TOTAL QUALITY MANAGEMENT IN HOSPITALS TAK ING PARTICULAR ACCOUNT OF HOSPITAL HYGIENE

Due to the law of hearth 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 quali ty management (QM) and quality assurance (QA). For the field of medica l and care taking treatment of patients in the hospital the term ''qua lity'' 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 conce pt for QM and QA in the hospital three categories of quality have prov ed to be worthwhile, namely the structure quality which deals with the quality related arrangement of the frame conditions of hospital produ ctivity the process quality which comprises the improvement of diagnos tic, therapeutic, care taking and medical activities in the hospital a s well as interactions between the hospital staff and the patient or h is 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 st age of information) as well as motivating measures (initial stage of c onduct) whereas latter has to be considered as an essential basis for a staff-related realization of quality assurance measures in the hospi tal. Possibilities for a practical realization of QM and QA are shown by means of the modular concept established in the Clinics of the Univ ersity of Heidelberg. Thereby, one could experience that a successful QM in the hospital requires the declared willingness of the hospital l eadership 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.