Abstract
To deal with medical malpractice, apart from sanctions an ethical code has been developed
since ancient times which shapes our present expectation of a good physician. A century
ago, industrialization and standardization initiated medical quality management in the
USA. In the 1950s, the Japanese concept of total quality management arose, winning huge
influence also in medicine. Every recent system of certification or accreditation
originates from these roots.
In the last 15 years in Germany, minimum standards in health care have been enforced by
law with increasing sophistication. Additionally, self-governed institutions of physicians
have been clearly contributing to the quality of care.
Quality management has become an integral part of the German healthcare system, most
notably in risk management and patient orientation. There are also a multitude of
voluntary physician-driven initiatives to improve the quality of care, among others the
guidelines of the medical societies.
A survey was conducted by the author to evaluate the implementation of quality management
in otolaryngological departments and practices. The degree of implementation was
predominately higher than for the national peers.
Currently there are substantial challenges to the health care system which impact the
quality of care. Lack of funding, shortage of qualified staff, societal changes and
effects of rapid scientific progress are a few to name.
To achieve a broad implementation of quality management in the future, wise political
decisions and proper funding are crucial – the concept as such has long been
accepted.
Key words
Quality management - quality assurance - certification - accreditation - German health care system
