Archie Cochrane’s ladder of evidence. It’s helpful viewpoint for evaluating whether a treatment is worthwhile, isn’t it? Accreditation is a treatment that is supposed to create quality…whatever that is.
Like everything else, the accreditation philosophy rests on the base of presupposition.
Does the ladder help accreditation get off the ground? Er…no…the accreditation ladder has no rungs.
Is accreditation efficacious – can it work? Em…we have no idea.
Is accreditation effective to inspect in quality – does it work in practice? There’s no sign of it. There’s also no sign of anybody interested in looking. All we know is that quality can’t be inspected in after the event in other systems. The laborious rituals are sufficient in themselves to provide satisfaction for those with this compliance fetish.
Is it cost-effective – is it worth it? UKAS claims it is, but that’s wishful thinking. They don’t seem to know much about clinical trials or quality of evidence. We haven’t got anywhere near this stage yet.