CC BY 4.0 ATTRIBUTION 4.0 INTERNATIONAL DeedMead, Elaine ShelfordTeeling, Sean PaulMcNamara, Martin2024-07-152024-07-152024-07-02Mead, E.S., Teeling, S.P. and McNamara, M. (2024) ‘A realist review protocol into the contexts and mechanisms that enable the inclusion of environmental sustainability outcomes in the design of lean healthcare improvement interventions’, International Journal of Environmental Research and Public Health, 21(7), p. 868. Available at: https://doi.org/10.3390/ijerph21070868.https://eresearch.qmu.ac.uk/handle/20.500.12289/13817https://doi.org/10.3390/ijerph21070868From Crossref journal articles via Jisc Publications RouterHistory: epub 2024-07-02, issued 2024-07-02Article version: VoRPublication status: PublishedSeán Paul Teeling - ORCID 0000-0002-4102-7280 https://orcid.org/0000-0002-4102-7280Healthcare makes a significant contribution to the social, economic and environmental benefits of communities. It is correspondingly a significant employer and consumer of both energy and consumables, often at high costs. Lean, a quality improvement methodology focuses on the elimination of non-value add (NVA) activities (steps that do not add value from the perspective of the customer) to improve the flow of people, information or goods. Increasingly, Lean thinking is evolving from its initial focus on eliminating NVA to a more holistic approach that encompasses sustainability. However, little work has been undertaken intentionally, including environmental sustainability outcomes in Lean healthcare interventions. Realist review methodology facilitates an understanding of the extent to which an intervention works, for whom, in what context, why and how, and has proven useful in research relating to Lean interventions in healthcare settings. This protocol provides details for a realist review that will enable an understanding of the specific contexts in which certain mechanisms are activated that enable the inclusion of environmental sustainability outcomes in the design of Lean healthcare improvement interventions.Licence for VoR version of this article starting on 2024-07-02: https://creativecommons.org/licenses/by/4.0/Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).http://creativecommons.org/licenses/by/4.0/article2024-07-13