National quality of care activities in Germany.

Quality assurance activities in Germany have a long tradition of being oriented to structural quality. For many years quality assurance in hospitals was limited to pathologist's examinations and ward rounds. The separation of health care services into in-patient and out-patient sectors has made it difficult to introduce a total quality management system. After passage of a revised social security act on quality assurance, physicians' organizations started quality management projects, which for the most part are still in the pilot phase. Many institutions and commissions are trying to develop quality assurance activities focusing on formulating practice guidelines. However, in order to make quality management a truly vital part of health care in Germany, adequate computerized documentation systems will need to be introduced.