A growing number of Health Care Systems have introduced Quality Management
Systems to manage both quality in medicine and financial ressources of the
society. These Systems have been developed successfully for manufactoring a
nd service business. Service Quality Management Systems can be modified for
the purpose of non-profit-systems, such as Health Care. The view of qualit
y differs among institutions and persons acting within this system. The foc
us of the customer is most important for any service offer to the patient.
The variety of external, internal and total Quality Management Systems is d
iscussed with regard to the adoption in elective orthopaedic surgery. Stron
g process orientation may favour the DIN ISO System, as the definition of p
rocesses in medicine should be enforced. Once the processes are clearly def
ined, elaborated (total) systems may be introduced easily. The process of t
he implantation of a total hip prothesis has been designed to DIN ISO confo
rmity by a project team of experienced surgeons and is given here as an exa
mple for process orientation in elective surgery.