Protocol: Identifying and mapping candidate interventions targeting relational contexts of hospitals - A review of the literature

Abstract Objective: To identify and map candidate interventions for improving the relational environment in hospitals, targeting aspects of context identified in realist programme theory. The findings will inform recommendations co-developed with stakeholders in Kenya. Introduction: The relational environment, or how health workers communicate and interact with one another, profoundly influences behavioural norms and is fundamental to the delivery of quality patient care in hospitals. However, it has been relatively neglected in interventions aiming to improve quality of patient care. We previously reported a realist synthesis of staff social ties in hospitals, and are currently refining the programme theory using realist evaluation. To inform upcoming stakeholder co-development activities, we now seek to identify and map candidate interventions which could target important aspects of context identified as influencing relational environment. Inclusion criteria: Relevant documents from credible sources in both the academic and grey literature. Interventions must primarily focus on the relational environment of hospitals and be relevant to our realist programme theory. Documents with richest and most relevant data will be prioritised for inclusion. Methods: Ovid Embase, Ovid Medline, and EBSCOhost CINAHL will be searched with no limits for language or publication dates. Reference lists of included documents will be screened. Grey literature will be purposively searched. Screening will be conducted by a single author, with a second screening a sample of retrieved documents to check for systematic error. Data will be extracted using NVivo and analysed thematically in NVivo and Word. Identified relevant interventions will be mapped and described by emergent typology.