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Donald M. Berwick
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Why have we not pursued Ernest Codman’s vision to determine the end results of patient care? What he asks is simple—ineluctable. We intend to help out patients, he says, so let us find out how we are doing. Habit is not enough, he says, nor is impression, nor is seniority, nor is oath, nor is good intention. The key, he says, is learning—learning from our own well-intentioned experience. In uncharted terrain, he asks that we build compasses, simple ones of paper and pencil, checklists, tallies, counting, measuring, learning. He does not, in the main, doubt our sincerity; he doubts only our intuition. In darkness, an airplane can be upside down and the pilot unaware of it except for what his instruments tell him. Codman recommends instruments.
Author(s): Donald M. Berwick
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Volume 67, Issue 2 (pages 262–267) Published in 1989
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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.