ABSTRACT
This chapter analyzes performance comparisons and their effects on U.S. hospitals in the period from 1870 to 1945. Several preconditions and obstacles to the realization of hospital performance as well as their consequences for hospital care are identified. These issues include comparisons of hospitals with other types of organizations, problems of comparability related to the categorization of hospitals and diseases, and the role of medical records in providing accounts of hospitals’ medical performance. Furthermore, this chapter provides an in-depth analysis of the most evolved attempt, at the time, inspired by scientific management, to establish a form of comparisons for medical performance. This “end result system’s” ultimate failure to prevail has previously been attributed to a lack of willingness among physicians to be subjected to this form of control. The analysis shows, however, that the system was unsuccessful in establishing the comparability of cases and a definitive set of criteria to evaluate the outcomes. The chapter finally provides observations on the problems of establishing decision programs in health care to enact performance comparisons.
