A Systems-Theory Based Approach to Healthcare: Exploring the Utilities of Quality Indicators through Accreditation Surveyors

Project: A - Government Institutionb - Ministry of Science and Technology

Project Details


The use of accreditation and quality measurement and reporting systems (QMR) in health care to improve healthcare quality and patient safety has been widespread across many countries. Whilst exhausting considerable resources of the participating agencies and health care organisations (HCOs), these systems are believed to induce quality outcomes. Despite the interest, an organisation’s improvement in quality has been found to be not well correlated with satisfying the accreditation requirements and the implementation of QMR systems. In cases where HCOs achieve accreditation and their QMR approaches are deemed acceptable, partial, inconsistent and conflicting success in improving quality has resulted. Chuang and Inder identified a holistic healthcare systems relationship model based on the systems theory. The model provides the platform for a series of adaptive studies into the control and communication relationships between the accreditation system, the QMR systems and the HCO-level healthcare system for quality and patient safety improvement in health care. Four relationships were revealed and evaluated as not satisfying with the current expectation. For a stable safety state and the sustainable quality improvement in health care, a feedback loops of information and control mechanism between the interrelated subsystems is required, in which the development of the control relationship between accreditation system and QMR system is an essential driver. To facilitate a better understanding of this important, but undeveloped, control relationship, and thus the potential to initiate the redesign of the current healthcare system’s components towards achieving the desired benefits through the systems theoretic model’s approach, a case study of accreditation surveyors in health care was designed. The study is to identify the current status of this control relationship from accreditation surveyors’ perspective, and consequently to suggest the requirements of systems redesign for developing integrated feedback loops among these three sub-systems in health care
Effective start/end date8/1/117/31/12


  • hospital accreditation
  • accreditation surveyor
  • quality measurement and reporting systems (QMR)
  • quality indicators


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