,(#(!)/..")(#.#)(- ),#'*,)0'(.( 2&&(., ,)'"#!"*, ),'#(!&#(#&(.1),%- /&.3) ##( DBCK ,(#(!)/..")(#.#)(- ),#'*,)0'(.( 2&&(., ,)'"#!"*, ),'#(!&#(#&(.1),%- 0%+$+9/8$82$8;$ *%9+9(38:*%$%)8%%3(*+03936*+%3#:38R*S ::*%2+=%89+:@3(903 a_`g J.'#-#(-% %/&.. >&##-%,,(,/DBCK "0&"1,#!&11"022&,+113*&22"!2,2%" 3)27,#"!& &+";+&4"01&27,#1), 008+)*:8%9%8=%$K368:3(:*+96;"0+#:+321@"% 8%683$;#%$38:8291+::%$H+22@(38138"@2@1%29H>+:*3;:6%81+99+32K 3=%8J;$ .%8;0$9%2;))%a_`bH $%02$)099=%8/J8:3(%138+0:5@=+#:+19 %683$;#%$>+:*6%81+99+32 8+2:683$;#:+32J There is a crack in everything. That’s where the light gets in. (:%8`d=%8@+2:%8%9:+2)@%8992;89%2%9:*%:+9:H 9:8:%$1@7;0+:@+1683=%1%2:.3;82%@+2 `hh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`hhgH *=%"%%2+2=30=%$+2:*%+1683=%1%2:$=+938:%13(:*%0%82+2)#300"38:+=%93( :*%38>%)+2%$+#0993#+:+32RSK :*9"%%28%>8$+2)%((38:K*%$+8%#:38(38683(%99+320 #316%:%2#%H 299".582 301H+2+:+:%$2$12)%$:*%#300"38:+=%9K 9 2 %?6%8+%2#%$ 6*@9+#+2H*%fully understood the importance of involving the clinicians in a knowledge based “bottom up” approach to quality improvementH)83;2$%$321;0:+683(%99+320#300"38:+32H1%9;8%1%2: 2$/23>0%$)%P"9%$+1683=%1%2:);+$2#%K 9:8:%$1@8%9%8#*.3;82%@+2a__d>+:*9;6638:(831 299".582H:*%;0+:@+1683=%1%2:(;2$ 3( :*% H 2$ (831 1@ 0%$%89 :. 8>+:A 2$ 22 %903 : +2)%8+/% *396+:0K *% .3;82%@ +2#0;$%$9:;$@3(:*%+2:%00%#:;0;2$%86+22+2)93(7;0+:@+1683=%1%2::8:13;:*+2a__f2$ a__gH::*%(33:3(:*%7;0+:@+1683=%1%2:)+2:9;0:0$%22$;)%2%%0932H2$;2$%8:*% >+2)93(8.38+% 3$(8%@K 1(38%=%8)8:%(;0:31@0%$%89(389;6638:+2)1@9:;$+%9K *=%1$%1@*P9:;$@;2$%8:*%"8=%2$9;6638:+=%0%$%89*+63( +0$%/8%$:=%+:3%2H2$ :*% $+8%#:38 (38 683(%99+320 #316%:%2#% +2 %9:8% +/%2 0($2 99K 2$389+2) 1@ 9:;$@H :*%@ 003>%$1%:3.3+2*683)81::*%#;0:@3(1%$+#+2%+H(38:*8%%@%892$2+2%132:*9+2 g_6%8#%2:3(1@639+:+3299%2+38$=+938::*%7;0+:@$%68:1%2:3(%9:8%+/%2 396+:08;9:K 38/+2)(38931%:*+2))8%:%8:*21%H *=%*$:*%60%9;8%:3+2=30=%:*%139:%?#%00%2: 8%68%9%2::+=%93(:*%2%?:)%2%8:+323(*%0:*#8%683(%99+3209+2:*%683#%99K :+9+168%99+=%:3 >+:2%99 :*%+8 %?#%00%2: %((38:9 +2 :*% $%=%0361%2: 3( 9;##%99(;0 %$;#:+320 683)819 "3;: :*% #32:+2;0 +1683=%1%2: 1%:*3$ 2$ 9/+009 :3 2 +2#8%9+2) 2;1"%8 3( 0%$%89H $=+9389 2$ +1683=%1%2::%19:%9:8%+/%22$3:*%8*396+:09+23;8*%0:*8%)+32H2$:39%=%8038>%)+2 ;2+=%89+:+%92$#300%)%)8$;:%9K :*2/ ;2% ;(:%H %8+: 8+% 0582%9H 22% ;8+:A%2H 09% 8%+2%9H 9:8+$ ;2$%9)8$H 32% *38%9%2H8)8%: #3"9%2H;$00%2 ;)%2H%2:%329%2H%::%0"%8)H%2$%8+)=%$H *8+9:+2%8+%@))H%8%:%+2.82H8+%8)0+H0+9"%:* 9H+)$+9#*%%1"H2$%8P8+/ 303H:*%1%1"%893((38;1H2$001@3:*%8#300%);%9(38@3;8#336%8:+322$/23>0%$)% 9*8+2)K 2$$+:+32H *=%*;2$8%$93(683(%99+3209:3:*2/(38>*: *=%0%82%$(831:*%+8#*2)%%((38:9K *=%"%%2>38/+2)2$0%82+2):3)%:*%8>+:*:*%19+2#% 0%(:1@639+:+3292;89%2%9:*%:+9:+2 `hha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n this thesis, “we” means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aa ;0@P9:;$@ >+:*=0;"0%2$"83$%?6%8+%2#%(831#8+9+912)%1%2:H69@#*393#+09;6638:2$:8;1#8% >+:*+29;8)%8@H2%9:*%9+303)@H+2:%8201%$+#+2%H69@#*+:8@H2$(1+0@1%$+#+2%K :+9+1638:2:(381%:3#311%138:%$3#:38 3*230+2330%(38*+9830%+2:*%;9:+2"+0+:@9:;$@ 3(:*%9;##%99(;003#01%$+#08%96329%(:%8:*%:5@:%8838::#/K+89:H30+2>9=0;"0%93;8#% 3(+2(381:+32"@*+9639+:+329$;0#3112$%8:*:$@9H2$:*%2*%>91%1"%83(:*% 8%9%8#*:%1;2:+0*%9;$$%20@$+%$+2%"8;8@a_`cH+2:*%3;2:+293(*132+?K aaK ;0@a_``H30+2>9:*%*+%(%$+#0((+#%83(:*%9;8)+#0$%68:1%2:3(+2)%8+/%2$!8;1 *396+:0K9#%8:+(+%$$=2#%$8;1+(%;6638:RS+29:8;#:38H*%>9$8+=+2)(38#%+2:*% $%=%0361%2:3(:*%03#0%1%8)%2#@1%$+#09%8=+#%K 2:*%0:%(:%823323(aa ;0@H*%=30;2:%%8%$ (831=#:+32H9=+2)0+=%92$68:+#+6:+2)+2:*%:#:+#00%$%89*+6:%1>+:**+9*+)*0@668%#+:%$ #316%:%2#%K >2::3:*2/:*%R(%>S(8+%2$92$(1+0@1%1"%89>*3*=%"%%26@+2)1@9:;$+%9+2:%8%9:H2$ 00:*%3:*%89(38*%06+2)1%%9#6%(831:*+932)3+2)H+2:%29+=%=%2:;8%"@9;6638:+2)1@830%9 (8+%2$H9+9:%8H;2:H#3;9+2H13:*%8H13:*%8+20>H2$2%?:8%1%0@*66@)82$13:*%8:3:%23(:*% 139:>32$%8(;0$30%9#%2:92$#*+0$8%2K +200@H :*2/1@*;9"2$2$"%9:(8+%2$8@)=%K*2/@3;(380>@9"%+2):*%8%(381%K*2/ @3;(3868:+#+6:+2)>+:*6:+%2#%+21@8%(0%#:+3293=%8:*%/+:#*%2:"0%$@3;:2$$@+200:*%9% @%89H683=+$+2)1%>+:*);+$2#%H>+9$312$/23>0%$)%"9%$32@3;83>2#$%1+#.3;82%@H2$ 32@3;812@@%8999%2+3812)%8+208)%38)2+A:+329>*%8%#329:2:#*2)%+9:*%23810K 6 !)-+=6.&&+",4%",-,'"'"-"(', >9>9&) )(.(.- 8KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK` "*.,C8/'',#-6&#-.-( #(#.#)(-KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK` `K`K"0%3(#32:%2:9KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK` `KaK;118@KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKd `KbK*%9+99:8;#:;8%KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKe `KcK8+)+2066%89KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKf `KdK"0%9H+);8%92$3?%9KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKg `KeK 03998@Z""8%=+:+329KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKh `KfK 2$%?3(:*%9+?#32$+:+329(381/+2):*+2)9)38+)*:KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK`c 8 KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK`f "*.,D8,)&'-,#*.#)(KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK`f D8C8"3#1)."#-5KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK`f aK`K`K8@+2)*8$%8>+0023:>38/KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK`f aK`KaK*%=3+#%3(:*%*%0:*#8%683(%99+320KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK`g aK`KbK +)*6%8(381+2)*%0:*#8%9%8=+#%9KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK`h aK`KcK 2$+=+$;07;0+:@=%89;99@9:%17;0+:@KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK`h aK`KdK/+2)9%29%3(:*%38@2$+:9;9%+2+1683=%1%2:KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKa` D8D8",-,"+/-.#)(-) ."."-#-KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKaa D8E8&#(.#)() ."."-#-KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKab "*.,E8..) %()1&!KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKad
Details
-
File Typepdf
-
Upload Time-
-
Content LanguagesEnglish
-
Upload UserAnonymous/Not logged-in
-
File Pages276 Page
-
File Size-