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The German Agency for Quality in Medicine (ÄZQ) was established as a joint institution of the German Medical Association (BÄK) and the National Association of Statutory Health Insurance Physicians (KBV) in 1995. Starting as a small quality assurance co-ordination unit of the German physicians' national self-governmental bodies, ÄZQ has been developed during the last decade into a centre of excellence for clinical practice guidelines, patient information, patient safety, evidence-based medicine, and knowledge management. The article summarises the institution's acitivities over the period of 15 years with respect to its national projects and international collaboration, being a founding member of the Guidelines International Network. In the future ÄZQ's programme priorities will be in the fields of knowledge transfer and implementation of medical decision aids into the daily work of health-care providers., (© Georg Thieme Verlag KG Stuttgart · New York.)

Since the release of the report "To Err is Human" by the American Institute of Medicine (IOM) the subject "Medical Risks, Errors and Patient Safety" has gained increasing interest in literature. In Germany, neither extensive statistics nor generally significant epidemiological studies regarding common errors associated with damages caused to patients' health exist. In recent years the subject has become increasingly interesting both in specialist discussion and it the lay press; it has become evident that the different use of terms, especially those originating from the Anglo-Saxon language, can lead to misunderstandings. Hence, as one of the first steps of its action programme, the expert panel "Patient Safety" of the German Agency for Quality in Medicine has compiled a glossary of technical terms to provide adequate support to the discussion this important subject of nomenclature.

Quality management systems had originally been designed for industrial purposes and were hardly applicable for small enterprises, there have been adjustments to the two main applications EFQM and ISO enabling utilisation also in ambulatory care. There are also different approaches like the Dutch Visitatiae concept which reflects the needs of GP's and is based on peer exchange. The presented paper gives an overview of existing quality management and certification systems and presents an instrument for evaluation. This checklist was developed by an interdisciplinary expert panel of the Agency for Quality in Medicine and serves as an aid for users and graders of quality management systems with regard to the feasibility of these systems.

The role of practice guidelines as a tool for quality management in health care is now widely accepted in Germany- not only by health professionals, but also in politics. The physicians' professional associations as well as health care authorities (physicians' self-governmental bodies) and parliament introduced several incentives and regulations, aiming at a regular use of guidelines in health care. Among these the German guideline clearinghouse with the systematic approach towards identification, dissemination, and implementation of best available evidence-based guidelines, as well as the country-wide implementation of disease management guidelines seem to be effective and efficient in quality management as well as in patient care management in the German health care system. The article gives an overview on background, procedures and barriers to country-wide implementation of clinical practice guidelines within a social security health care system.

Within the German health system guidelines are increasing considered as a meaningful and necessary aid to decision making. In this context the effectiveness of guidelines essentially depends on their methodical quality. Because of the fact that most of the German-language guidelines introduced within the past years show obvious methodological defects, the Agency for Quality in Medicine developed within the last two years the following programme for quality-assurance and promotion of guidelines: 1. Definition of quality policies for clinical practice guidelines in Germany 2. Establishment of quality demands for guidelines 3. Methods and instruments for quality promotion of guideline programmes 4. Measures to promote and check the quality of guidelines ("German Guidelines Clearinghouse") The following article reports on background, aims, instruments, method development and acceptance of the programme.

In April 1996 the working group of the leading statutory health service officials (Arbeitsgemeinschaft der Leitenden Medizinalbeamten der Länder [AGLMB]) organised a hearing in the course of which the German Medical Association and the National Association of CHI Physicians presented a joint stocktaking of their activities in the discipline of quality assurance during 1955 to 1995. On the basis of this analysis 10 theses have been evolved to develop quality assurance in Germany: (1) quality assurance and quality improvement are in the interest of the medical care of patients. (2) The main task of quality assurance and quality improvement is not the improvement of efficiency. (3) Quality assurance schemes must be problem-orientated and coordinated; there must not be a difference in the quality of out-patient and in-patient medical care. (4) There has to be a systematic evaluation of the suitability of quality assurance schemes. (5) Transparency, communication and cooperation are preconditions for a successful quality assurance and quality improvement. (6) Continuous quality improvement is based on an extensive internal quality assurance. (7) The initiative for the priority development of internal quality assurance procedures must come from external quality assurance. (8) Quality assurance has only a chance of being realised if the individual is convinced and anxious to provide high-quality services, to continuously review and improve his services and to compare them with other services. (9) Quality has its price. (10) Quality assurance and continuous quality improvement are the cornerstones of a quality policy in the health care system. The article concludes with extracts from the checkup and the relevant literature.