Internal and external measures of quality assurance in gynecological surgery.

In the light of exploding costs in health care and increasing demands for public accountability, gynecological surgeons are forced to improve the effectiveness and efficiency of their care in order to increase the satisfaction of their 'clients'. To do so, the implementation of a structured quality management system in gynecological care units is strongly encouraged. Basic requirements for an efficient quality management system comprise developing appropriate structures for the system, training staff in management techniques and using tools to monitor the quality of care. An important part of a quality management system is structured data collection permitting regional benchmarking between hospitals. The study 'Quality assurance in gynecological surgery' of the German Society of Gynecology and Obstetrics is mentioned as an example of such an external measure. Profiles help gynecological care units to recognize problem areas of their care. A list of further structural characteristics of a quality-oriented gynecological care unit, such as second opinion techniques or the application of clinical practice guidelines, is given to enable the evaluation or certification of quality management systems in gynecological departments.