title: Using clinical indicators to facilitate quality improvement via the accreditation process: an adaptive study into the control relationship.
abstract: OBJECTIVE
  The aim of the study was to determine accreditation surveyors' and hospitals' use and perceived usefulness of clinical indicator reports and the potential to establish the control relationship between the accreditation and reporting systems. The control relationship refers to instructional directives, arising from appropriately designed methods and efforts towards using clinical indicators, which provide a directed moderating, balancing and best outcome for the connected systems.
  
  
  METHODS
  Web-based questionnaire survey.
  
  
  METHODS
  Australian Council on Healthcare Standards' (ACHS) accreditation and clinical indicator programmes.
  
  
  RESULTS
  Seventy-three of 306 surveyors responded. Half used the reports always/most of the time. Five key messages were revealed: (i) report use was related to availability before on-site investigation; (ii) report use was associated with the use of non-ACHS reports; (iii) a clinical indicator set's perceived usefulness was associated with its reporting volume across hospitals; (iv) simpler measures and visual summaries in reports were rated the most useful; (v) reports were deemed to be suitable for the quality and safety objectives of the key groups of interested parties (hospitals' senior executive and management officers, clinicians, quality managers and surveyors).
  
  
  CONCLUSIONS
  Implementing the control relationship between the reporting and accreditation systems is a promising expectation. Redesigning processes to ensure reports are available in pre-survey packages and refined education of surveyors and hospitals on how to better utilize the reports will support the relationship. Additional studies on the systems' theory-based model of the accreditation and reporting system are warranted to establish the control relationship, building integrated system-wide relationships with sustainable and improved outcomes.
authors.affiliation: The School of Mathematical & Physical Sciences\Statistics, The University of Newcastle, Callaghan, Australia.
authors.forename: Sheuwen
authors.initials: S
authors.lastname: Chuang
authors.forename: Peter P
authors.initials: PP
authors.lastname: Howley
authors.forename: Stephen
authors.initials: S
authors.lastname: Hancock
mesh_terms: D000068:Accreditation / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D001315:Australia; D006739:Hospital Administration / Q000379:methods; D006761:Hospitals / Q000592:standards; D006801:Humans; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care / Q000458:organization & administration / Q000592:standards; D011795:Surveys and Questionnaires
keywords: accreditation; clinical indicators; control relationship; feedback; quality measurement and reporting; systems theory