As I spent some time re-reading their manuscript it got me to thinking about laboratories and accreditation. I understand that Boiral and Amara did not look at accreditation and that in Canada, most laboratories have mandated accreditation rather than voluntary certification, but the concept of external evaluation underlies both.
My personal experience with laboratory accreditation is that the following are probably all true for many (most?) medical laboratories in North America:
A - Most laboratories have not developed or sustained a Non-conformity Events (NCE) or Critical Incident (CI) program, and thus they can not document that the accreditation process has resulted in error reduction.
So if I am right, why has the experience been so successful for my laboratory and less so for many others. A few variables come to mind. First and foremost, we got into the process on a voluntary basis because we saw an opportunity for customer satisfaction improvement. Once we got started we saw that implementation lead to improved quality processes (planning, and studying results and implementing for improvement).
Second, because we are a small (very small) organization, we were all able to see that improvements had a direct impact on everyone’s work load and work satisfaction level. Certification led to the establishment of a sustainable Culture of Quality.
Third, because we received positive vibes from the process we were able to develop a positive working relationship with our Quality Partners.
Fourth, through the better relationships with our clients and our improved procedures we were able to develop a sustained reduction in costs of poor quality and improved financial health.
This is pretty consistent with what the authors wrote: “This study supports the fact that it is not so much the standard or the moment of implementation that has a positive impact on performance, but rather the way [it] is implemented, what the standard represents for respondents, and above all, the reasons explaining its adoption.”
So is this a testable hypothesis, or am I just feeling pumped as we get ready for another visit?