[Evaluation of external quality assurance in accordance with sect. 137 SGB V at the Carl Gustav Carus university hospital in Dresden]. / Evaluation der Externen Qualitätssicherung gemäß § 137 SGB V am Universitätsklinikum Carl Gustav Carus Dresden.

BACKGROUND: Obligatory external quality assurance is an established method used to ensure the quality of inpatient care in Germany. The comprehensive approach is unique in international comparison. In addition to the statutory requirement, the health insurance funds require this form of external quality control in order to foster quality-based competition between hospitals. Ever since its introduction, healthcare providers have scrutinised the effects of the mandatory use of this survey. METHOD AND MATERIALS: The study was based on all patients in the University Hospital Dresden, for whom a quality assurance sheet (n = 45,639) had to be recorded between 2003 and 2011. The documentation of these sheets was carried out by specially trained personnel. For each performance area, the duration of the documentation quality sheets was assessed, and a descriptive analysis of all quality assurance sheets was conducted. In the presence of statistical significance the so-called "Structured Dialogues" were analysed. RESULTS: Over the whole period, 167 statistically noticeable problems occurred. Nine of these have been rated as noticeable problems in medical quality by the specialised working groups of the project office quality assurance (PGSQS) at the Saxon State Medical Association (SLÄK). The remaining 158 statistical anomalies included 25 documentation errors; 96 were classified as statistically significant, and only 37 were marked to indicate that re-observation by the PGSQS was required. The total effort estimate for the documentation of quality assurance sheets was approximately 1,420 working days in the observation period. DISCUSSION: As far as the quality of patient care is concerned, the results can be considered positive because only a small number of quality indicators indicate noticeable qualitative problems. This statement is based primarily on the comparison of the groups of Saxony and Germany, which are included in the quality report of external quality assurance in accordance with sect. 137 SGB V. The majority of noticeable statistical problems were due to documentation errors. Other noticeable statistical problems that are medically indicated, but without effect on the extramural care to patients, recurrently occur with the respective quality indicators. Examples include the postoperative mobility indicators of the implementation of endoprostheses which cannot be used to draw conclusions about patient outcomes. Information on the quality of life as well as the post-hospital course of disease would be important in this context, but is still lacking. The use of external quality assurance data in accordance with sect. 137 SGB V for evaluation research has so far been handled quite restrictively. Thus, in-depth analyses on the quality of treatment cannot be derived.

The evolution of dental group practices.

Dentists and the dental profession are changing. One significant change in the deliver of dental care is the evolution of group practices to include networks of dental practices with central management by various service organizations that are owned or financed by private equity firms. This article discusses their evolution and potential advantages and disadvantages for dentists who join them. The article concludes with a prediction about the future heterogeneity of the dental care system.

Power, ethics, and corporate dentistry.

The North Carolina Dental Association recently sought to place clear statutory limits on the influence of corporate, nondental interests over dentists practices' decision-making. This report describes the two-year legislative battle with well-funded and politically connected parties that ultimately resulted in laws that protect patients' rights to be treated by a dentist free of outside commercial interests.

La gestión de conflictos relacionales en las organizaciones de servicios / The management of relationship conflicts in service organizations

En el presente trabajo se explora la relación entre el conflicto relacional y el clima de servicio analizando el papel modulador de los estilos de gestión del conflicto y tomando como nivel de análisis la unidad de trabajo. La muestra está compuesta por 397 empleados de contacto directo con el cliente (recepcionistas y camareros) pertenecientes a 91 unidades de trabajo de hoteles y restaurantes de la Comunidad Autónoma Andaluza. Los resultados muestran los efectos perjudiciales que el conflicto relacional tiene sobre el clima de servicio y el papel modulador que ejerce el estilo de gestión integración en dicha relación. En concreto, cuando las unidades de trabajo, ante un conflicto relacional, utilizan la integración a niveles altos, éste no se relaciona negativamente con el clima de servicio. Así, se concluye que es la integración y no la evitación el estilo de gestión más eficaz para aminorar los efectos negativos del conflicto relacional en estos contextos (AU)

The main goal of this study was to explore the relationship between relationship conflict and service climate. To this end, we have studied which specific conflict management styles reduce or increase the relationship between relationship conflict and service climate at the work-unit level. Hypotheses were tested by tracking 91 work-units (397 employees) from 42 hotels and restaurants in southern Spain. Results revealed that relationship conflict is negatively related to service climate and that an integrating conflict management conflict style plays a moderating role in this relationship. This means that, when work-units use an integrating style to manage relationship conflict this conflict type is not related to service climate. Thus, the present study supports the idea that it is integrating and not avoiding the most effective style to manage the relationship conflict in these contexts (AU)

Los profesionales sanitarios titulados como elemento de cohesión: nuevo reto del Sistema Nacional de Salud / Health care professionals with degree as cohesion element: new challenge of the Spanish National Health Service

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Gestión de Políticas Públicas y Salud / Management of public policies and health

En nombre del proyecto Gestión de Políticas Publicas y Salud liderado en Antioquia por la Dirección Seccional de Salud y la Facultad Nacional de Salud Pública, agradezco a los organizadores la invitación que nos han hecho para que compartamos con ustedes hoy algunos de los conceptos y experiencias relacionados con la gestión de políticas públicas en salud. Los organizadores me han pedido especialmente retomar algunos conceptos básicos relacionados con el tema que hemos trabajado en otros espacios y que podrían facilitar el trabajo interinstitucional. Por eso he estructurado esta ponencia en cuatro partes. En la primera retomaré brevemente, a manera de glosario algunos conceptos básicos relacionados con la comprensión y gestión de las políticas públicas, cuya revisión podría facilitarnos lacomprensión del resto de la ponencia. A continuación desarrollo algunas reflexiones sobre las preguntas que podrían o deberían hacerse los agentes interesados por las políticas públicas de salud y sobre los métodos que podrían ayudarles a resolver sus inquietudes. La presentación termina con una conclusión que podría ser objeto de debate a lo largo del evento. Esta ponencia defiende tres ideas centrales: En primer lugar, que las políticas públicas que afectan la salud son siempre complejas y suelen ser principalmente extra-sectoriales. Por esta misma razón deben ser enfocadas interdisciplinaria y trans- sectorialmente. En segundo lugar, que la gestión de políticas públicas es el reflejo de intereses con frecuencia opuestos y por ello mismo debería incluir la participación de los afectados. Y finalmente, que los alcances de la participación de lasociedad civil pueden ser muy limitados si ésta no se organiza de manera efectiva.

On behalf of the Public Policies Development and Health Project led by the Divisional Management of Health an the National Faculty of Public Health in Antioquia, I thank the organizers for the invitation they made us to share some of the concepts and experiences related to the Public Policies Development in Health. The organizers have especially asked me to review some basic concepts related to the topic we have worked before, which could facilitate interinstitutional work. Due to what was mentioned above, this presentation has been divided in four parts. In the first part, I will briefly mention some basic concepts related to the comprehension and development of public politics, to facilitate the understanding of the rest of the presentation. The concepts are distributed in a glossary. Following this, I present some thoughts on the questions that individuals, interested in public policies of health and in methods that could be of help when answering inqueries, could or should ask themselves. This presentation defines three main ideas: firstly, the public policies that affect the health sector are always complex and tend to cover multiple sectors. Due to this, they should have an interdisciplinary and trans-sectoral focus. In second place, the development of public policies is the reflection, usually, of opposite interests, and therefore, should include the participation of those involved. Finally, the range of the civilian participation could be very limited, if this part of society doesn't become organized in an effective manner