The exact documentation is a principal problem of quality assurance systems (QAS), from the very beginning of the design to the final implementation and continuous operation of the system.
Spain has some tradition of quality assurance systems, although less than in Anglo-Saxon countries.
This could be attributed to lack of quality assurance system in the animal feeds value chain in Kenya.
For example, Zardawi analysed the implementation of a quality assurance system that is primarily designed to reduce errors but they also found a reduction of TAT, even though it was not their main objective [ 158].
The implementation of quality assurance measures in Germany since the nineties initiated a process, which also affects changes in the health system culture: Traditional reservations need to be overcome for new patterns of interdisciplinary and interprofessional cooperation.
Much work has been done to ensure high quality of microscopic examination by implementation of quality assurance measures.
The interviews with the clinic providers were shorter, as they were describing their personal experience with quality assurance and often served as a means to verify the clinic-level implementation of quality assurance practices described by the NGO.
It identified different situational and operational factors at the national, hospital and topic level, that seemed to influence the effectiveness of strategies for the implementation of quality assurance.
Accordingly it is a principle to make providers and insurances responsible for the implementation of quality assurance measures including the necessary financing.
For a European collaborative teleradiology model to succeed, the most crucial challenges are: implementation of a solid quality assurance system, seamless integration with electronic patient records, solutions to assure the quality and increase the value of radiology reports and solutions to improve communication with (locally) referring clinicians.
