Knowledge on the effect of improvements on system performance (element #3) requires special types of measurement, techniques that include time in the analysis, as all improvement involves change over time gaining this knowledge also requires the use of balanced measures that accurately reflect the richness and complexity of the phenomena under scrutiny. A knowledge of particular contexts (element #2) is developed by enquiry into the identity of local care settings-their processes, habits and traditions. The generalisable scientific knowledge we need (element #1) is constructed from empirical studies that work to control context as a variable, thus minimising or eliminating its effect on what is being studied. Figure 2 Formula illustrating the way in which knowledge systems combine to produce improvement.Įach of the five elements in this equation is driven by a different knowledge system (table 2 2).
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