Prof Carolyn Steele-Gray discusses the critical gap in understanding of underlying mechanisms that are activated by strategies to generate desired implementation outcomes. Despite substantial growth in implementation research, the field has become increasingly dominated by frameworks and studies that catalogue barriers and enablers to implementation success. While these approaches have been instrumental in identifying contextual determinants of uptake, they often stop short of explaining how implementation strategies produce change. As a result, implementation studies frequently emphasize what strategies were used to support putting an innovation into practice, and whether those strategies achieved intended outcomes, while paying far less attention to the cognitive, relational, organizational, and team-level processes through which change unfolds. This imbalance has left a noted critical gap in our understanding of the underlying mechanisms that are activated by strategies to generate desired implementation outcomes. In this lecture, Dr. Carolyn Steele Gray draws on insights from cognitive psychology (e.g., habit formation and mental models), sociology (e.g., professional identity, power, and social networks), organizational and team science (e.g., leadership, sense- making, and team processes), and theories of innovation and adoption (e.g., diffusion of innovations) that can help reveal the mechanisms that can underlie strategy success. Using empirical examples from studies of digital health and integrated care implementation, the lecture illustrates how a developed understanding mechanisms can help better tailor strategies to unique environments, helping to shape adaptation, spread, and sustainability of innovations in complex health systems. The session also explores the methodological challenges associated with studying mechanisms, including issues surrounding definitional clarity, complexity, temporality, and multi-disciplinary dynamics that may not be adequately captured by dominant evaluation approaches. By foregrounding mechanisms as a critical but understudied force in implementation, this lecture argues for a more theory-driven and mechanism-informed approach to strategy development which can help to enable scale, transferability, and long-term sustainability of innovation. About the speaker: Carolyn Steele Gray, MA, PhD holds a Tier 2 Canada Research Chair in Implementing Digital Health Innovation. She is a Senior Investigator at the Science of Care Institute and in the Lunenfeld-Tanenbaum Research Institute at Sinai Health, and an Associate Professor in the Institute for Health Policy, Management and Evaluation at the University of Toronto in Canada. Dr. Steele Gray is an Implementation Scientist whose program of work focuses on the role of digital health in supporting integrated, person-centred and primary care delivery for patients with complex care needs, applying implementation science theory and approaches, along with evaluation methods to uncover to how best to embed technology into novel delivery models. Key to her transformational work is her international leadership in the areas of digital health and integrated care, notably through her work as a Senior Associate with the International Foundation for Integrated Care (IFIC), and a member of the Executive committee with IFIC Canada, where she co-leads a Special Interest Group in Digital Services and Data Enabling Integrated Care, providing strategic guidance and expertise through IFIC programs like their international Integrated Care Academy. Her national and international leadership in the fields of digital health implementation and integrated primary care was recognized by Digital Health Canada who awarded her Digital Health Leader of the Year in 2025 as well as by the North American Primary Care Research Group who awarded her the Mid-Career Scientist Award in 2025.
