Background : The purpose of this study was to investigate the understanding and the attitude of Korean hospital CEOs toward the healthcare quality improvement. Methods : A mailed questionnaire survey to the CEOs of hospitals with 400 beds or more was conducted between September 15 and October 30, 2000. Of the 108 hospitals eligible for the study, 58 participated, yielding a response rate of 54 percent. Result : The hospital CEOs have expressed that their hospital management was arduous job, and they had been pressured by increasing competitions among healthcare providers. They indicated that the low fees of health insurance made their hospital management difficult. The results also indicated that there was general consensus that the improvement of service quality was important in encouraging their organizations, but the investment of manpower and equipment ranked higher than the improvement of service quality. The majority of the CEOs have good understanding about quality improvement activities. However the facts that in general QI must be focused at the process of services and customer satisfaction, meanwhile quality improvement activities are helpful for the organizational productivity embarrassed them. The hospital CEOs responded that there were successful changes in terms of quality of care, patient satisfaction, and process efficiency after QI activities, but no increase in patient number and profit. Lack of understanding to QI activities and limited budget seem to attribute unsatisfactory outcomes. Conclusion : The majority of Korean hospital CEOs have a good understanding and attitude about QI activities. As mentioned in the result, despite of several limitations, several facts regarding the CEOs of hospital in Korean can be elucidated. (1) The general cognition of the QI project is relatively high, and it is accepted with positive concern, (2) the priority of the QI project, however, is not set higher than other projects and (3) the specific concepts of the actual QI project such as customer (patient)-focused work driving, the recognition of the work accomplishment, and the importance of rewards have not sufficiently understood.