[Team and patient orientation in nursing as a part of quality management--status and needs for research]

The paper introduces a holistic concept of quality management in hospitals--the approach of employee and patient orientation ("MPO-Mitarbeiter- und Patientenorientierung"). It is shown that quality in health care does not primarily depend on the regulation of quantitative input and output of the health care system but is largely determined by improvements of processes within the system. TQM models like the European Quality Award are showing the way towards improving processes by focusing on employee and client orientation and satisfaction. Patient satisfaction has become a more and more popular indicator for quality in health care. However, reviews of the vast amount of literature on patient satisfaction reveal that present research suffers from the same problems and shortcomings that have already been criticised about 20 years ago. Only few studies choose innovative approaches by integrating the perspectives of patients and employees and by refraining from the insufficient measurement of satisfaction. Three of these studies are presented and compared. Against this background the MPO-approach is described; the approach integrates results from work psychology as well as from nursing research within the concept of complete activity. In contrast to other models of quality management the MPO-approach provides suitable methods for analysis and assessment of employee and patient orientation. These methods are described and are finally discussed with respect to strategies of total quality management in hospitals.