German health care is known for its rather strict and historically evolved separation between the various sectors. A new cross sectoral quality assurance QA)system aims to overcome this fragmentation. After a European wide tender, the Joint Federal Committee commissioned the AQUA-Institute with implementing a new QA system. From 2010, AQUA will also take over the task of external QA in the hospital sector, which so far was the responsibility of the Federal Office for Quality Assurance BQS).