American College of Surgeons - Yearbook (Chicago, IL)

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Hospital Standardization 7 profession have a right to shirk the task to meet squarely such considerations as these. The Regents realized at the outset that so intricate and com- plex a task could not wisely be approached in haste. There was no precedent in the history of medicine which might serve as a helpful guide in their proposed course. They realized that with some impatience the Fellows of the College looked forward to an active campaign throughout the continent for the betterment of hospitals. Then came the war and its quick eflfect to vitalize a high ideal of service not only in the profession and among hospitals, but tliroughout every phase of our national life. In the fluid state of mind thus created, soldiers, sailors, and the general public realized with new force that they are entitled to the best in medical science; and the profession in turn by this awakening was struck with a keener sense of the debt which the practice of medicine demands. Almost in a single morning all shadows of doubt as to whether a continent-wide standardization of hospitals could be entered into with continent-wide good will were cleared away. In outline the hospital program of the College was presented to the American Hospital Association. The program was unani- mously endorsed by the Association and a committee composed of Dr. Winford H. Smith, Superintendent, Johns Hopkins Hospital, Baltimore, Dr. Warren L. Babcock, Superintendent, Grace Hos- pital, Detroit, and Dr. Frederic A. Washburn, Superintendent, Massachusetts General Hospital, Boston, was appointed to cooper- ate with the College. The officers of the Catholic Hospital Association, together with His Eminence, James Cardinal Gibbons, also endorsed the pro- posed standardization plan of the College and offered their cooper- ation and aid. Cardinal Gibbons ' statement in this matter, addressed to the Secretary General of the College, reads as follows, — It is a pleasure to assure you of my interest in and approval of your plan, as explained to me, for the standardization of the hospitals of the United States. We should make every reasonable effort to reach the highest state of efficiency possible in each hospital; and bend every effort to bring about such uniformity as makes for progress.

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6 American College of Surgeons College could find its most adequate expression in a continent-wide standardization of hospitals. A sound analysis of hospital conditions was, therefore, not merely a task which the College may do. It was a task which the College must do, for the College is a responsible society of about 4,000 surgeons which aims to include in its Fellowship all who possess practical scientific knowledge of medicine and surgery, together with honor, trustworthiness, and strong moral character. In so far as the problem is concerned with hospitals, it is compli- cated by the fact that among hospitals there is wide discrepancy in the educational opportunities offered; there is confusion as to the value of all phases of these opportunities even among hospitals of like or comparable equipment. The Regents of the College were therefore confronted with two questions: First, what are the actual standards in the practice of medicine and surgery among hospitals? Second, what is an acceptable standard in the practice of medicine and surgery among hospitals? This second question involves the larger question as to whether the standards among our best hospitals are too good for the humblest patients anywhere on this continent. Both as an obligation of their trust, therefore, and as a con- structive service to the profession and to the public, the Regents of the College entered the field of hospital standardization. They believe that those charged with the care of the hospitals of this continent will welcome a broad, helpful, organized plan for ad- vancement. For example, thoroughness of diagnoses of patients, the fixation of responsibility in the care of patients, the continuity of the service of the physicians or surgeons responsible for the treatment of patients, matters of proper diet, of cleanliness, and of reasonable cost to patients are all indications of the value of a hospital to its community. Such matters are capable of analysis in definite terms. They are as figures on a barometer which indicate the degree of efficiency of a hospital or the degree of safety of a hospital to patients; they indicate the professional standard which the physicians and surgeons of the hospital set for themselves and which they transmit to the succeeding gener- ation. Neither the hospital governing authorities nor the

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8 American College of Surgeons This plan gives promise of better results in the immediate future, and prepares us for any contingency that might arise that would throw a tremendous burden on the hospitals. (Signed) James Cardinal Gibbons. In order to obtain mature and sane guidance upon the problems involved and, later, to obtain aid in the execution of the plan, the Fellows of the College were asked in November, 1916, to elect by ballot representatives of their respective states who were most thoughtful on questions of educational standards in the profession. On October 19 and 20, 1917, the first meeting of the State Com- mittees on Standards was held in Chicago, and throughout the two days a survey of hospital standardization was made. This survey was divided into three divisions: 1. The number, distribution, valuation, and general classification of hospitals; and the relation of hospitals to the general public. 2. What the profession of medicine wants in hospitals. 3. A discussion of how to bring about the desired con- ditions. In addition to the 337 members of the State Committees on Standards, about 60 of the leading hospital superintendents of the country were invited to the conference. The papers presented at this conference, together with a summary of the discussion there ofiFered, are published as a Bulletin of the College, Vol. Ill, No. i. Immediately following the conference, a General Hospital Committee was appointed by the Regents of the College, to which committee the general plan evolved at the conference is to be submitted on December 8 and 9 for revision and authoritative approval. The plan of action to be submitted to the General Hospital Committee includes a minimum standard of equipment and of efficiency which is to be the basis of the first classification of hos- pitals. The Regents have determined that the first provision of this minimum standard shall be in effect as follows: That all physicians and surgeons privileged to practice in an accredited hospital are to sign a declaration against the practice