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Zusammenfassung Ziel Ziel war die Bewertung von 14 international veroffentlichten, krankenhausbezogenen Patientensicherheitsindikatoren (PSI) hinsichtlich ihrer Ubertragbarkeit auf das deutsche Gesundheitswesen. Methoden Es wurde ein zweistufiges, modifiziertes Delphi-Verfahren unter Verwendung der QUALIFY-Gutekriterien mit einer multidisziplinaren Expertengruppe durchgefuhrt. Ergebnisse Elf der 14 PSI wurden als ubertragbar und praktikabel fur das deutsche Krankenhauswesen beurteilt. Schlussfolgerungen Es steht eine Auswahl an elf formal konsentierten PSI zur Verfugung, die sich potenziell fur die Qualitatssicherung im stationaren Sektor eignen. Eine weitere Operationalisierung und empirische Validierung wird vor der Verwendung empfohlen.

To assess the transferability of 14 evidence-based patient safety indicators (PSI) to the German hospital system.A two-staged modified multidisciplinary Delphi process was used, applying the scientific criteria of the QUALIFY instrument.Eleven of the 14 PSI were judged to be transferable to and feasible in the German hospital setting.The consented PSI are potentially suitable for German quality assurance measurement. Prior to implementation, further operationalisation and empirical validation is recommended.

Current concepts in leadership and governance on the level of supervisory board, management and departments are often considered as insufficient to cope with the profound structural change which actually takes place in the German health care system. While vertical and horizontal disconnecting is typical of the professional bureaucracy of hospitals, transition from functional to divisional structure further increases this risk. Accordingly, medical experts are oriented towards their professional peers and patient care on the one side; on the other side the management gets isolated and looses operative and strategic control. Several studies provide evidence for the relevance of role models to serve as agents of change, which are now developed into the concept of "Clinical Governance": evidence-based medicine, guidelines, continuous quality improvement, safety culture, resource accountability and organisational learning. The present situation makes it necessary to extend this conception, which focuses on the departmental level in an organisation with divisional features, to one of "Clinical Corporate Governance". This term, which also includes supervisory structures and the management board and is relevant for the total hospital and company, respectively, is based on the corporate governance concept. Inside the hospital, the management and the heads of the departments have to agree that (1) experts really need to be integrated into the decision process, and that (2) the outcomes of the entire hospital have to be regarded as equal or superior to the aims of a single department. The public image of the hospital should be one of a strong and reliable partner in health care and health care business on a local, regional and national level. Members of the supervisory board should clearly put corporate aspects above political and other implications and pay attention to personal independence from the leaders of the medical departments.