[Quality management and quality assurance in the hospital with special reference to hospital public health]

Abstract

Due to the law of health reform and health structure the hospitals in the Federal Republic of Germany are asked to not only think about cost reduction but at the same time to also face the requirements of quality management (QM) and quality assurance (QA). For the field of medical and care taking treatment of patients in the hospital the term "quality" can be described as the total of characteristics of the medical services necessary for the realization of all requirements which lead to an optimal patient treatment. Hospital hygiene as part of hygiene in the broader sense deals with the bases of disease prevention of all persons actively or passively connected with the institution hospital as well as with the natural and social hospital environment and, thus, in every respect proves to be a guide discipline for the realization of QM and QA in the hospital. For the realization of an overall concept for QM and QA in the hospital three categories of quality have proved to be worthwhile, namely the structure quality which deals with the quality related arrangement of the frame conditions of hospital productivity the process quality which comprises the improvement of diagnostic, therapeutic, care taking and medical activities in the hospital as well as interactions between the hospital staff and the patient or his relatives, and the outcome quality, which judges the changes in the patient's condition by means of predefined target values. Furthermore, QM in the hospital needs detailed informative activities (initial stage of information) as well as motivating measures (initial stage of conduct) whereas latter has to be considered as an essential basis for a staff-related realization of quality assurance measures in the hospital. Possibilities for a practical realization of QM and QA are shown by means of the modular concept established in the Clinics of the University of Heidelberg. Thereby, one could experience that a successful QM in the hospital requires the declared willingness of the hospital leadership to regard quality as the main theme of medical services and that QM has to be carried out staff-orientated for only by improvement of the employers' activities on all levels of the hospital gains the medical process of service its quality.