“…To cope with changing clinical routines, organisational and structural changes have to be realised and new regulatory mechanisms introduced. Against statutory duties in various countries to introduce internal quality management (QM) systems, the increased importance of this subject has led to numerous activities and successful health system certifications (Peters et al, 2004;Doebert et al, 2005;Jansen-Schmidt et al, 2001;Beholz et al, 2003, Staines, 2000.…”