A main reason is that autonomy, participation and decision making are theoretical and multifaceted concepts which are difficult to operationalize and measure in practice.
Based on this study, there is a need for acknowledgment at the macro level that aspirational goals seem difficult to operationalize and implement in the current regulatory regime, and there is a need for more knowledge on the role of the macro-level institutions in assisting in the implementation of government expectations for QI in health care.
Though it proved difficult to operationalize and apply in the past, it remains appealing and variations on the theme proliferate as peace dividend, violence mitigation or conflict transformation.
This strategy may require high formalization of interactions between providers and may be viewed as difficult to operationalize in a context where providers have varying schedules and high caseloads.
In relation to the second reason, i.e. 'attitude' is a hypothetical construct which is difficult to operationalize and measure, we believe it is important to apply the general theoretical frameworks of this construct in social psychology to the needs of a particular research situation (see also Fan & Ji, [2014]).
Generic definitions are more difficult to operationalize, and they trade specificity for generalizability; disaggregated definitions recognize that quality has different essential components, each providing only a partial picture of quality, but together the components create a more specific description of quality for particular aspects of health care.
From experience, we have found that general models lack specificity, are therefore difficult to operationalize and subsequently inconsistently applied.
To some degree, psychosocial adjustment has been seen as a vague criterion, difficult to operationalize and not suitable for objective quantification.
Secondly, the variables that vary within each country (between hospitals or over time) are often difficult to operationalize and data may not be available.
