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INTRODUCTION Today's healthcare environment dictates that management decisions are clinically sound, operationally efficient, financially responsible and supportive of current health service strategic initiatives and policies. Furthermore, it is also recognised that clinical decisions should be based on the best possible evidence of effectiveness (National Health Service Executive, NHSE 1998). However, there has been increasing recognition that many practices in health care are based on tradition or local circumstances. Some commentators assert that healthcare suffers from a lack of relevant, comparative information based on clinical outcome measures (Teisberg, Porter and Brown, 1994). The National Health Service in the United Kingdom (UK) is being encouraged to ensure uniform provision of high quality health care (Department of Health, DoH 1997). According to Ellis (2000a), the concept of quality as it relates to health care is a complex, seldom defined and requires constant analysis and clarification. Notwithstanding this, the modern health service has extended the requirements...

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