Germany

The German healthcare system is characterized by a principle of subsidiaries, which implies a decentralization of power, as well as by a strong separation of different sectors of care such as inpatient and rehabilitation care. These conditions may impede the successful implementation of healthcare reforms that address quality of care and patient safety. However, since the 2000s, several reforms have been introduced. Among these are: obligatory quality management (QM) in the outpatient and inpatient setting, hospital quality assurance with publicly available quality reports, disease management programs (DMPs) for chronic diseases, and integrated care contracts to overcome sectoral separation. These reforms have transformed the quality and safety landscape where new institutions have emerged. However, whether these reforms have made an impact on patient outcomes remains controversial. The most important barriers for future development of the quality and safety landscape lies in the fragmentation of the healthcare system, limited transparency, access to data, and, on a more general level, the lack of a patient safety culture and a lack of system thinking in German healthcare.