Other limitations are inherent in the observational study design, including the difficulty of measuring implementation levels and the large number of unmeasured factors and interactions that influence outcomes in real-world settings.
With this in mind, in an earlier project we created the Clinical Governance Development Index (CGDI) designed for tracking clinical governance development, with a focus on structures and processes and on measuring implementation of government policy [ 15].
Even though there is an explosive growth in design and operational measures implementation and growing research interest in investigating their impact on performance indicators, there is lack of a systematic evaluation of their benefits.
The EU project SPARD (Spatial Analysis of Rural Development Measures) took those data as a starting point to find out more about the causal relationships between RD measure implementation, and their determining factors and impacts with a specific look at their spatial dimension: in which rural development measures is success determined by neighbourhood conditions, and at what scale?
The legislation states that it will reject "material support" of the measures' implementation, and goes on to claim that any person found to be exercising powers established in Sections 1021 or 1022 would risk criminal penalties.
Furthermore, quality systems following the whole chain of outbreak management (alert, outbreak control measures, implementation, and evaluation) are needed.
Ongoing surveillance is needed for rapid diagnosis, risk factor investigation, control measure implementation, and further virus characterization.
We were unable to directly measure the implementation and effect of the national public awareness campaign, fast-track protocols and prehospital triage.
From the research perspective, researchers across discipline need to incorporate more rigor towards the definition of the study questions, methods and measures, implementation procedures, and reporting.
The conclusions, then, would have allowed for specific propositions as regards to the identification and management of the policy problem, the ability of the Dutch governments and its agents and structures to take measures leading to implementation, and measured descriptions of facilitators and barriers beyond the control of government that impact on the implementation process.
