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Table 1 Initial hypotheses (see [26] for more detail about how these hypotheses were developed, including a more in-depth consideration of their content)

From: Collective action for implementation: a realist evaluation of organisational collaboration in healthcare

The contexts of CLAHRCs will determine how the ‘programme’ plays out and will provide an explanation of those contexts that might be more appropriate or conducive.
 All action occurs within a context, which is multi-layered and multi-faceted. There is a growing evidence base about factors that have been identified that might explain whether contexts are more or less facilitative of implementation, including culture, communication, resources, leadership and tailoring of approaches/strategies (or not) to implementation contexts.
The way in which CLAHRCs’ interpret ‘knowledge’ will determine the importance and value they assign to different sources of knowledge and how these are privileged.
 Propositional and non-propositional source of knowledge have the potential to impact practice. Types of evidence from these sources (e.g. research, experience etc.) are often valued, and therefore privileged differently by different stakeholders.
How CLAHRCs develop ‘facilitation’ roles, including how they fit into their overall framework(s) for implementation, and the strategies, approaches and interventions they might employ will determine their success at supporting implementation-related activity.
 Facilitation and facilitators enable or make things easier—there are many roles that might (in theory) fulfil this function with a CLAHRC.
CLAHRCs with more effective patient and public involvement (PPI) strategies will achieve more relevant and impactful implementation.
 There is a very limited evidence base about PPI in implementation, but given what we know from PPI in research, for example through INVOLVE (, more relevant and impactful implementation may be determined by how they engage with stakeholder such as the public and patients in the locale.
How knowledge is prioritised and then particularised will vary within and across contexts, over time, and be prompted by the different choices of many stakeholders.
 How organisations store, share and learn from knowledge provides one indication of their capability as learning organisations. In theory, learning organisations are environments in which implementation and improvement might be more successful.
The way in which CLAHRCs’ respond to their local health, human and social geography will determine their ability to address implementation challenges that are important to the region.
 The CLAHRC’s commissioning brief was focused on delivering improvement in response to regional health priorities. Therefore, geography is an important aspect of a CLAHRC’s context, in that it has the potential to drive, shape and be impacted by service change.
How agents (those involved in producing and implementing CLAHRC work), beneficiaries (those that might profit/benefit from CLAHRC) and victims (those excluded or suffer opportunity costs) respond to the opportunities the CLAHRC offers, will help explain how and why the CLAHRC programme works (or not).
 As an interactive and deliberative endeavour, implementation processes and impacts are dependent on the individual and collective action of actors and agents working at different levels and places within the organisation(s).
A CLAHRC’s history, age and stage of development will impact on their approach and ability to implement knowledge.
 The funder’s expectation was for CLAHRCs to implement their own research within 3–5 years (this did not preclude them implementing existing research), placing an importance on the concept of time. Time therefore sets a frame of reference for any changes instigated, occurring and explained.
A CLAHRC’s approach to developing their formal and informal structures will vary and therefore will provide some insight into architectures that are more or less helpful for implementation through collaboration.
 In theory, structures and processes that enable closer engagement between health services and higher education should be those that facilitate relationship building and collaborative working.