Table 7 Categories of strategies to achieve alignment

Design and prepare

(n = 15)

Designing an EBI with alignment in mind increases chances of implementation success [48, 60, 67, 68]. Especially as the complexity of implementation increases with size of organization [55], number of strategic plans [35] and with poor goal specificity [44]. The involvement of staff or employees in general was also highlighted as important during preparation, as well as during implementation and sustainment of the EBI [23, 44]. To prepare by allocating time and resources [29, 33, 46, 57], having protocols emphasizing alignment [30], training staff [44], and establish groups in the organization to ensure alignment [51], was thus considered as an important strategy.

Contextualize

(n = 12)

The need for contextualization on different levels in healthcare systems was highlighted in a couple of the included studies. For example, to be able to successfully implement future heath care reforms there is a need to anchor suggested changes with staff in the concerned context and align changes with their values [70]. On lower system levels an overall organizational preparedness [44], integration of EBIs into existing clinical practices [25, 53, 71], facilitation of relationships between organizations [30] and consideration of organizational culture [48], may contribute to achieving alignment. Wood [46] demonstrates that to succeed with an implementation, communication of change need to be tailored to the context from which the target audience derives. Both Wood [46] and Postema et al. [28] highlighted the importance of understanding trends and variation among hospitals to allow context specific adaptation beneficial for alignment. Additionally, individuals with the right contextual experience and capacity need to be lead the implementation [34, 54, 69] and staff need to be included from all levels of the organization [67]

Communicate

(n = 7)

To communicate was raised as an important strategy in creating and/or sustaining alignment [1, 44, 60], for example in order to achieve a shared understanding of goals and strategies [6, 20, 33, 37]. Training could also be seen as a type of communication effort, for example, for example, Nazi [25] devoted part of a training to alignment of system use with clinical workflow. Also, patient activation was highlighted as an implementation strategy that may initiate and guide patient-provider discussions with the potential of aligning the priorities of patients and providers [49]. Feedback was specifically important, allowing for the refinement of plans and goals necessary for alignment within or between organizations [25, 44, 46, 65].

Motivate

(n = 5)

Incentives were mentioned in one study as a motivator to facilitate perceptual alignment [44], while three studies highlighted motivation in general as key [1, 68, 71]. O’Reilly et al. [47] suggested that the articulation of having a new strategy in place could be seen as motivating.

Evaluate

(n = 5)

Evaluation of alignment throughout the implementation process was concluded beneficial for creating and/or sustaining alignment [22, 24, 26, 38, 45].