>90% say accreditation delivers benefits…but…

Authors employed by bodies including the US Public Health Accreditation Board (PHAB) have written that >90% of public health departments the PHAB accredits report benefits that might have been expected.

This sounds a lot like ISO accreditation although the details of the accreditation regime are not given in the paper.  Perhaps it’s better.  At least it is still voluntary.

Kronstadt J, Meit M, Siegfried A, Nicolaus T, Bender K, Corso L. Evaluating the Impact of National Public Health Department Accreditation ― United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:803–806. DOI: http://dx.doi.org/10.15585/mmwr.mm6531a3


What is already known about this topic?

In 2011, the Public Health Accreditation Board launched the national, voluntary public health accreditation program as a strategy to advance the quality and performance of governmental public health departments. As of May 2016, 134 state and local health departments have been accredited. In addition, Florida, in which employees of all 67 local health departments are employees of the state, achieved accreditation for the entire integrated local public health department system in the state. Collectively, nearly 167 million persons, approximately half the U.S. population, are covered by an accredited health department.

What is added by this report?

A survey of health departments that had been accredited for one year indicates that >90% report experiencing benefits such as stimulation of quality improvement and performance improvement opportunities; increased accountability and transparency; and improved management processes.

The authors acknowledge at least three serious limitations:

The findings in this report are subject to at least three limitations. First, all survey data are self-reported and have not been verified independently. Social desirability bias could result in respondents overreporting their quality improvement activities. Second, survey respondents are among the early adopters of accreditation. Although the health departments included in this study were diverse in size, geographic location, and structure, they might not be representative of all health departments. Finally, because accreditation is a voluntary program, selection bias might apply. For example, health departments are required to provide examples of quality improvement activities to demonstrate conformity with the PHAB standards. Therefore, health departments that were already active in this area might be more likely to apply, particularly in the first few years of the accreditation program. As a growing number of health departments are accredited, future studies can use other quantitative techniques to study the effects of accreditation. 

Without taking these more seriously in their analysis it’s just a user satisfaction survey like the ones the BSI and UKAS do to congratulate themselves and fool the buyers.

UKAS Customer Satisfaction Survey – Q1 2016-17

  • 86% were satisfied or very satisfied with UKAS’ overall service over the last year.
  • 99% were satisfied or very satisfied that the UKAS assessment team had the right skills and knowledge.
  • 94% were satisfied or very satisfied that the assessment team had the right attitude.
  • 90% were satisfied or very satisfied that UKAS generally responded to your needs in a timely manner.

You can test this yourself using a ISO 9001 customer satisfaction survey template.

iso 9001 survey

PR, not science

At best this MMWR report is uncontrolled research like most of the journal papers reporting benefits from ISO accreditation.  Attempts at controls are rare and controlled results are the opposite of customer satisfaction surveys.

Without controlling for the biases identified, of what value are the results?

How would it feel to have done so much work, to have paid so much money if accreditation failed to deliver its promise?  Maybe that’s why the accreditation victims rate it so highly.

Next time, try asking customers questions like,

What specific benefits have you noticed since accreditation? 

Answers like “better quality” or “complies with regulations” don’t count.

How much would you be willing to pay for this improvement?

See if the people that matter obtain real benefits or whether accreditation only helps the inspectors.


This entry was posted in Bureaucracy, Cartel, History, Laboratory medicine, Medicine and tagged , , , , , , , , , . Bookmark the permalink.

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