[Aspects of process quality in quality assurance regarding inpatient psychosomatic rehabilitation]

Quality assurance in in-patient psychosomatic rehabilitation is performed basically by an external, general, structure-oriented and outcome-oriented programme of quality assurance conducted by statutory insurance bodies. In contrast, the differentiation of quality assurance in special fields of rehabilitation as well as the elaboration of the dimension of process in quality assurance have been neglected. Particular conditions of treatment in in-patient psychosomatic rehabilitation highlight the importance of the quality of procedure. Among these are the relatively longer duration of treatment, the particular dynamics and liability to disturbances of psychotherapeutic interaction, the cooperation of different therapeutic fields within a comprehensive plan of treatment and the specificity of treatment goals for each individual patient. Such a kind of quality assurance relating to procedure is made feasible by two types of structural elements of quality of procedure in in-patient psychosomatic-psychotherapeutic treatment. Iterative structural elements of procedure (e.g. team conferences, supervision) serve to control the cooperation of the team by means of a random sample of patients. Sequential structural elements (e.g. admission conference, intermediate review conference, discharge conference) help in monitoring systematically the course of treatment in relation to each individual patient. As for the obtaining of information, sequential structural elements of assurance of quality of procedure make routine monitoring possible, whereas iterative elements create space for spontaneous notification of disturbances.