The evidence on evidence is conclusive. Incorporating evidence in decision-making processes can improve decision-making outcomes (Davies and Nutley 1999), but few healthcare systems have embraced the use of evidence to the extent needed to achieve the potential benefits. Throughout the world, health systems have "not delivered the desired health outcomes that are possible with current professional knowledge " (Ibrahim and Majoor 2002) . Browman, Snider and Ellis have suggested that there has been a lack of systems - level uptake of evidence-based healthcare: While systems may have access to the evidence, existing structures and processes have not facilitated effective transfer to operations.

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