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Furthermore, there is a particular challenge with respect to introducing performance-related payment: It is difficult to define objective and commonly accepted performance criteria and even more difficult to implement and apply those performance criteria, given political interference and lack of good governance and transparency and the existence of corruption as well as nepotism.
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Grouped self-assessments are particularly important for program evaluation in the Portuguese context, where it is difficult to define an objective measure of clinical competence which can be considered the gold-standard at a national level.
Standard UICC International Union Against Cancerr) criteria were used to define objective clinical response [ 9].
The appropriate use of radiology services is difficult to define, since an objective measure to assess the value of radiology procedures in terms of improved health care outcomes is currently lacking [ 4- 6].
Given that it is difficult to define entities by a lack of findings, an objective definition for pediatric oligodendroglioma will likely remain a challenge until these tumors are better characterized at the molecular level.
Also the concept of "validity" of QoL instruments has been particularly difficult to define and measure due to the lack of an agreed and objective gold standard of QoL.
There are differences in objectives for other organizations that make overall quality difficult to define.
The lack of dependency on a cellular objective is a marked advantage of this approach as the latter is difficult to define for multi-cellular organisms.
Premature ejaculation is difficult to define.
American Folk art is difficult to define.
Interesting prose is difficult to define.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com