Quality management in ambulatory care |Quality certificate

While quality assurance measures serve to secure a defined quality standard, quality management prospectively aims at continuous quality improvement.The National Association of Statutory Health Insurance Physicians (NASHIP) developed the quality management procedure "QEP – Qualität und Entwicklung in Praxen®" (quality and development in doctor's offices) specifically for medical practices together with established doctors and psychotherapists as well as employees of Associations of Statutory Health Insurance Physicians (ASHIPs) and QM experts including professional associations and doctor's assistants.

This indicator-based and manual-based system has a modular structure and can be implemented in stages by the doctor's office. The core piece of this system is a catalog of quality objectives which primarily serves the introduction and implementation of quality management in doctor's offices as well as the analysis of the actual status (self-assessment). Optionally, a certification can be carried out by a neutral third party (external assessment). At the beginning of September 2006, the first three doctor's offices certified according to QEP received their certification from Dr. Andreas Köhler, chairman of the NASHIP.

Other elements include a manual (incl. implementation proposals, sample documents) and a training curriculum which are provided to support the QM implementation. The system was tested in 61 doctor's offices during a pilot period, externally evaluated and is now available for daily operation. 

What are the benefits of quality management in doctor's offices?

What are the benefits of QM?

Quality management (QM) is a useful instrument of business management. It helps to optimize work processes and to maintain and further develop the quality of products and services. A key feature is the so-called PDCA cycle (Plan – Do – Check – Act) which is constantly repeated.

With QM, relevant procedures and processes in a doctor's can be planned and organized. This related to both the medical/psychotherapeutic processes and the organizational aspects of a doctor's office. If all procedures and processes are systematically planned and implemented with defined responsibilities as well as questioned with regard to possibilities for improvement, this can contribute to the stabilization of the practice routine. This leads to further improvements in patient care as well as to savings in resources in the doctor's office.

Doctor's offices which have already implemented QM report time and cost savings, e.g. through reduction of overtime, change in storage, saving of double work processes, less expensive purchases, more favorable insurance fees and much more.

Everyone benefits from quality management: The head of practice, employees and patients.

Benefits for doctors and psychotherapists

For doctors and psychotherapists, QM is a management instrument for the entire doctor's office and has numerous positive effects:

  • Optimum use of financial and human resources thanks to structured processes
  • Reduced workload and greater work satisfaction thanks to an efficient and (partially) standardized organization of the doctor's office
  • Avoidance of errors and minimization of risks thanks to a clear regulation of responsibilities
  • Increased transparency by documenting the know-how
  • Optimization of the internal and external communication and cooperation structures (improved flow of information between doctors, employees and healthcare establishments)
  • Easier implementation of innovations or special agreements such as the Disease Management Programs
  • Objectivization of activities by defining quality features and objectives as well as regularly checking them

Benefits for employees

Employees also benefit from QM. Benefits:

  • Reduced workload thanks to an efficient work organization
  • Job satisfaction thanks to a clear regulation of responsibilities
  • Easier incorporation of new employees and seamless vacation and sick leave cover thanks to a transparent documentation
  • Pleasant working atmosphere

Benefits for patients

  • A survey conducted by Bertelsmann Stiftung showed that the majority of insured persons want more transparency in quality in care. This is exactly what QM ensures.
  • Thanks to an efficient organization of the doctor's office, doctors or therapists have more time for their patients.
  • The continuity of treatments is guaranteed thanks to a complete documentation and the improvement of the flow of information to other doctors and healthcare facilities.
  • Patient satisfaction is determined in surveys.

Background information

Quality promotion and presentation is discussed intensively. This, among others, includes quality circle work, quality management, quality reports or quality indicators. Encouraged by the decisions of the conference of health ministers and with the inclusion of the internal quality management in the law reform (SHI Modernization Act) from 1 January, 2004, the necessity for Associations of Statutory Health Insurance Physicians addressing this issue arouse. On 1 January, 2006, the QM directive of the Federal Joint Committee which determines the requirements for QM systems in doctor's offices came into effect (see “Legal requirements for QM”).

In 2002, as part of the quality initiative, the board of directors of the NASHIP made the issue of quality management a priority which is to be developed primarily alongside the development of feedback systems, the further development of quality circle work and the creation of quality reports.