While quality assurance measures ensure a defined quality level, quality management aims at continual quality improvement..
The National Association of Statutory Health Insurance Physicians (NASHIP) has developed the general practitioner's office-specific quality management procedure "QEP – Qualität und Entwicklung in Praxen®" [Quality and Development in general practitioner's offices], together with practising doctors and psychotherapists, and employees of associations of statutory health insurance physicians (ASHIPs) and QM experts, including professional associations and doctor's assistants.
This indicator-based and handbook-supported system has a modular structure and can be implemented in stages by the general practitioner's office. The centre piece of the system is a catalogue of quality objectives, which primarily serves to introduce and implement quality management into general practitioner's offices, and for 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 general practitioner's offices certified in accordance with QEP were given their certification certificates by the Chairman of the Board of the NASHIP, Dr. Andreas Köhler.
Further components include a manual (incl. suggestions for implementation, sample documents) and a training curriculum, which are provided to support the QM structure. The system was tested in a pilot phase with 61 general practitioner's offices, externally evaluated, and is now available for regular operation.
Quality management (QM) is a useful instrument in company management. It serves to optimise work processes, and maintain and further develop the quality of products and services. A significant feature is the so-called PDCA cycle (p - plan, d - do, c - check, a - act), which is continually repeated.
With QM, relevant processes and sequences can be planned and structured in a general practitioner's office. This relates to both the medical / psychotherapeutic processes and the organisational aspects of a general practitioner's office. If all processes and sequences are systematically planned and implemented with clarified responsibilities, and questioned with regards to possible improvements, this can contribute to the stabilisation of the procedures of a general practitioner's office. This not only leads to further improved patient care, but also to saving resources in the general practitioner's office.
General practicioner's offices, which have already introduced QM, report time and cost savings – for example due to the reduction of overtime, the changed storage, the saving of double work processes, cheaper purchasing, lower cost insurance premiums and much more.
Whether general practitioner's office management, employees or patients – quality management offers advantages for everyone involved.
QM offers doctors and psychotherapists a management instrument for the entire general practitioner's offices – with numerous positive effects:
- Optimum use of financial and staff resources due to structured processes
- Reduced workload and greater work satisfaction due to efficient and (partially) standardised general practitioner's office organisation
- Avoiding errors and minimisation of risks due to clear regulation of responsibilities
- More transparency due to documentation of general practitioner's office knowledge
- Optimisation of internal and external communication and cooperation structures (improved information flow between doctors, employees and healthcare establishments)
- Easier implementation of innovations or special contracts such as the Disease Management Programme
- Objectivisation of own role through definition of quality features and practical goals, as well as regularly checking them
Employees also benefit from QM. Their advantages are:
- Work satisfaction due to clear regulation of responsibilities
- Arbeitszufriedenheit durch klare Regelung der Verantwortlichkeiten
- Easier integration of new employees and flawless holiday and illness cover due to transparent documentation
- Pleasant working atmosphere
- A survey by the Bertelsmann Foundation showed that the majority of insured parties want more transparency in the quality of care. That is exactly what QM does.
- Efficient general practitioner's office organisation enables the doctor or therapist to have more time for the patients.
- Due to the complete documentation and the improvement of the information flow to other doctors and healthcare establishments, the continuity of the treatment is guaranteed.
- The satisfaction of the patients is determined in surveys.
Quality improvement and presentation are intensively discussed. This includes quality circle work, quality management, quality reports or quality indicators. Promoted by the decisions of the conference of the health ministers and through the introduction of internal quality management in the law reform (GMG) from 1 January 2004, the necessity arose for the associations of statutory health insurance physicians to tackle this topic. Since 1.1.2006, the QM guideline of the Federal Joint Committee, which firmly determines the requirements of the QM systems in general practitioner's offices, has been in force (see "Legal requirements for QM").
As part of the quality offensive in 2002, the Board of Directors of the NASHIP already declared the topic of quality management to be one of the priorities, which should be dealt with urgently, alongside the development of feedback systems, further development of the quality circle work and the preparation of quality reports.