Table 6 Categories of involved actors of alignment

Leaders

(n = 29)

In the original articles actors named as change management specialist, executive leader, executive director, leader, manager, project leader, project manager, senior leader, supervisor and unit heads were included as leaders in this review. The term leader was used most frequently [1, 29, 30, 34,35,36, 47, 50, 52,53,54, 56] followed by manager [22, 29, 33, 44, 64, 67, 71]. For example, project leaders were said to have a crucial role in creating alignment [31, 32, 55] and managers were described as responsible for providing employees with motivation and enthusiasm in the alignment progress [31]. Harrison et al. [53] emphasize that participation and support from upper management in a strategic initiative is key to align organizational priorities and O’Reilly et al. [47] confirms that alignment of leadership across hierarchical levels is vital for successful implementation of a new strategic initiative.

Healthcare providers

(n = 28)

Identified healthcare providers in this group of actors were: nurse, physician, clinician, counsellor, project team member, service provider, social worker, health promotor, healthcare staff, healthcare provider/stakeholder, health system provider, coordinator, primary caregiver and inter-professional team member. Nurse appeared as the main actors involved in creating and/or sustaining alignment [13, 18, 26,27,28,29,30, 33, 42, 55, 57, 58, 68] followed by physicians [18, 26,27,28, 30, 42, 55, 57].

Change agents

(n = 7)

In some articles, different kinds of change agents were involved actors in the process of creating and/or sustaining alignment [18, 19, 23, 29, 37, 55, 66]. A change agent was described as an actor facilitating the change process providing knowledge and support to those involved in the change [37, 55]. A change agent also evaluated project progresses and adapted change strategies if needed [55, 66]. In one study, a change agent was described as “the champion during the intervention” facilitating sustainment [66]. All articles emphasized that a change agent’s mission was to align employees, visions and practices for a positive implementation outcome.

Administrative staff

(n = 7)

Administrative staff was a group of actors involved in creating and/or sustaining alignment. Administrators were identified as the main actor in this category [6, 21, 37, 46, 67], followed by information technology staff [21, 22, 26]. In a study by Selick et al. [37], administrative staff was part of the implementation team and contributed with their content expertise in the process of both developing and adapting tools. It was pointed out that it was a facilitating factor to have a strong inter-professional team, and lacking some expertise, e.g., the administrative staff, created challenges to perform tasks.

Community actors

(n = 5)

Community actors refer to health promoters who are not affiliated with a specific organization, i.e. community members [30], community-collaborative stakeholders [30], community health workers [60], provincial actors [60], school stakeholders [61], and non-governmental organizations [19, 57, 60]. Main tasks for community actors were to create and/or sustain alignment between, for example, donor countries’ development efforts with local strategies and systems [19]. Two articles highlighted non-governmental organizations as important actors in the creation and maintenance of alignment [19, 60].

Policymakers

(n = 5)

In some studies, policymakers were identified as actors in the process of creating and/or sustaining alignment. Policymakers were identified from the following actors: political leaders [18], politicians [60], Ministry of Health [57], agencies [66], and policymakers [17]. This group of actors were vital in the creation of alignment by, for example, contributing to management of demand and access and demonstrating policy alignment [18].

Patients

(n = 3)

Three studies [17, 49, 52] describe patients as actors involved in creating alignment. Patient activation was emphasized, i.e. the importance of aligning patient's and provider's objectives to facilitate the outcome of the EBI [49].

Other

(n = 6)

Other types of actors that contributed to creation and/or sustainment of alignment were identified, such as donors/funders [35, 57], epidemiologists [65], doctoral students [32], potential users of secondary data [17], civil liberties groups [17], and public [52].