Table 2.

Summary of search strategy, activities and results at each of the four steps

Step	Purpose	Activity	Interim results	Final result
1	To conceptualise implementation of large-scale hospital interventions.	Build an initial list of concepts and associated features based on research team’s research and clinical experience, validated by key informants on the wider project. Search databases for implementation of large-scale hospital interventions, screen title and abstract for relevance, data extraction.	5 concepts and 12 features listed. 381 articles found. 51 relevant articles. Exclusions: not hospital-based, not large-scale, implementation not described. 4 additional features identified from the literature.	5 concepts and 16 features identified and described.
2	To scope suites of implementation strategies used with large-scale hospital interventions.	Extracted data from Step 1 literature that report implementation strategies. Search for published literature on implementation and screen for large-scale hospital criteria. Include known literature. Individual studies extracted from reviews. Search of targeted websites and other grey literature. Strategies aggregated and sorted then mapped to ERIC implementation strategies.	45 articles. 585 reviews found: 31 found to include relevant studies some reporting on multiple implementation strategies. Data extracted from 5 sets of grey literature documents.	302 reports of 28 different implementation strategies identified and collated. 28 implementation strategies mapped to ERIC taxonomy, 1 did not map.
3	Identify potential initial programme theory areas.	Identification of potential initial programme theories using all data generated from the project so far plus other realist studies, compilations of programme theories and literature describing individual formal theories.	3 broad domains of action identified.	5 initial programme theories mapped to implementation strategies.
4	Focus on a promising implementation strategy-theory pairing and development of CMOs.	Research team workshop to develop initial CMO statements informed by Organisational Readiness Theory. Testing and refinement of CMO statements through review of literature from Steps 1–3. Final iterations of CMOs.	All data collected so far. 51 articles+4 articles that focused on organisational readiness assessment.	24 CMOs were hypothesised and literature used to support or refute them.

CMO, context–mechanism–outcome configurations; ERIC, Expert Recommendations for Implementing Change.