title: [Health insurance dentists' subjective perceptions of quality when implementing quality management in practice - results from a nationwide survey].
abstract: BACKGROUND
  Statutory health insurance dentists working in private practice have a duty to maintain and improve the quality of dental care. An individual practice's approach to quality management (QM) can be made to reflect the practice's philosophy on quality and standards and can be adapted to the specific requirements of the practice setting they are meant to serve. This study set out to collect data on the subjective perceptions of quality that exist among German dentists, and to canvass their views on the process and benefits of implementing QM systems. In doing so, this study aimed to identify the incentives and obstacles that currently exist in relation to the implementation and further development of practice-based QM systems.
  
  
  METHODS
  As part of a nationally representative cross-sectional study, a random sample of 2,084 dentists was asked to complete a questionnaire on perceptions of quality and QM. The response rate was 40.3 % (n=838). The study's primary end point was defined as the surveyed dentists' interpretative description of quality. The study's secondary end point was defined as the dentists' subjective evaluations of the benefits of QM in the day-to-day management of their own practices. Responses to open-ended questions were analysed using content analysis, while quantitative questions were analysed using descriptive univariate analysis.
  
  
  RESULTS
  When analysing respondents' subjective perceptions of quality (primary end point), the following dimensions were revealed as highly significant: patient (mentioned by 31.4 % of the responders), quality of treatment (29.5 %) and staff (14.8 %). As far as the benefits of QM in the day-to-day management of the respondent's own practices (secondary end point) were concerned, these appeared to be linked to the ease of implementation of the organizational tools offered by QM systems: managing emergencies, team meetings and procedural check lists were ranked as "can be implemented to a reasonable degree" and "can be fully implemented" by 82.3 %, 80.2 % and 79.9 % of respondents, respectively. There appeared to be a disconnect between the respondents' subjective perceptions of quality and the benefits of QM as part of day-to-day practice management, with QM systems failing to reflect the respondents' subjective views on quality.
  
  
  CONCLUSIONS
  The perceptions of QM among German statutory health insurance dentists are generally positive but marked by a disconnect between aspects of quality currently measured by QM systems and the dentists' views on what is required in order to assess quality standards in relation to the dimensions "patient", "quality of treatment" and "staff". A targeted review of the tools offered by QM systems may lead to improved ease of implementation. If QM is to form an integral part of clinical practice, all future developments need to consider the dentists' subjective perceptions of quality and their attitudes towards QM.
authors.affiliation: Institut der Deutschen Zahnärzte (IDZ), Köln, Deutschland. Electronic address: n.kettler@idz-koeln.de.
authors.forename: Nele
authors.initials: N
authors.lastname: Kettler
authors.affiliation: Zentrum Zahnärztliche Qualität (ZZQ), Berlin, Deutschland.
authors.forename: Regine
authors.initials: R
authors.lastname: Chenot
authors.affiliation: Institut der Deutschen Zahnärzte (IDZ), Köln, Deutschland.
authors.forename: A Rainer
authors.initials: AR
authors.lastname: Jordan
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003625:Data Collection; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards*; D003815:Dentists; D005260:Female; D005858:Germany; D019538:Health Care Surveys / Q000379:methods* / Q000592:standards; D006284:Health Plan Implementation / Q000458:organization & administration* / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration* / Q000592:standards*; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D011795:Surveys and Questionnaires; D017749:Total Quality Management / Q000458:organization & administration* / Q000592:standards*
keywords: Befragung; Dentistry; Einstellungen; Qualitätsförderung; Qualitätsmanagement; Zahnärztliche Versorgung; attitudes; continuous quality management; quality improvement; survey