Articles from the search process were imported to Rayyan [ 13]. Next, all abstracts were screened separately by two reviewers (RL and research assistant 1). At weekly meetings, conflicts detected in Rayyan were discussed between the two reviewers, and if necessary, with a third reviewer (AR or HH). If disagreement remained after discussions, the article was included for full text screening. Throughout the review process, we exercised the recommended approach for retaining a high inter-reviewer reliability when reviewing topics that may include difficult judgements [ 14]. In this case, primarily to make sure that selected studies included a conceptual use of alignment (i.e., that describe inter-linkage of an EBI with elements of the inner and outer context of a health care organization, or elements of the inner and outer context with each other as a consequence of implementing an EBI). Use of the term alignment to describe other phenomenon’s (e.g., that results are in alignment with previous findings, or alignment between salary and performance) were excluded.

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