[Thoughts on certification on ambulatory care--exemplified by DIN EN ISO certification].

In the worldwide discussion about the quality and possibility to finance institutions in public health, certified quality management programs are often stressed as suitable means. It is, however, an essential requirement for a successful quality management in out-patient care to consider quality aspects in the system of reimbursement, to solve the interface problem, and to invest considerably in personnel and financing. Additionally, the fact that medical institutions increasingly take it for granted to dedicate themselves to services and customer satisfaction can pose a problem. Growing pressure due to competition within health care does encourage spreading of certified quality management systems. However, certification in industry implemented for this very same reason did not as a rule lead to a continuing improvement of quality. Against this background, it is necessary to reckon with a considerable discrepancy between certified quality management systems and actual continuing quality improvement.