Economic aspects have gained increasing importance in recent years. The operating room (OR) is the most cost-intensive sector and determines the turnover process of a surgical patient within the hospital. Thus, optimisation of workflow processes is of particular interest for health care providers. If the results of surgery are viewed as a product, everything associated with surgery can be evaluated analogously to a manufacturing process. All steps involved in producing the end-result can and should be analysed with the goal of producing an efficient, economical and quality product. The leadership that physicians can provide to manage this process is important and leads to the introduction of a specialised "OR manager". This position must have the authority to issue directives to all other members of the OR team. An OR management subordinates directly to the administration of the hospital. By integrating and improving management of various elements of the surgical process, health care institutions are able to rationally trim costs while maintaining high-quality services. This paper gives a short introduction into the difficulties of organising an OR. Some suggestions are made to overcome common shortcomings in the daily practise. A proposal for an "OR statute" is presented that should be a basis for discussion within the OR team. It must be modified according to individual needs and prerequisites in every hospital. The single best opportunity for dramatic improvement in effective resource use in surgical services lies in the perioperative process. The management strategy must focus on process measurement using information technology and feed-back implementing modern quality management tools.However, no short-term effects can be expected from these changes. Improvements take about a year and continuous feed-back of all measures must accompany the reorganisation process.

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The role of quality programs and criteria for performance excellence in hospitals is evolving. This gets even more important with the implementation of DRG systems. A future match of DRG compensations to documented quality standards cannot be ruled out. However, a clear cut definition of "health care quality" does not exist. Different systems of quality assessment are in use (ISO, EFQM, KTQ, JCAHO) and may help hospitals to define and document their quality standards.

Background: Clalit Health Services (CHS) is a large health care provider for 4.6 million enrollees in Israel. This is the country's largest medical organization with an annual budget of approximately 17 billion New Israeli Shekel (NIS). Rabin Medical Center comprising Beilinson and HaSharon hospitals is the biggest medical center of CHS, an academic, tertially, referral center, with 1200 beds, including all services of a modern hospital. Aim:To describe the establishment process of integrated quality assurance and patient's safety service and to evaluate its success in 4 years of activity. Quality indicators (process and outcome) were developed and monitored. Improvement was assessed by comparing the results of 2013 and 2016 indicators. Methods:We believe in "No blame or shame" and "To err is human" strategy. The patient is always in the center, continuous learning is being conducted with conclusions and improvement plans, implementation and systematic approach, measuring and proactive activity to improve patient safety. We used Plan Do Check Act (PDCA) cycle in most of the processes. Results:We established 4 units: quality assurance, risk management, regulation committee for policy, strategic affairs and legal aid, and unit of quality indicators and quality working plans. Quality improvement plan was performed every year. We demonstrated a significant improvement in most of the quality indicators measured. Conclusion:Organizational changes focused on patient safety, based on clinical protocols, quality indicators and special committees, brought the hospital to new, high level, achievements. We believe that our patients enjoy high level quality of care in the hospital safe environment.