Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 1 Seminar on QM in German hospitals 08.11.2013 - Dr. Erwig Pinter Quality assurance

Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 1

Seminar on QM in German hospitals

08.11.2013 - Dr. Erwig Pinter

Quality assurance in

German hospitalsQM -

Implementation

Oncological Centers &OnkoZert-

Certification Scheme

Mandatory Certifications of German Health Care Providers

QM in Teaching QM in Clinical studies

Quality assurance in German hospitals

Qualität imKrankenhausBeratungsgesellschaft mbH

Dr. Erwig Pinter, QKB


1. Quality and hospitals in Germany2. Internal quality assurance3. Focus in different Certification Schemes4. External quality assurance5. Risk management6. Quality management in clinical reality7. Transparency and Marketing with Quality8. Assessment of the benefits of QM9. Literature

Topics


1. Quality and hospitals in Germany

Topics


Terms according to DIN EN ISO 9000:2005

Definitions

Quality: “degree to which a set of inherent char acteristics fulfils requirements”

Quality management (QM): “coordinated activities to direct and con trol an organization with regard to quality”

Quality management system (QM-System): “management system to direct and control an organization with regard to quality”


Definition according to § 2 no. 1 Hospital Law: Medical and nursing assistance Diagnosing, healing or relieving of diseases,

suffering or disfunctions or obstetrics Board and Loading of persons

Hospitals in Germany


TypeService

Stationary

treatment

Pre- and post-

stationary Day Unit

Outpatient

treatment

Admission Treatment Board Loading Connected toStationary

Types of hospital service


Public Hospitals: Owner is Federal Republic or a Federal State,

Communal Authority or a Social insurance

Charity based Hospitals: Owners are Churches, Social associations

foundations, Associations

Private Hospitals: Owners are private companies, organisations or

persons

Segmentation of hospitals by ownership


Ownership segments acute hospitals

2017 acute hospitals in

Germany

Source: destatis, 2012


718 charity based

hospitals698

private hospitals601

public hospitals

0,17 Mio. beds

6,41 Mio. cases/yea

r0,24 Mio.

beds9,1 Mio.

cases/year

0,09 Mio. beds

3 Mio. cases/yea

r

Ownership segments acute hospitals

2017 acute hospitals in

Germany



Segmentation data acute hospitals

< 100 beds

100-199 beds

200-499 beds

> 500 beds

Total number

Number of hospitals 696 443 624 254 2017

Number of inpatient care 0,8 Mio. 2,2 Mio. 12,4 Mio. 8,0 Mio. 18,3 Mio.

Length of stay in days 8,8 8,0 7,6 7,4 7,8

Number of personnel 51 199 466 1666 -



Owners segments prevention/reha hospitals

1212facilities in Germany



321 charity based

659private

232public

0,07 Mio. beds

0,3 Mio. cases/yea

r0,03 Mio.

beds0,4 Mio.

cases/year

0,11 Mio. beds

1,3 Mio. cases/yea

r

Owners segments prevention/reha hospitals

1212facilities in Germany



Segmentation data prevention/reha hospitals

< 50 beds

50-99 beds

100-199 beds

> 200 beds

Total number

Number of hospitals 286 261 355 310 1212

Number of inpatient care 0,8 Mio. 0,19 Mio. 0,6 Mio. 1,05 Mio. 2 Mio.

Length of stay in days 30,3 27,7 25,35 25 25,5

Number of personnel 19 39 82 148 -



2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

500

1000

1500

2000

2500

hospitals public

charity based private

Key data


Number of German hospitals decreased by 8% between 2000 und 2011


18,3 Mio. stationary patients

18 Mio. outpatients

83 Mrd. € turnover cost/year= 3,6 Bio. Rubel(3,2 % gross national product)

2017 acute hospitals in total6 Mio.

emergency cases

Population in Germany: 82 Mio.

Key data acute hospitals

Source: DKG 2011 and destatis, 2012

1,1 Mio. professionals

160 tsd. Physicians700 tsd. Nurses, Function service, Medical engineers80 tsd. Administration200 tsd. Others (technicians etc.)


2. Internal quality assurance

Topics


Development of QM in Germany

1997-2000: Demonstration project QM

1975: Quality Control: Munich perinatal study

2000: Internal QM,federal governing board for quality assurance

2004: G-BA

2013: - Mandatory certification of rehabilitation hospitals, - quality assurance report with 289 quality indicators, - patients rights law

Increasing requirements for proving and for transparency

2005: Quality assurance report, Alliance Action for patient safety

1989: external quality assurance


National Association of Statutory Health Insurance Funds

National Association of StatutoryHealth Insurance Physicians

National Association of Statutory Health Insurance Dentists

German Hospital Federation Federal Medical Chamber Council of Nursing

Organisations developing quality assurance


Social Code Five (SGB V) § 70 SGB V: Quality, Humanity and Economic

Efficiency Health care for the Insured according to the

recognized medical evidence Sufficient, advisable and not exceeding the

extend of necessity According to the professionally required

quality

Legal framework


Social Code Five (SGB V) Since the year 2000 steadily more specific and

demanding: § 135a SGB V: Requirements for quality assurance

Implementation and further development of an internal QM

Participation in measures for external quality assurance

§ 137 SGB V: Regulations and decisions for QM Federal Joint Committee (G-BA) formulates basic

requirements for an internal QM and defines quality indicators for the legally

requested quality report

Legal framework


Federal Joint Committee (G-BA) Highest regulating committee of the self governing

authority of the health care partners Regulatory competency Defines services of health professions to be

paid by the health insurance funds QM in the medical care Regulations in quality

management:internal QM, external quality assurance (=quality control), quality report

Common Federal Council

G-BA(Federal Joint Committee)

Health Insurance Funds

Medical Care

Medical

Profess-ions

Dental Surgeo

n

Hospitals


Mandatory elements of the internal QM according to the Federal Joint Committee (G-BA)

Requirements for an internal QM in Germany

Continuous improvement

Preventing and handling of

failures

Target-orientation and

flexibility

Employee-orientation,

cooperation and participation

Process orientation

Efficiency

Responsibility and leadership

Patient orientation

Elements of the internal

QM


Federal Joint Committee (G-BA) requirements for the internal QM-System in a hospital

Internal QM

StructureGoverning council or Steering committeeQM-officer for the executive management

ProcessesQM as part of the facility policyPatient orientationResponsibility of the hospital directorateKey processes, Evidence based Medicine with clinical pathways, guidelines, standards

Other requirements

Effectivity and efficiencyCost-Benefit relation


Working Group of the Scientific Medical Associations (AWMF): Systematically developed (Evidence based

medicine) Describe the Current state of the art and medical

science Ascertain the decision making procedures of

doctors and patients in respect to an adequate medical diagnostic and treatment standard for specific diseases or health problems

Clear recommendations to act based on assessements of the scientific value and usability of study results

AWMF Guidelines


AWMF: Guidelines are corridors for the medical decisions

and actions Deviations are possible in certain cases, but

reasons have to be stated The workflow according to the scientific guidelines

of the AWMF has to be adapted to the individual applicability in an individual situation according to the parameters indication consultation, preferences participation in decision making

Clinical relevance of the AWMF Guidelines


AWMF: S1: Recommendations of scientific expert groups S2: Guidelines based on evidence (S2e) or

consensus of a discipline representing committee (S2k)

S3: Guidelines based on evidence as well as on the consensus of a discipline representing committee

Remark: In Germany it is important for the doctors liability

to obey in detail at least the S-3 guidelines (and a must to get some certifications like OnkoZert)

Classifications of AWMF guidelines


5 stages in the life of a guideline (AWMF)

Evaluation and Planning the Updating

Implementation

Editorial process and Publishing

Development of a guideline

Planning and organisation

Development process of AWMF-guidelines


ISO KTQ JCI USA OnkoZert

Basics

Requirements DIN EN ISO 9001

Question- Catalogue with 6 categories

JCI- accreditation standards in 14 chapters

OnkoZert Questionnaire with 10 chaptersGerman Cancer Soc.

Certifi-cation

Certification audit Self assessment and conformity assessment

Self assessment, accreditation-survey

Certification audit by team of general QM-auditor and oncological expert

Special

characteristic

s

Structured QM, process orientation, certification of organisational parts of the hospital possible, internationally recognized, yearly control audit, internal audits

Certification of the entire hospital, specific German certification model for health sector

Certification of the entire hospital, from USA, internationally recognised

Oncological centers: comprehensive cancer centers, cancer organ center, cancer entities, cancer based items, certified general internal QM-System as pre-requirement

General and special Certification Schemes


7. Yearly conformity audits

6. Issuance of the certificate for 3 years

5. Audit stage 2

4. Audit stage 1

3. Certifying organisation defines audit team

2. Formal pre-check of the certification application

1. Select a certifying organisation

ISO-Certification


Problems in status assessment: no publicly available source about precise certification

numbers since certification in acute hopitals is voluntarily Each certified hospital promotes its own certification Only active KTQ certifications are listed publicly ISO certifications are not released from the certification

organisations Private data sources about hospitals differ in definitions from

the Federal Authority of Statistics

Result: We could evaluate for you the current certification situation only on a reference basis of about ¾ of the 2017 acute hospitals, namely in 1576, but we can offer at least an overall view of conclusions

Certification status in acute hospitals


Source: DKA, 2012

Owner Certified

Non-certified

Charity 285 345

Public 217 315

Private 127 287

Hospitals 629 947charity based public private

0%10%20%30%40%50%60%70%80%

45% 41%31%

55% 59%69%


certified not certified

Number of non-certified acute hospitals is still predominant Highest portion of certified acute hospitals is in the charity

based owner sector



Acute hospitals: about 40 % of the acute hospitals in Germany are certified

in General Certification Schemes (status 2012) Many hospitals are additionally

certified in specific disease certification Schemes

Rehabilitation hospitals: Each rehabilitation

hospital is mandatorily required to show its valid certificate

Market share of Certification Schemes

Market Share of Certification Schemes

in German acute hospitals

KTQ ISO0%

10%20%

30%40%

50%60% 52%

48%

Source: DKA, 2012


Distribution of KTQ and ISO Certifications in owner-sectors:

ISO certification: more frequently at private acute hospital owners

KTQ certification: more frequently in charity based and public acute hospitals charity based public private0%

10%20%30%40%50%60%70%

56% 53%

39%44% 47%

61%

KTQ DIN EN ISO

Certification Schemes in owner sectors

Source: DKA, 2012

Certification distribution


These three hospitals are certified in Germany according to JCI: Central Military Hospital Koblenz Clinics of Red Cross Berlin Communal Central Hospital Chemnitz

JCI-Certifications


ISO QM Standards: DIN EN ISO 9000:2005, Quality management

systems- Fundamentals and vocabulary DIN EN ISO 9001:2008, Quality management

systems, Requirements DIN EN 15224:2012, Health care services - Quality

management system

Standards


ISO KTQ

Basics

Not specific for Health Care.Origins from Industry

3 year periods between conformity assessements

Benefit

Valuable structured approach but not all ISO elements meet the special needs of indiviual patient

Self-assessment is big workload (1/2 year) in the valuable overall evaluation. Implementation of the possible improvements however is separate act

Special

characteristic

s

Some doctors see much formalism not really improving outcome but hindering patient work

If executives are not convinced by QM and their necessary daily support goes to a minimum: the hospital freezes in QM between the 3 yearly self-assessements ->No further organization developement

Critics to General Certifications Schemes


Preferred is structured QM approach of ISO type but only with special touch to meet the health sectors needs: Development in the health-care sector in understandable

language of the health care professionals Focus on patient orientation Evidence based medicine Risk-management Prevention of defects and non-conformities Usable for all health-care organisations For small and very complex organisations with all necessary

aspects (patient care, medical competence, clinical pathways etc.)

Assessment after 20 years QM experience


DIN EN 15224:2012 Defines ISO 9001 for the health-care sector Specifically designed for all healthcare services Requirements to the QM-system Will become the main certification standard Language of the health-care sector Emphasizes the process orientation and risk-management Three standards: clinical process, process of science and

process of teaching Combined certification according to DIN EN ISO 9001 is

possible

The prospective Standard in Europe


Examples for associations of medical doctors German Association of hematology and oncology (DGHO) German diabetes Association (DDG) Association of children hospitals and children departments in

Germany e.V. (GKindD e.V.) German Association of orthopedics and traumatology (DGOU) German association of angiology (DGA)

Example for other associations German Cancer Association (DKG)

Associations emphasizing and influencing QM


Certificate Association Number of certified facilities

OnkoZert German Cancer Association

Organ-Cancer Centers: 860Oncological Centers: 57Comprehensive Cancer Centers (CCC) 3

DGHO German Association of Hematology and Oncology

Oncological Centers: 40Competence Centers: 3Study Centers: 6

Quality Seal DDG

German Association of Diabetology

For Clinics:Basic recognition: 248Diabetologicum: 48 Podological specialist for treatment of diabetic feet: 79

Special Certification schemes of Associations


Certificate Association Number of certified facilities

Quality seal for children hospitals

Association of children hospitals and children clinics in Germany

Clinics for Children and adolescent: 280

Centers for vessel diseases

German Asociation of angiology, German Association of vessel surgery, German Association of radiology

Vessel Centers: 66

Nephrological focus clinic

German Association of nephrology

Focus Clinics: 22

Special Certification schemes of Associations


3. Focusing different Certification Schemes

Topics


Main chapters of DIN EN ISO 9001:2008:4. Quality management System5. Management Responsibility 6. Resource Management 7. Product realization7.5 Production and Service provision (Patient care)8. Measurement, analysis and improvement

DIN EN ISO 9001:2008


Categories1. Patient-orientation in Patient Care2. Ensuring employees-orientation3. Safety in Hospital4. Information 5. Hospital management6. Quality management

KTQ – catalogue version 5.0


Patient oriented Standards International Targets for Patient safety Access to and continuity of treatment Patient and family rights Assessment of Patients Treatment of Patients Anesthesiology und surgical treatment Management and application of medicines Training of patients and of their relatives

JCI – catalogue 4. revision I


Organisational oriented Standards Quality improvement and Patient safety Prevention and Control of infections Control, Leadership and Management Facility Management and security Qualifications of employees and further

education Communication and Information management

JCI – catalogue 4. revision II


1. Structure and processes (e.g tumour boards) 2. Organ-specific diagnostics 3. Radiology4. Nuclear medicine5. Surgical Oncology6. Chemotherapy/Internal Oncology7. Radiooncology8. Pathology9. Palliative Care und Hospice service10.Tumour documentation/Outcome quality

OnkoZert - Survey


Compliance with requirements defined in checklists:

Profile checklist for facilities for the Basic Treatment of severely injured persons

Checklist for a Regional Trauma Center Profile Checklist for a Supraregional Trauma

Center

Requirements: Personnel requirements Facility and equipment requirements Measures for Quality Assurance

Trauma Network - Requirements


4. External quality assurance

Topics


Measures for external quality assurance according to the Federal Joint Committee’s requirements: Goal: improvement of the quality and comparability of health care services German-specific Documentation and transmitting of data to the

evaluating institute in regard to defined quality indicators in 30 chapters e.g. obstetrics, transplantation of cardiac pacemaker

Recording and analyzing data across all hospitals in Germany

Some quality indicators are also part of the quality report

External quality assurance


6. Objective agreement on quality improving measures

5. “Structured dialog” in significant deviations from normal

4. Inform hospitals about results of the analysis

3. The regional authority and the AQUA Institute analyze the data

2. Transmitting the data to the AQUA Institute and regional authority for quality assurance

1. Patient care and documentation

External quality assurance


1658 hospitals participated 465 quality indicators of 30 chapters 4 Mio. data sets to analyze Results:

In total, the quality of health care in Germany is on a high level

But specific potentials for improvement identified:E.g. Current documentation in the field of liver transplantation has to be strengthened with more parameters

Results of the external quality assurance 2012

Quelle: AQUA Institut, 2013


Legal obligation for hospitals to publish yearly a quality report

Content, range and data format are defined by the Federal Joint Committee (G-BA)

Part A: information about structure and health care services of the hospital

Part B: information about structure and health care services of specialty departments of the hospital

Information about quality assurance

Quality reports of hospitals

Quality Report


5. Risk management

Topics


Risk“the combination of the probability of an event and its consequences”

Risk-management“coordinated activities to direct and con trol an organization with regard to quality”

Clinical risk“negative effects on the patient outcome according to quality requirements in health care“ E.g. wrong treatment, complications

Risk management


Risk management as part of quality management Avoiding to do the same work twice Efficient resource management Harmonised documentation Transparency of structures Legal security

Risk management

RM

QM


Risk management processbecomes more and more important for hospitalsin Germany Patients rights law DIN EN 15224:2012 Alliance Action for

patient safety

Risk management

1. Establishing the context of use

6. M

onit

orin

g an

d re

view

2. Risk identification

5. Risk measures

4. Risk evaluation

3. Risk analysis

DIN ISO 31000:2011


Partners of the Alliance action for patient safety Federal Joint Committee German Federation of Hospitals Health Insurers Charité Berlin Private Hospital Chain

Projects: Action on Patient Safety Action Clean hands! (Hygienic project) Hospital network CIRS Germany Time out procedures

Risk management


Survey of the Alliance Action for patient safety Deals with the status of implementing a clinical risk

management system in Germany Results: 484 hospitals participated 27% implemented a risk

management system 31% have a strategy for

implementing a system

Risk management

Survey of the Alliance Action, 2012

yes27%

no26%

intention16%

partially31%


Critical incident reporting system (CIRS) Goal: prevention by collecting information about

critical incidents, learning from failures Factors for success:

No sanctions Voluntary, anonymous, trust Analysis of incidents by experts System-oriented

Mainly based on a program from a medical liability insurer

CIRS


Realisation of CIRS in German hospitals Survey of the Alliance Action for patient safety

35% have a systematic CIRS

Main risk factors identified yet: Interaction between

departments pharmacotherapy Infections Hygiene

CIRS

no18%

not yet15%

intention19%non-sys-

tematic13%

system-atic CIRS

35%

Survey of the Alliance Action, 2012


Learning from the aviation CIRS-systems Checklists Certification procedures for medical and nursing

personnel Training Centers Simulator Training Psychological behavior in stress situations Become sensitive to systematic non-conformities Focus on preventive action

Risk management


Goal: Patient safety and empowerment of patients Codification of court decisions in more than the last

30 years medical liability claims Asserts legally the status of the continuously

extended patients rights and the defined good medical practice in Germany by Courts

Some new requirements: Doctor has to proof information consent

(now it is doctors burden to proof before court. Before it was patients burden)

Requirements regarding documentation: General rule: “What is not documented did not happen”

Patients rights law


6. Quality management in clinical reality

Topics


Level of competence

Acute hospital segmentation in treatment/size

Hopitals with main focuses

Regular and basic services

Differentiation and scope of service

spectrum

1000 beds +

400-1000 beds

20-400 beds


QM-approaches differ due to hospital size and service:We experienced during the 20 years QM realisation in respect to type and extent of QM realisation: Dominating factors in initiatialization and realisation of QM

Basic Services: Individual executive experiences

Main focus Services: Recommendations of associations

Maximal Service: Legal requirements factor

QM implementation approaches differ


Short way communications and decisions Two possible ways:

QM is responsibility of some individual persons additionally to and together with their actual work or

Special appointed member of management with responibility for Qualitätsmanagement and e.g. risk-management

Important: Priority setting is a must in different QM-projects

QM in regular and basic hospitals

QM


Central QM reports to executive management withsome special employees for QM

Appointed QM persons (QMB=ISO 5.5.2) in individual clinics with tasks and responsibilities more specifically differentiated

QM in main focus hospitals

QM

B

QM

B

QM

B

Central QM


Central QM in the top management of the Holding Local QM in the different sites Specialists for the different QM-sectors in the

central QM Central QM responsible for Public relations and

marketing with QM-topics and the further strategic developing of QM as well as of their organisation (think tank).

QM in maximal spectrum hospitals

Top management and central QM

QM

B

QM

B

QM

B

Central QM

QM

B

QM

B

QM

B

Central QM

QM

B

QM

B

QM

B

Central QM


7. Transparency and Marketing with Quality

Topics


Hospital navigator4QD-Quality clinics

Top-ranking doctors list Focus

Ranking list of hospitals or of doctors in weekly magazin Focus

Online search for the best suitable hospital on basis of parameters important for patients provided by biggest health insurer

Online portal with open comparative ranking of participating primarily private hospitals

Transparency and Marketing with Quality


4QD-Quality clinics Initiative of private hospital chains , e.g. Sana, Rhön, Asklepios Voluntary partcipation of hospitals Mutual audits of the participating

clinics Quality indicators:

340 indicators regarding Outcome quality

21 indikators regarding patient safety

10 each regarding patient and practitioner satisfaction



4QD-Quality clinics Search for the suitable hospital according to the speciality

clinics, indications, treatment possibilities and location Online search with certain parameters or with the body picture Patient gets informations about:

Clinic details Quality parameters Quality Certificate Treatment spectrum Main focuses Equipment/Service



Hospital navigator Initiative of the statutory health insurance (AOK) Informations are based on the

Legally requested Quality reports Voluntary informations of the hospitals Results of patient satisfaction surveys of the legal health

insurers (Patient Experience Questionaire)

Anonymised routine data from the datapools of the health insurers

No verification procedure regarding the voluntary informations of the hospitals and the Quality reports



Hospital navigator Comparison of at least two hospitals in:

General informations Recommendations by patients Main focuses of the hospital Personnel Quality Assurance with

routine data Legally required para-

meters of the QA Patient satisfaction



Top-ranking doctors list Focus The weekly magazin “Focus” publishes

periodically ranking lists of specialised doctors and of hospitals based on quality parameters

Quality Indicators: Recommendations of doctor collegues Recommendations of associations of patients Selfassessements of the doctors publications

Written and phone interviews



8. Assessment of the benefits of QM

Topics


Focus in personnel training in Germany very important Mandatory further education of doctors has to be proven all

five years (via collection of certification points per event) Additional special health personal trainings in QM,

teambuilding, teamwork and communication Most important in practical terms (BÄK/Bundesärztekammer):

QM-qualification by the Federal Medical Association “Curriculum of medical quality management” 200 hours in three parts in one year with examination Target groups:

Medical chief executives, senior physicians and Consultants

QM postgraduate education as success factor


QM has to be implemented and is to be applied in the entire hospital (S. Pilz et al. 2013)

Deficiences in the implementation (N. Kasper, 2011)

1. Application of the implemented methods and elaborated standards is not successful

2. Monitoring, measuring and act deficiencies in the independent evaluation of the results of QM deficiencies in act to improve

timely the non-conformities

Areas for improvement

Plan

Do

Check

Act

2

1


Surveys on behalf of the Federal Joint Committee about the perception of the users about the Quality Reports

Patients and doctors underutilize the Quality Reports of the clinics in the clinic selection Patients in majority don‘t even know the Quality Reports

Perception of the hospitals Quality Reports do merely adequate reflect the real

spectrum and quality of the services of a clinic Quality Reports have to be improved in the way of

presentation, detailedness, comprehensibility for lay people, freedom of too narrow legal arrangement

Areas for improvement

M. Geraedts et al. 2010


Study of the Society of Quality management in Health Care: The role of QM personnel in hospitals Anonymous Online-Survey of QM-employees in

health care 248 participants in Germany:

different owners and sizes of the facilities 77% of the participating facilites had been

certified

Effectivity of QM

S. Pilz et al. 2013


Results dynamic, developmental QM contributes effectively

by Structuring, establishing tranparency of and

optimizing the internal workflow Minimizing costs and risks Increasing patient safety Assisting the top management

Effectivity of QM

S. Pilz et al. 2013


Results The crucial success factor: Close cooperation

between QM and Top management Top management of successful facilites typically

requires and accepts the support by QM

Effectivity of QM

wenig er-folgreich

erfolgreich0%

10%20%30%40%50%60%70%

23%

36%

12%

61%

wenig be-deutsambedeutsam

Less important

important

Significance of the cooperation between QM and executives

S. Pilz et al. 2013successful

less successful


Different possible roles of QM in a hospital:

Effectivity of QM

Sommerhoff 2012

leading

changing

subordinate

preservative Orientation of QM

Posit

ion

of Q

M

Organisational development

Project reserve

Security Force

Control station

- Quality Control- Repair- Management system-administrator

- Quality Control- Moderator in conflicts - Management system-designer

- Change manager - Internal Consultant

- Project manager- Project service


Certified QM in health sector is becoming more and more mandatorily required by law: QM as safety factor in economically stringent situations Convincing evidence for benfits by QM in outcome and

processes based on our practical experience Medical laboratories have to prove specified capabilitiesCertifications required: Rehabilitation hospitals DentistsMandatorily QM implementation: QM has to be implemented mandatorily by law

in each health service, e.g. practitioners, emergency medical service, psychiatry etc.

Mandatorily required QM


9. Literature

Topics


Homepage Bundesministerium für Gesundheit: http://www.bmg.bund.de/ministerium/english-version.html

Homepage Deutsche Krankenhausgesellschaft:http://www.dkgev.de/dkg.php/cat/257/aid/10696

Homepage G-BA: http://www.english.g-ba.de/ Homepage AWMF: http://www.awmf.org/ Homepage BÄK:

http://www.bundesaerztekammer.de/page.asp?his=4.3569 Homepage Aktionsbündnis Patientensicherheit:

http://www.aktionsbuendnis-patientensicherheit.de/ Homepage GQMG: http://www.gqmg.de/ Homepage AQUA Institut: http://www.aqua-institut.de/

Literature

http://www.aqua-institut.de/

Documents

Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 1 Seminar on QM in German hospitals 08.11.2013 - Dr. Erwig Pinter Quality assurance