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All hospitals, rehabilitation clinics, as well as registered contract doctors and dentists in private practice, are obliged to introduce and further develop quality management at intra-institutional level. This serves to develop the organisation, and is to maintain and expand the level of quality by examining and raising questions. The Federal Joint Committee (G-BA) stipulates the requirements in its Directives.
The hospitals provide information regarding the state of implementation in their Structured Quality Report.The competent Associations of Statutory Health Insurance Physicians and Associations of Statutory Health Insurance Dentists call on a specific number of surgeries which are selected at random to report on the state of implementation.
Methods and tools used in quality management include in particular
- measuring and evaluating quality goals,
- recording the “as is” state and carrying out self-evaluations,
- regulating responsibilities and competences,
- process and workflow descriptions,
- interface management,
- team discussions,
- (further) training activities,
- patient surveys,
- staff surveys,
- complaint management,
- patient information and education,
- risk management,
- error management,
- error reporting systems,
- emergency management,
- hygiene management,
- safety of drug therapies,
- pain management,
- measures to avoid falls and the consequences of falls.
We would like to provide some more information below on a few of these methods and tools. You will find additional information in the G-BA’s quality management directive(in German).
The obligation to undergo further training forms part of quality management. However, all medical professionals in Germany already have to take part in quality assurance measures on the basis of their professional regulations. Moreover, the obligation to undergo further training is prescribed in Book V of the German Social Code (Sozialgesetzbuch V). Statutory health insurance physicians in private practice), as well as statutory health insurance dentists in private practice, are obliged to demonstrate at regular intervals to their Association of Statutory Health Insurance Physicians or their Association of Statutory Health Insurance Dentists that they have complied with this obligation. Otherwise, their fees may first of all be cut, and they may ultimately even lose their licences.
In hospitals, it is the medical management that has to monitor compliance with the obligation to undergo further training on the part of their specialist physicians, psychological psychotherapists, as well as child and youth psychotherapists. Compliance with the obligation to undergo further training is documented every year when the Structured Quality Reports are published.
Error management and participation in inter-institutional error reporting systems form part of quality management. All hospitals, rehabilitation clinics, registered contract doctors and dentists in private practice are obliged to introduce error management systems. These are intended to provide training in dealing with errors and ensure that improvement measures are introduced.
The involvement of hospitals in inter-institutional error reporting systems is to be promoted by means of supplementary payments. The G-BA has already adopted the requirements that are to be made of the error reporting systems. The error reporting systems are used to report, collect and evaluate critical events and errors, and the information is used to provide physicians with further training. This is to prevent the critical events or medical errors repeating themselves.
Registered contract doctors and dentists in private practice are free to take part in inter-institutional error reporting systems, and this is explicitly welcomed by their lobbies.
All hospitals, in-patient rehabilitation clinics, registered contract doctors and dentists in private practice are to have a complaint management scheme. Patients must be informed on the spot of the possibility of their filing a complaint. The feedback is evaluated and taken into account in improvement measures.
The use of checklists is in the interest of patient safety. It protects against mix-ups and promotes seamless organisation and treatment workflows.
Checklists are to be drawn up and used in hospitals which are tailored to the facility in order to prevent undesirable events and risks such as mix-ups of patients, sides and operations, as well as serious complications.
Amongst other things, as part of the WHO project entitled “Action on Patient Safety: High 5s”, and under the management of the Agency for Quality in Medicine (ÄZQ), 16 hospitals from Germany drew up Recommendations for Action on “Preventing wrong-site surgery” and “Assuring medication accuracy during transitions in care” using checklists. They are available for use by hospitals as an aid in implementation.