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Methods of quality management and quality assurance aim at improving medical facilities, procedures and services to benefit patients and avoid potential harm. It is prudent to call these measures "secondary technologies" because they are used to optimize the so-called "primary technologies" used in medicine such as diagnosis, therapy, rehabilitation and counseling. However, in light of the considerable efforts and high costs associated with quality assurance measures, it is important that these measures be subject to critical review. Like all other procedures or technologies used in health care, quality assurance measures must be reviewed with respect to their effects and costs prior to and during implementation. The primary issue of such pre-evaluation and re-evaluation is to analyze whether the benefits justify the costs and then to define how quality assurance measures can be used to help improve the outcomes of health care services. Quality assurance measures must focus on health care priorities. They should be limited to common and serious health problems, the core services of the different health care providers and to high-risk interventions. Quality assurance must contribute primarily to the health of patients and protect them from avoidable harm. Quality management must be patient and outcome oriented and should uphold the ideal of the responsible and informed patient, whose dignity and autonomy must be respected. Above all, strengthening the position of health care users requires comprehensive, comprehensible and easily accessible information on the targets and outcomes of quality management. This is a basic requirement for setting up a quality-oriented information culture in the health care system and should be given high priority.