This 1918 classic by Ernest Amory Codman argues that hospitals must systematically track whether their treatments actually work. He proposes the End Result System, a method of following every patient long enough to judge lasting success and analyzing every failure. It is the conceptual origin of modern outcomes measurement and quality improvement.
Every morbidity and mortality conference you attend descends directly from this paper. Codman's central insight was that improvement is impossible without an assigned responsibility to ask whether treatment worked and to analyze why it failed. Trustees audited money but never audited the clinical product.
His four-cause classification of failure is the mental model behind modern root-cause analysis: when an outcome is poor, distinguish surgeon factors from system factors from disease factors from patient factors before assigning blame. The End Result Card is the conceptual seed of today's outcome registries, the AJRR, PROMs, and hospital quality metrics that now shape reimbursement.
The practical lesson for a resident: track your own results honestly, follow patients long enough to know if you actually helped them, and treat every complication as data rather than something to bury.
This 1918 classic by Ernest Amory Codman argues that hospitals must systematically track whether their treatments actually work. He proposes the End Result System, a method of following every patient long enough to judge lasting success and analyzing every failure. It is the conceptual origin of modern outcomes measurement and quality improvement.
Every morbidity and mortality conference you attend descends directly from this paper. Codman's central insight was that improvement is impossible without an assigned responsibility to ask whether treatment worked and to analyze why it failed. Trustees audited money but never audited the clinical product.
His four-cause classification of failure is the mental model behind modern root-cause analysis: when an outcome is poor, distinguish surgeon factors from system factors from disease factors from patient factors before assigning blame. The End Result Card is the conceptual seed of today's outcome registries, the AJRR, PROMs, and hospital quality metrics that now shape reimbursement.
The practical lesson for a resident: track your own results honestly, follow patients long enough to know if you actually helped them, and treat every complication as data rather than something to bury.