Integrating clinical indicators (CIs) within the accreditation process has become a national priority and proposed policy in Taiwan for continuous quality improvement of healthcare. This study revealed important strategies required to support implementation of such policy. A survey of 249 surveyors was undertaken by questionnaire surrounding the use and perceptions of CIs of four nationwide quality measurement systems (QMSs). Five key messages were identified and interpreted in light of a holistic healthcare systems relationship model: (1) surveyors’ use of CIs was positively associated with the level of their understanding of the indicators and hospitals’ use; (2) hospital's use of CIs was positively associated with the length of time the QMS existed; (3) surveyors responded to abnormal CIs by assuming auditor, investigator, and/or consultant roles; (4) a gap exists between surveyors’ perceptions of CIs’ suitability for key parties and their need in the accreditation process; (5) over half of surveyors reported that hospital accreditation needs improvement, with positive and negative comments about using CIs. Developing value-added reports, increased training and support, encouraging surveyors to assume multiple roles, and mandatory CI use would collectively better integrate CIs within the accreditation process and enhance relationships between QMS, hospital accreditation, and healthcare delivery systems.
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