The US health care system is plagued by a paradox. Creativity is prized and innovation is commonplace, but clinical quality, at least as judged in comparison with other industrialized countries, is seen as lackluster.1 One aspect of this problem is the large gap between the generation of evidence, which would be produced by a well-conducted clinical trial, and the reliable implementation of that evidence in the community hospital.2 One of the difficulties in translating and applying evidence to the bedside might relate to hospital organization.3
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