The 4^th SIRC conference marks the start of a series on Mechanisms of Implementation: What Works and Why? This theme was chosen because it seems tailored approaches to implementation outperform standardized, but there are no clear methods for informing tailored protocols. Consequently, strategies are often mismatched to barriers (e.g., intrapersonal/individual level strategy like training used to address organizational level barrier like poor culture) and implementation interventions (i.e., multifaceted or blended protocols derived of discrete strategies) are increasingly complex and costly without enhance impact. This problem of how best to tailor implementation strategies requires a 2-part solution.

First, we must understand the cause of the implementation problem (i.e., the determinant of practice; barriers). Second, we must select implementation strategies based on their mechanism of action (i.e., the processes by which a strategy exerts its effect; e.g., the mechanism of action for training is knowledge and attitudes) because it conceptually aligns with (or targets) the key determinants. Work to identify determinants is well underway with countless descriptive studies notating at least 600 unique factors and over 400 quantitative measures to evaluate their impact. Although the field has begun to develop and test implementation strategies, the majority of the existing studies specify implementation strategies a priori without careful attention to the local determinants.

SIRC believes the field is ready and ought to uncover mechanisms of implementation to build effective, robust, and pragmatic interventions that optimize outcomes. The 2017 program highlights significant advances to this line of research. View the detailed program here.