medical practice.
For information on Codman’s role and activities within the American College of Surgeons, see the ACS Archives.
“Ernest Amory Codman, 1869-1940,” New England Journal of Medicine, 1941, 224:296-299.
“Ernest Amory Codman (1869-1940): A Biography,” by Anthony F. DePalma, M.D.
Cover story, Massachusetts Physician, November 1971, p. 6.
Gerald Austen, Presidential Address: “A Tradition of Humanism; The Voluntary Hospital,” Transactions of the American Surgical Association, 1986, p. 14-16.