Which quality management systems are used in German Hospitals?

German hospital legislation requires all hospitals to adopt „a quality management system”, but there is no regulation as to which system should be used.

Consequently, almost all the possible QM-systems and certifications have their customers: The JCC (joint commission certificate), the DIN-ISO 2000 etc., the European quality award EFQM and two specific systems, which were developed by the hospital scene together with the social security health insurance, KTQ (Kooperation fuer Transparenz und Qualität) and ProCumCert. These systems all have in common, that the general procedures for important activities have to be written down, followed and evaluated. In addition, factors like patient and staff satisfaction, financial solidity and leadership are important – though the weight differs between the systems. The PCC-certification was created for the many hospitals under church responsibility; here aspects of spirituality and religious orientation are additional criteria.

Over all, it is to my knowledge fair to say that KTQ and KTQplusPCC have the largest part of the certification market.

In addition, there is an increasing number of specialized certificates: Breast centers (mammary oncology), intestine centers (intestinal oncology) and others are certified by an institution called Onkozert; efforts in favour of breast-feeding are certified with a family-orientation certificate by the WHO; the WHO-initiative called health-promoting hospitals makes for an increasing network, also the initiative for smoker-free hospitals with 3 different levels of certification. Special institutions within hospitals again have their special QM-certifications: laboratories (DAR), radiology (governmental radiation control) etc.

Of course all these systems and procedures of quality management are focussed on the aspects of structural quality and procedural quality. Outcome quality is hardly an issue in these systems. And, of course, a measurement of outcome quality, moreover in benchmark comparison with other hospitals, is a difficult issue. Some hospitals have started to address it cautiously, by including additional data in their annual quality reports.

These reports are also required by law every two years and have to be published on the internet. They provide information on the hospital’s infrastructure, the most frequent medical procedures and also on the quality management system that is adopted by the hospital. On a voluntary basis, some hospitals also publish statistics like mortality rates, infection rates etc..

Two more quality management aspects should be mentioned:

For certain procedures a special government institution has published minimum quantity standards regarding the number of procedures per year. For example: A hospital, that has not performed a minimum of 50 total knee implant operations in one year looses the permission to continue offering this type of service.

And for an also increasing number of medical procedures hospitals have to provide a host of medical data to the central medical councils. These data are studied by special committees of physicians, and clinics or departments with big deviations from the standard are faced with critical reports that call for measures to improve the situation. But up to now, also because the criteria are very medical and their relevance is not always obvious to a layman, these reports are not available to the public yet.