<![CDATA[Introduction. Hospital accreditation is widely used to assure quality and patient safety, yet evidence on its association with clinical outcomes remains inconsistent, and the role of risk adjustment in producing fair performance comparisons is still underdeveloped, particularly in Indonesia. Method. This article presents a conceptual synthesis and evidence-mapping framework built on literature identified to date, guided by Joanna Briggs Institute principles and reported following PRISMA-ScR; the definitive search, screening, and full-text selection process remains underway, and the final search dates, eligibility parameters, and protocol registration have not yet been finalized. Result & Analysis. Mapped evidence spans multiple study designs and health systems and shows that accreditation is more consistently associated with structural and process measures than with hard clinical outcomes such as mortality and readmission, while risk-adjustment practice increasingly incorporates demographic, clinical, and social variables that can materially change hospital performance classification. Discussion. These patterns indicate that transforming accreditation into outcome-based accountability requires methodological change, not only conceptual reorientation, with risk adjustment serving as the mechanism linking clinical outcomes to fair institutional comparison. For Indonesia, integrating outcomes into accreditation is more realistic as a staged process, supported by stronger data quality, interoperability, and validated risk-adjustment models suited to national conditions.]]>
