CC BY-NC-ND 4.0 · Laryngorhinootologie 2020; 99(S 01): S336-S428
DOI: 10.1055/a-1012-9442
Eigentümer und Copyright ©Georg Thieme Verlag KG 2019 Article in several languages: deutsch | English
Frank Wallner
1  Universitäts-HNO-Klinik Heidelberg
› Author Affiliations
Further Information

Publication History

Publication Date:
16 March 2020 (online)



To deal with medical malpractice, apart from sanctions an ethical code has been developed since ancient times which shapes our present expectation of a good physician. A century ago, industrialization and standardization initiated medical quality management in the USA. In the 1950s, the Japanese concept of total quality management arose, winning huge influence also in medicine. Every recent system of certification or accreditation originates from these roots.

In the last 15 years in Germany, minimum standards in health care have been enforced by law with increasing sophistication. Additionally, self-governed institutions of physicians have been clearly contributing to the quality of care.

Quality management has become an integral part of the German healthcare system, most notably in risk management and patient orientation. There are also a multitude of voluntary physician-driven initiatives to improve the quality of care, among others the guidelines of the medical societies.

A survey was conducted by the author to evaluate the implementation of quality management in otolaryngological departments and practices. The degree of implementation was predominately higher than for the national peers.

Currently there are substantial challenges to the health care system which impact the quality of care. Lack of funding, shortage of qualified staff, societal changes and effects of rapid scientific progress are a few to name.

To achieve a broad implementation of quality management in the future, wise political decisions and proper funding are crucial – the concept as such has long been accepted.