Health care reform, health care modernization law and new organizational forms of treatment are continuously and progressively challenging hospitals. To master these successfully, new quality management systems are put into action. The goal of the quality management of the university medical center Knappschaftskrankenhaus Bochum is to continuously improve processes and methods in patient care: recognize weaknesses via patients questioning and to analyze and remedy them. This includes the initiation and guidance of in-house projects (suggestion systems, emergency room management, care guidelines, patient security, CIRS, fire prevention, route orientation system, clinical standards of treatment, work safety) as well as writing the obligatory annual quality report. Special emphasis is on the certification of the hospital through the KTQ (cooperation for transparency and quality in health care). In 2004 the Knappschaftskrankenhaus was the first university medical center in Germany to be certified for its excellent work with this quality label and has been certified five times in succession.