The Ernest Amory Codman Award was presented earlier this year to Najmedin (Najm) Meshkati, PhD, whose work focuses on leadership areas applied to health care that supports The Joint Commission’s mission of continuously improving the safety and quality of care. In conjunction with receiving the award, Dr. Meshkati delivered a lecture at the Physician Leader Forum hosted by The Joint Commission in Oak Brook, IL.* The presentation, titled Lessons from the Nuclear Industry, touched on the culture of safety and its importance.
The Codman legacy
The Ernest Amory Codman Award, established in 1996, recognizes achievement in performance measurement and honors the legacy of Dr. Codman, a Fellow of the American College of Surgeons (ACS), who originated what is today known as outcomes reporting and transparency. It was Dr. Codman’s lifelong mission to establish an end results system to track the outcomes of every patient treated for a given condition in order to identify clinical mistakes and develop solutions to improve patient safety and the quality of patient care. He believed that all of these data should be made public, so that patients would have the information they need to objectively guide their selection of physicians and hospitals.
Dr. Codman was a surgeon at Massachusetts General Hospital, Boston, and one of the founders of the ACS and its Hospital Standardization Program, which eventually became The Joint Commission.
In his Presidential Address at Clinical Congress 2014 in San Francisco, CA, Andrew L. Warshaw, MD, FACS, FRCSEd(Hon), delivered an address that touched on the life of Dr. Codman and the relevance of his legacy to surgeons today.
Dr. Warshaw recounted that Dr. Codman, as a medical student in 1895, and a classmate, Harvey Cushing, MD, FACS, witnessed a fatal outcome from the administration of ether anesthesia. “To provide data to ensure the safety of their patients, they began to record pulse, respiratory rate, and blood pressure when this anesthesia was used,” Dr. Warshaw said. “These ether charts, now residing in the Harvard Medical School Countway Library of Medicine, were the first anesthesia records and have contributed to saving many thousands of lives.”†
According to Dr. Warshaw, however, Dr. Codman’s biggest contribution to surgery was the “end result idea.” “This concept centered on the common-sense notion that every hospital and every surgeon should follow every patient long enough to determine whether the treatment was successful, and to inquire, ‘If not, why not?’” Dr. Warshaw said.†
The purpose of this assessment was to prevent similar failures in the future and to improve the efficiency of care. At the time, Dr. Codman’s end results idea—and his opinion that outcomes should be the basis for determining surgeons’ promotions—was not well received. “With a century’s hindsight, we see the strength of his pioneering ideas on quality based on a record of scientific truth, as he put it—on evidence, not eminence,” Warshaw said. “He asked if it was possible to standardize the treatment of disease or the work of individual members of hospital staffs. He answered, ‘Such standards can be established. The object of standards is to raise them.’ Good enough is not good enough.”†
Dr. Meshkati’s distinguished commitment to safety
Dr. Meshkati was chosen to receive the award earlier this year because he embodies Dr. Codman’s legacy. Dr. Meshkati is a professor of civil/environmental engineering, industrial and systems engineering, and international relations at the Viterbi School of Engineering at the University of Southern California, Los Angeles. He was a Jefferson Science Fellow and a senior science and engineering advisor, as well as an Office of Science and Technology advisor to the Secretary of State, U.S. State Department. He also is a member of the advisory council of CRDF Global.
Dr. Meshkati has been a trailblazer and innovator in his field and has been dedicated to solving high-risk problems, such as risk reduction and reliability enhancement for complex technological systems, including nuclear power plants. He was part of a national panel that investigated the Deepwater Horizon explosion and oil leak near the Gulf Coast. He also has been the principal investigator or co-investigator on several projects of the U.S. Nuclear Regulatory Commission, and his knowledge of human factors and how humans interact with technology—in particular, the automation of systems, how they function, and how human intervention can save the day when automation fails—has direct relevance to patient safety and quality of care.
In an interview after receiving the Codman Award, Dr. Meshkati said, “It was one of the most pleasant surprises of my life.” To see the interview, visit Vimeo.
The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily represent those of The Joint Commission or the American College of Surgeons.
*Meshkati N. Lessons from the Nuclear Industry. Physician Leader Forum, The Joint Commission. Oak Brook, IL; April 13, 2016.
†Warshaw AL. Presidential Address: Achieving our personal best: Back to the future of the American College of Surgeons. Bull Am Coll Surg. 2014;99(12):9-18. Available at: bulletin.facs.org/2014/12/presidential-address-achieving-our-personal-best-back-to-the-future-of-the-american-college-of-surgeons/.