The problem is larger than accreditationism. Robert Brook of the Rand Corporation argues in the JAMA that 40 years after the birth of the quality improvement movement, we still don’t know much about what’s been accomplished.
He writes of clinical quality improvement initiatives rather than ISO accreditation which has not caught on so well in the USA as Europe, but the issues are similar. It is telling that he can discuss the broad ecosystem of quality programmes without ISO management systems being mentioned.
He recounts the birth of the quality improvement movement 40 years ago in response to deficiencies in care. The focus moved from the condition of facilities to what was done to patients to the outcomes of their treatment. The quality industry arose.
The quality improvement movement morphed into the patient safety movement even though the difference is not clear. This failed to re-energise its members and the focus shifted again, this time from the health of patients to the business case for quality with the presupposition that this would save money. The data to support this are very limited and probably cannot be generalised across industries. Brook observes that few studies consider the economics of quality. This unproven supposition of quality reducing costs is central to UKAS’s argument for itself.
Brook sees potential for identifying the level of quality that gives good value. He advises academic and industry leaders to focus on both quality and cost:
“The results of this work would help to distinguish between a level of quality that is good value and the best available quality that may produce small improvements in health at enormous cost.”
Better for staff, better for patients, worse for the zombie bureaucrats that feed off them.
The absence of clear evidence after 40 years is informative.