[Quality management. Concepts and application in orthopedics]

A growing number of Health Care Systems have introduced Quality Management Systems to manage both quality in medicine and financial resources of the society. These Systems have been developed successfully for manufacturing and service business. Service Quality Management Systems can be modified for the purpose of non-profit-systems, such as Health Care. The view of quality differs among institutions and persons acting within this system. The focus of the customer is most important for any service offer to the patient. The variety of external, internal and total Quality Management Systems is discussed with regard to the adoption in elective orthopaedic surgery. Strong process orientation may favour the DIN ISO System, as the definition of processes in medicine should be enforced. Once the processes are clearly defined, elaborated (total) systems may be introduced easily. The process of the implantation of a total hip prothesis has been designed to DIN ISO conformity by a project team of experienced surgeons and is given here as an example for process orientation in elective surgery.