4.3. Limitations
There are two limitations that should be noted in this paper, Firstly, a small number of studies related to the objective of the present study, i.e., 24 “relevant” articles ,had been identified by the systematic review of literature. This seems to derive primarily from the stringent selection criteria that we adopted, in particular indicators from multiple measures and application to actual setting. Therefore, we should have applied more lenient criteria, excluding gone or a few of these conditions from the selection criteria, to obtain a larger number of relevant papers. However ,the main purpose of the systematic review was not identification of an exact set of “useful” indicators for hospital management, but preliminary selection of potential indicators. Therefore, we believe that the indicators extracted from the 24 relevant articles were applicable enough for this purpose. Secondly, only a small number of healthcare experts participated in the questionnaire survey for “usefulness” rating of potential indicators. It may also be plausible that data collected in the survey were somewhat biased since all of the respondents were healthcare staff working for the organizations of the project members. In addition, they were more likely to make positive rating and were reluctant to view indicators negatively for their usefulness. The present paper reported a pilot study on holistic hospital management based on performance indicators which will be applied to the Japanese context.