Although many quality improvement frameworks havebeen developed in Western counties, relatively few in Japan(but see [21]). Several studies have shown that differencesin national culture make it questionable to transfer resultsacross cultural borders [22,23]. In this paper, we report aconceptual framework for performance measurement as apilot study on holistic hospital management in the Japanesehealthcare context. The conceptual framework was createdand a minimum set of indicators were determined by theuse of a systematic review of literature and a questionnairesurvey to healthcare experts. We also discuss implicationsof the theoretical framework with respect to its applicationto actual settings.