Our beginning assumption was that if systems thinking took place as a result of LDP practices, this would support LDP institutionalisation.
We recommend that the LDP could be strengthened by a more explicit integration of CQI philosophy and principles into its existing tools, and greater attention paid to context to support its institutionalisation.
Once ended, there was little evidence of teams' efforts to support LDP institutionalisation. None of the five teams engaged in another LDP cycle, no new staff were oriented in the LDP, no funds were set aside for LDP activities, and meeting minutes and staff conversations no longer reflected mention of the LDP.
The results showed that the organisational setting and the broader community environment supported program institutionalisation; whilst the design and implementation of the program worked against institutionalisation.
This focus on creativity stimulates systems thinking, which supports LDP institutionalisation.
Multiple, reinforcing feedback mechanisms (R1 and R2) neither supported LDP institutionalisation, nor systems thinking among district teams (O).Had our original assumption been borne out, we would see a third reinforcing loop (R3) between systems thinking and LDP institutionalisation.
(22) Future project involvement should shift its focus from school-based support to countrywide institutionalisation of CFS concepts.
Lastly, we are collecting information on factors that can influence QoL, as demonstrated in the literature, such as acute disease for both the patient and his/her primary caregiver, change in home care support, hospitalisation or institutionalisation [ 37].
He emphasises that both dimensions risk being ineffective if not supported by thorough institutionalisation of an articulate system of rules and roles capable of defending the public and private rights of citizens, together with the legitimate interests of governments.
