Table 1 Realist terminology

Context-mechanism-outcome configurations (CMOc)

“CMO configuring is a heuristic used to generate causative explanations about outcomes in the observed data. A CMO configuration may be about the whole program or only to certain aspects. One CMO may be embedded in another or configured in a series (‘ripple effect’ in which the outcome of one CMO becomes the context for the next in the chain of implementation steps). Configuring CMOs is a basis for generating and/ or refining the theory that becomes the final product of the review” [36].

Context

“Context can be defined as all factors that are not part of the program or intervention itself, the “backdrop” to implementation, yet does interact, influence, modify, facilitate or hinder the intervention and its effectiveness (in our case the sustainability of Lean efforts)” [37].

Mechanisms

Mechanisms are the combination of resources (intended and unintended) offered by a social program under study (Lean) and the response to those resources (cognitive, emotional, motivational reasoning etc.) by stakeholders [24].

“Causal mechanisms are underlying entities, process or structures which operate in particular contexts to generate outcomes of interest” [38].

Outcomes

“Outcomes are a result of a program firing multiple mechanisms which have different effects on different subjects in different situations, and so produce multiple outcomes. Realist evaluators examine outcome patterns in a theory testing role. Outcomes are analyzed to discover if conjectured mechanism/context theories are confirmed” ([24], p., 217).