Table 5 Categories of outcomes of alignment

EBI implementation

(n = 31)

A large proportion of the included studies described alignment as a facilitator in the process of implementing an EBI, such as a program/model or a strategy/practice (Additional file 3, column 7). Out of these articles, a majority (n = 21) describe alignment as vital for implementation success [18, 21, 25, 27,28,29,30, 36, 37, 40, 47, 49,50,51,52,53, 56, 60, 63, 69, 71]. For example, implementation was facilitated by alignment of the program with organizational goals and values [21]. Additionally, Kegeles et al. [71] concluded that when actors were aligned, implementation of an EBI became more effective. Five articles in this category describe failure of implementation due to lack of alignment [19, 22,23,24, 55]. For example, Sorensen et al. [23] highlights a lack of alignment between EBI and existing workflow, which resulted in a barrier to implementation. Some of the articles discusses outcome of alignment from both perspectives [1, 22, 34, 58, 71], for example, that alignment is a necessity to succeed with an EBI and that misalignment can result in fragmentation, poor quality, and soaring costs of care [1].

EBI sustainment

(n = 5)

Five studies describe alignment as an important prerequisite for sustaining the achieved change. These studies targeted both organizations [36, 54, 66] and population [59, 62].

Healthcare performance

(n = 18)

All articles in this category described alignment as important in change efforts initiated to improve organizational performance and/or improve health care, with the overall aim to improve capacity and/or quality of care. This category contains various strategic initiatives where alignment is part of improved care performance, for example to achieve coordination of change efforts [46] or to improve change management [65]. Data in this category consists of descriptions where alignment has contributed to improvement in healthcare [1, 20, 26, 32, 33, 46, 50, 57, 61, 64, 65, 67, 68] and/or where it is claimed that alignment was necessary in order to achieve improvements in healthcare [1, 31, 34, 35, 44, 48].