[Quality assurance--an important factor in the structure of medical management of the future]

Quality of medical practice has several prerequisites. A certain structural quality is essential to ensure good quality medical performance. Structural and performance quality both lead to result quality. Performance quality is dependent on well-working structures. With respect to neurosurgery a high level hospital organisation is required which allows equally qualified medical performance. Structure therefore has to attain a standard to stand up to quality assurance criteria. Next to hospital equipment structural quality requires sufficient staff capacity as well as unlimited neurosurgical access to technical equipment such as computerized tomography, MR, angiography and also intensive care under neurosurgical supervision. Quality assurance has been widely discussed in recent years. Measures to guarantee quality assurance, as required by federal law in Germany, are taking three different steps, first a model phase as a scientific study developing methods and observation, a second phase called study phase with wide effects and institution in various departments. In this phase the effectiveness of the procedure is tested and assured. In the third phase routine use is instituted. In quality assurance in neurosurgery phase two is presently tested, phase three is in preparation.