George Henry Torney, M.D

1914 Boston Medical and Surgical Journal  
We have believed it to be the wish of this congress that we should examine the ways and means by which this body might best do its share in the general movement which the public is beginning to demand toward increasing the efficiency of hospitals. We shall presently offer to you three definite suggestions for action by which you may mate rially aid this important movement, but first we should like to call your attention to the method by which we have approached this subject. By what standards
more » ... By what standards can we compare hospitals? It is obvious that there are many. There may be a standard of architecture, of cleanliness, of kindness to the patients, of nursing, of medical education, etc. To some persons the per capita cost, the number of patients annually treated, the success in private practice of their medical and surgical staffs, the quality of the scientific papers produced, or the up-to-dateness of the laboratories may seem the important elements. Some hospitals seem satisfied with the famous contributions to medical science which some member of their staff made a hundred years ago ! We believe that you will agree with us that even cleanliness, marble operating rooms, famous physicians and surgeons, up-to-date laboratories and time-honored reputation do not necessarily mean that the individual patient will today be freed from the symptoms for which he seeks relief. Even the standard of kindness cannot replace the actual facts of the relief or prevention of symptoms or of the prolongation of life. For does a scientific paper written about the autopsy give the patient the satisfaction that a successful operation might, have done! The more time we have spent on this subject, the more obvious it has seemed to us that the only firm ground on which we can compare hospitals is by the actual results to the individual patient. Even a statistical comparison of the results of the treatment of the disease is less satisfactory. A patient operated on at the same sitting for fibroids of the uterus, gallstones and epithelioma of the nose cannot properly be classified under one of these headings for comparison with other individuals, nor does this combination of diseases form a group frequent enough to tabulate. A comparison of the morbidity reports of many of the best institutions in this country has convinced us of the futility of the great labor and expense which has been expended on them. Owing to diversity of methods of classi-• fication they are not, comparable except in the most gross way. Some are arranged by disease alphabetically, some by regions, and others by elaborate systems modelled after the International List of the Causes of Deaths. Our impression of the futility of such praiseworthy efforts without cooperation and coordination, we have found to be shared by the members of the staffs of even those institutions making the greatest efforts in this direction. We believe that those who compile these statistics would welcome a more simple and direct form. We also believe that it is almost useless for one hospital to undertake statistics of this kind unless other similar institutions adopt like methods. Since these tables are compiled only from the condition of the patient at the time of discharge from the hospital, they are at best a mere rough statement of immediate mortality and do not represent the real result to the patient of the treatment received. Nevertheless, we are convinced that no standardization of hospitals can be fair which is not based on what
doi:10.1056/nejm191401081700214 fatcat:o2xywft7j5dp3g6buosjaqkhpy