Christopher Booker discovered Irving Janis’s Victims of Groupthink. He used it as a framework for his report Global Warming: A Case Study in Groupthink. We reported James Delingpole’s summary earlier.
Here are Irving’s three rule of groupthink, useful because they also are relevant to ISO accreditationism and those who are deceived by it.
3 The three rules of groupthink
Rule one is that a group of people come to share a common view or belief that in some way is not properly based on reality. They may believe they have all sorts of evidence that confirms that their opinion is right, but their belief cannot ultimately be tested in a way that confirms this beyond doubt. In essence, therefore, it is no more than a shared belief.
Rule two is that, precisely because their shared view cannot be subjected to external proof, they then feel the need to reinforce its authority by elevating it into a ‘consensus’, a word Janis himself emphasised. To those who subscribe to the ‘consensus’, the common belief seems intellectually and morally so self-evident that all right-thinking people must agree with it. The one thing they cannot afford to allow is that anyone, either within their group or outside it, should question or challenge it. Once established, the essence of the belief system must be defended at all costs.
Rule three, in some ways the most revealing of all, is a consequence of that insistence that everyone must support the ‘consensus’. The views of anyone who fails to share it become wholly unacceptable. There cannot be any possibility of dialogue with them. They must be excluded from any further discussion. At best they may just be marginalised and ignored, at worst they must be openly attacked and discredited. Dissent cannot be tolerated.
Janis showed how consistently and fatally these rules operated in each of his examples. Those caught up in the groupthink rigorously excluded anyone putting forward evidence that raised doubts about their ‘consensus’ view. So convinced were they of the rightness of their cause that anyone failing to agree with it was aggressively shut out from the discussion. And in each case, because they refused to consider any evidence that suggested that their two-dimensional ‘consensus’ was not based on a proper appraisal of reality, it eventually led to disaster.
The insights should be also applied to the inspection cartel. It may be a slightly smaller and more obscure lie than global warming but that is part of what may make it more durable.
Scott described the growth and death of fads in surgery:
It’s not so different from the curve based on real data published by Walsh which observed the fate of other management fads:
- Walshe, K. Pseudoinnovation: the development and spread of healthcare quality improvement methodologies. International Journal for Quality in Health Care 2009; Volume 21, Number 3: pp. 153–159. DOI: http://dx.doi.org/10.1093/intqhc/mzp012
Walsh does not specify whether the slow growth of the accreditation line includes ISO accreditation. It probably refers to non-ISO schemes since it doesn’t reflect the faltering curve for ISO 9001:
The significant life cycle of other methodologies is usually less than a decade. Peaking for only a few years has been enough to ensure their decline because of undramatic effects.
The ISO inspection cartel has captured the minds of professional leaders. Its compulsion to purchase a rehashed document every few years has kept it going longer than other pseudoinnovations. Managers always love a new fad to waste money on and keep staff stressed. It saves them from the dreariness of continual improvement or the risks of radical improvement.
Unlike surgery where the effects of innovations become clear and are audited, nobody bothers trying to measure outcomes meaningfully in many other fields.
UK governments boast of how much taxpayers’ money they have spent on the NHS. They don’t say how much is wasted and few ask. Money spent does not necessarily relate to benefits. In an industry with price discovery through profit and loss accounts, managers would wise up or close down.
That’s why we need more academic investigation of why the ISO continues to not die.
Uptake of ISO 9001 in European hospitals is lower than specialised healthcare accreditation schemes (15%) of 73 hospitals in this study. So evidence on its effectiveness is weak.
“There is little hard evidence of the impact of these systems on hospitals to justify the amount of time and money spent on organizational assessment, or to choose between available programmes.”
Results “implied that hospitals that were accredited scored higher on composite measures of quality and safety than hospitals that were ISO certified.”
The effect of certification and accreditation on quality management in 4 clinical services in 73 European hospitals. Charles D. Shaw et al. 2014, International Journal for Quality in Health Care, 26(suppl_1), 100-107, 2014. https://doi.org/10.1093/intqhc/mzu023
Shaw et al had earlier published evidence in this chart:
Black box – non-ISO accreditation. Shaded box – ISO 9001 certification. White box – neither. So these interventions make little difference overall. The authors say, “This analysis of data from the MARQuIs study suggests that in the samples of hospitals the impact of ISO certification on quality and safety may be less than with hospital accreditation, but it appears that either system is better than no system.”
Despite this, for airy-fairy justification of using ISO 9001 in hospitals try,
Why adopt ISO 9001 certification in hospitals? A case study of external triggers and sensemaking in an emergency department in Norway. Dag Tomas Sagen Johannesen and Siri Wiig. Safety in Health (2017) 3:7 DOI 10.1186/s40886-017-0058-5.
US doctors have got themselves organized to oppose being exploited to prove their ability.
http://changeboardrecert.com/ is the place to read what’s happening in US medicine.
We need to see similar organization against labs being exploited for accreditation by the ISO publishing and inspection gang.
Dear Fellow Physicians,
Opposition to Maintenance of Certification (MOC) continues to gain momentum as a top national medical news story…
We take issue with the bulk of the MOC process: The Practice Improvement Modules and Patient and Peer Reviews amount to little more than busy work, and the costly, time-consuming Secure Examination—which requires an enormous amount of preparation and time off from work —is clinically irrelevant and has no place in the life of a practicing physician.
Of course, these criticisms are sticking points for our Boards, which derive income directly from this part of MOC. In fact, the ABIM claims it makes no money from MOC and that its members receive a minimal stipend to attend meetings and write exam questions—yet each such question costs $4,000 (through “stringent psychometric testing”), the ABIM President makes a salary of about $2,000 a day, and the costs associated with the MOC program since 2006 have inflated the ABIM’s revenue to $149,800,000—a number which grows yearly and with each modification to MOC.
Here’s how the figures look:
You can read more about the background of this commercial exploitation of doctors in the NEJM here:
Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients Paul S. Teirstein, M.D.
Check out the supportive comments beneath.
Similarly to the US medical certification Boards, the ISO derives income from selling ISO standards which are often not optional. ISO standards get revised without the validation that would be required of laboratories because the ISO needs to sell everyone a new batch to keep up its income.
BSI and UKAS’s entitlements to regular income also goes unchallenged despite them offering no proof of their claims to assure quality and avoiding legal responsibility for the disasters that have occurred despite their accreditation.
And it has been alleged that the IAF is the personal piggy bank of a lady who keeps a low profile. Some of the financial aspects are very much worth investigating:
7.) IAF is Elva Nilsen’s Personal Piggybank. The trick used by not-for-profit (NFP) organizations is to claim no salary on their tax return, but then pay exorbitant amounts third-party consulting firm, which then pays off the officers in some way. That way, the officers can claim no compensation on the NFP’s tax return, which faces the public, while actually cashing a check behind the scenes. We can’t know for sure if that is what IAF is doing, but it’s only major expense was an annual payment of $278,000 to Elva Nilsen’s consulting company, EJN Consulting. That payment represented a whopping 48% of IAF’s total annual expenses in 2015. Nilsen is the Secretary of IAF at the same time. So while the officers show no compensation by IAF, IAF can make a payment to Nilsen’s private company, whose tax returns are not available for public scrutiny, and Nilsen can then write checks to those officers without anyone knowing.
So let’s see similar organised resistance to the ISO accreditation scam.
Gold bugs generally aren’t in a position to have to care about ISO accreditation or certification. But Egon von Greyerz tells of something else to worry them,
FAKE GOLD – SILVER EXPLOSION – END OF BULL MARKET
March 23, 2018
We warned readers six years ago that the ISO certification was part of the fake gold industry. You can read about the accreditation gang issuing certificates for counterfeited gold here.
Behind most disasters the ISO has accredited a key component. Oxebridge is the site to look at for detailed examinations of deadly engineering failures and certification corruption.
The fake gold offered to you will not have the ISO certificate displayed. That’s just quality assurance to ensure the criminals don’t lose out.
Maybe the certificate is also a fake one. Read Oxebridge’s investigation of fake certificates and how the IAF seems to be the personal piggy bank for its secretary.
Patel et al. have written about the use of new, rapid Point Of Care (POC) tests in Advances Afoot in Microbiology,
Participants in the Academy’s colloquium recommended that clinical microbiologists “retain oversight of the quality assurance of infectious disease diagnostic tests.” This may not be possible in all instances; however, health care systems should ideally involve microbiologists knowledgeable about microbiology POC tests in the development, implementation, and maintenance of processes associated with the use of such tests. While we agree that clinical workflow redesign is needed, this may not be sufficient and instead, patient care processes may need to be redesigned (from scratch, in some instances) to incorporate this new type of testing. Consideration and approval of new POC microbiology tests within health care systems should rely upon established groups with expertise in POC program management and oversight, including M.D. and Ph.D. laboratory directors, clinicians from patient care areas proposing to use POC tests, medical technologists, and POC coordinators. These groups may or may not now include microbiologists; however, input from microbiologists on the implementation of new infectious disease POC tests and systems for quality control will be essential. The basic principles of POC management and implementation are, however, unlikely to differ between infectious disease tests and any others.
Accreditation does get one mention in the paper but it’s not the key to assuring quality according to these American authors.
Colloquium participants were appropriately concerned that POC microbiology tests would not be immune to some challenges of conventional microbiology NAATs, including contamination, changes in assay performance postmarketing, detection of organisms not causing patients’ symptoms (e.g., colonizing organisms), etc. Several strategies to address these concerns are outlined in the report, including regulatory and accreditation suggestions, as well as postmarketing evaluations. We agree that, like all microbiology tests, POC tests should be periodically reevaluated because disease epidemiology changes over time as a result of changing vaccination practices, emerging infections, evolving antimicrobial resistance, new medical and surgical interventions, etc., alongside the rapid evolution of microorganisms in general. There should be a mechanism for postapproval surveillance of waived devices and removal of poorly performing POC tests from the market. Groups such as the Diabetes Technology Society are beginning to address the issue of postapproval surveillance of glucose meters, but the issue has received too little attention for other commonly used waived tests. Also, in our opinion, POC microbiology NAATs should be designed to be very rapid (≤20 min and even faster as technology improves)—it remains unclear whether devices with longer turnaround times will lead to more efficient care in the hospital or clinic environment. (emphasis added)
In the UK and Europe compliance with ISO accreditation and EU regulations have almost assumed more importance than the patients.
Who’s going to do the studies to see what difference accreditation makes to patient outcomes between the two sides of the Atlantic?
Why are Irish software companies ditching ISO 9000? Mainly cost. Read the whole palaver:
O’Connor, Rory and Coleman, Gerry (2009) Ignoring ‘best practice’: Why Irish software SMEs are rejecting CMMI and ISO 9000. Australasian Journal of Information Systems, 16 (1). ISSN 1449-8618
Full text available as:
Software Process Improvement (SPI) ‘best practice’ models such as ISO 9000 and the Capability Maturity Model Integrated (CMMI) have been developed to assist software development organisations by harnessing their experience and providing them with support so that they can produce software products on time, within budget and to a high level of quality. However there is increasing evidence that these models are not being adopted by Small to Medium sized Enterprises (SME) and primarily remain the remit of large organisations. This paper presents the results of a Grounded Theory study into why Irish SME software product companies are not using these SPI models. The key inhibiting factor found was the issue of cost. We discuss the findings in relation to cost of process and the factors affecting it, including bureaucracy, documentation, communication, tacit knowledge and organisational creativity and flexibility, and the associated impact on the adoption of SPI best practice models.
Scott Adams’ Dilbert understands the ISO scam, even if he doesn’t document the corruption and criminality as thoroughly as Oxebridge. Adams recognizes how another source of cognitive dissonance can work in a TV interviewer:
And here’s the original:
By the end, has she fallen in love with the discombobulator of her previously-unchallenged Weltanschauung?
Believing and loving ISO; cognitive dissonance happens
Chris Paris has evaluated the 2016 ISO report on ISO 9001’s uptake. Read his analysis here.
The ISO hasn’t bothered to correct misleading figures designed the inflate the standard’s popularity but it continues its secular trend of decline.
China and Italy have yet to see through it, but many other countries have begun to understand its worthlessness and are rejecting it.
You can understand why it’s so important for UKAS to gain gullible allies to continue the transfer of money from taxpayers to the inspection cartel. ISO 15189 and 17025 continue to fool the medical and scientific professions and are growing as if they were compulsory.
It’s strange because even if they often lack the access to true price discovery and profit and loss accounts, these professionals have the statistical and investigatory knowledge to be able to prove the wastefulness that UKAS spreads. Yet in their management and professional societies they push these practices without assessing their value. They’d think more carefully if it were a new treatment for patients, yet ignore this ethical aspect as if they believe it is unlike other treatments and has no power to harm. Why might that be?
UKAS hovers around in a safe zone where it’s learning to tell doctors what to do yet is distant enough to ensure it doesn’t get sued when things go wrong.
Things do go wrong and accreditation gives no clear protection. Many major incidents occur despite (and perhaps because of) ISO accreditation.
Randox Testing Services
Accreditation won’t form part of the investigation. UKAS is clean of any responsibility. The solicitor will be writing to the hospital.
The UKAS Update newsletter tell us,
Working with NHS England to increase uptake of accreditation
NHS England recognises that quality improvement is critical to achieving world class, patient focused, safe, effective and efficient healthcare. Accreditation is one of the tools which provides assurance of standards, supports patient safety and ensures consistency of the quality of services and care that is delivered. UKAS continues to work with the Chief Scientific Officer of NHS England, Professor Sue Hill, and her team to raise awareness of the benefits of accreditation and support Trusts on their journey towards gaining accreditation for their full repertoire of scientific and diagnostic services.
Recently UKAS Senior Assessment Manager, Rebecca Gibbons, co-presented a webinar directed at Trust Lead Healthcare Scientists to provide background information about the different healthcare accreditation programmes that UKAS provides. UKAS’ Business Development Director, Lorraine Turner, was delighted to present to NHSE’s Leadership, Improvement and Advice (LIA) group. The LIA group is a consortium of senior healthcare science leaders from Trusts across England and is chaired by Fiona Carragher in her capacity as Deputy Chief Scientific Officer.
These presentations were aimed at encouraging Lead Scientists to utilise existing quality management expertise held within the Trusts to support the expansion of their scope of UKAS accreditation to cover other areas, and to highlight the similarities of the different accreditation programmes delivered by UKAS: Medical laboratories, Physiological Diagnostics (IQIPS), Diagnostic Imaging (ISAS) and Medical Physics and Clinical Engineering (MPACE).
In response to requests from Trusts and NHS England, UKAS is taking a more joined up approach to the assessment and accreditation of scientific and diagnostic services. This approach could result in improving the efficiency and effectiveness of the systems in place to provide assurance to patients, as well as reducing the overlap and resources required to undertake the UKAS assessments.
UKAS is also able to adopt a similar approach in other UK countries where it would be helpful, please speak to your Assessment Manager or the UKAS Team Leader for Healthcare, Le Tran (email@example.com), for more information.
Expanding the scope for UKAS’s income generation in the name of quality.
Some hospitals are pushing ISO accreditation and Deming-based quality improvement at the same time. They can’t see the contradiction.
They stand less chance of understanding it now that the ISO is trying to rewrite history and say they believed Deming in the first place.
Ask a patient if they notice an improvement because of accreditation. Ask them if they’d pay their own money for it.
UKAS welcomes new Non-Executive Director
UKAS has recently welcomed Professor Adrian Newland to the UKAS Board as Non-Executive Director. Bringing a wealth of healthcare experience, Professor Newland is currently Professor of Haematology and Honorary Consultant at Barts Health NHS Trust in London and at the Queen Mary University of London. He is also Chair of the National Institute for Health and Care Excellence (NICE) Diagnostic Assessment Programme, co-Chair of the WHO Standing Advisory Group of experts in In vitro Diagnostic Devices and National Clinical Advisor in Pathology to NHS Improvement.
Throughout his career, Professor Newland has been involved in the establishment of standards and accreditation in the Healthcare sector. This began as a council member in the early 1990s when he was involved in the development of the Clinical Pathology Accreditation (CPA) scheme with Professor John Lilleyman for the Royal College of Pathologists. In subsequent years, he remained involved and was instrumental during his time as President of the Royal College of Pathologists (2005-2008) in helping forge closer links between CPA and UKAS. At that time, he also advised the President of the Royal College of Radiology, Dame Janet Husband, on the development of their radiology accreditation scheme, ISAS. Later in his role as secretary of the Academy of Medical Royal Colleges, he became their advisor on accreditation and was chair of the UKAS Healthcare Policy Advisory Forum.
On behalf of the Academy, Professor Newland also helped to develop the Healthcare Quality Improvement Partnership (HQIP) and was a member of its first board. He was also involved in the appointment of the executive team for the first physiological science accreditation scheme, IQIPS, for the Royal College of Physicians. Professor Newland was previously the President of the British Society for Haematology and the President of the International Society of Haematology (ISH) from 2014 – 2016.
Please join us in welcoming Professor Newland to UKAS.
Organisations that become members of UKAS become unable to criticise because they have been complicit in the errors.
Listen to the rest of the world that is rejecting ISO 9001 rather than the UKAS speaker at the dinner!
Posted in Laboratory medicine, Management, NHS
Tagged Chris Paris, ISO 15189, ISO 17025, ISO 9001, ISO report 2016, NHS England, Oxebridge, UKAS, WE Deming