An imposed factitious disorder


The presumption of professional incompetence is central to accreditation.  Likewise, it is at the heart of government policy regarding professions outside the Civil Service, politicians and banksters.

"It's a good job the bank wouldn't employ me!"

It is driven in part by the desire of regulators to be seen to be Doing Something to control bad things that people fear.  Or at least scaring them that there are bad things that they should fear.  Or appeasing do-gooding journalists and single-issue campaigners with an overly-simple understanding of the problem.   But mostly it is the desire to earn a living controlling others.

Factitious disorders involve feigning, exaggerating, or self-inducing physical or psychological ailments.  The goal is to be seen in the sick patient role.  This sick role entitles the factitious disorder patient to care, guidance, attention, and protection.  It also exempts them from their usual responsibilities.

? Munchausen syndrome by cartel

The cartel imposes an analogous factitious disorder upon its professional victims.  It massively exaggerates the importance of minor omissions and inconsistencies in records that often could have no bearing on the performance of the task.  Accreditation bodies make accreditees patients in need of never-ending supervision and prompting from inspectors.  Malingering becomes a requirement.  Nothing unaccredited is adequate. Normal roles and responsibilities are crippled by playing along with the inspectors’ game.  In return they get to use the UKAS or CPA logo.

Cool accredited

The record-keeping in this arrangement provides a get out of jail free card for the inspectors as long as those sample records that are inspected are correct.

Can they be sued for harm from an erroneous result?  As long as the inspections are alright they cannot take responsibility for wrong results among the great number that were not inspected.    Consultants have to take responsibility for every result.  Inspectors can walk away.  They don’t need insurance.  They have power without responsibility.  What then is accreditation worth?

Quality cannot be inspected in afterwards.  The inspection system eludes responsibility to consider factors beyond those required by accreditation while perhaps paying lip service to doing so through records of corrective, preventive and improvement actions.

Health and safety?  Out of their remit.  It could lead to public embarrassment.

Dreadful management?  SMART?  Management in seven tiers by projects and workstreams?  These designed by the need to give managers work rather than for the benefit of patients.

Blackboard with SMART Goals listed

That’s OK as long as the management structure is drawn out in the Quality Manual.  Inspectors would lose business if they judged the quality of the management.  They judge the completeness of the paperwork instead.

Management can have a quality certificate even if it launches expensive and disruptive change programmes, ostensively to save money, but without calculating the costs, savings, benefits or disasters that lie ahead.  This way there is no yardstick by which to measure failure.

Cramped facilities?  They’ll inspect them but can’t afford to lose your business if you can’t afford a new building.

The time that might have been given to professional care and relationships has been spent on record-keeping for inspectors instead.

Gary North writes:

Success indicators are usually numerical.  Surely a  profit-and-loss statement is.  If the numbers look bad, the situation is bad. Red ink cannot flow forever.  Deficits do matter.         

“Yet numerical success indicators are subject to a major flaw: they can be substituted for actual success.  We call this “gaming the system.”         

“Consider this familiar example from the economic history of the Soviet Union.  The central plan is issued by the government.  The demand is for nails. But what size?  If number is the standard, the factory produces something like thumbtacks.   If weight is the criterion, the factory produces roofing nails.         

“The famous bottom line in the free market is subject to gaming. “The Puritan Gift” is a remarkable book on how large American corporations after 1970 shifted from customer service to profit alone. The authors mark this shift with the rise of certification by business schools.   The great weakness, they argue, is the business schools ignore what is called “tacit knowledge.”

“This is the hands-on knowledge that long-term employees gain after working in the system. This is line knowledge. It is the kind of knowledge that Hayek spoke of when he wrote about the local knowledge that is called forth by the free market.         

“This is knowledge equivalent to tying a shoelace. You cannot learn this in graduate school by means of textbooks and formulas.”

(Emphasis added.)

There remain things you cannot describe in SOPs or measure with audits, graphs, charts, or any instruments.  And they matter.

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This entry was posted in Bureaucracy, Cartel, Education, Laboratory medicine, Management, Medicine, NHS, Politics, Psychology, Questions and tagged , , , , , , . Bookmark the permalink.

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