6 Determinants vs Barriers vs Root Causes

Question 1

What is a determinant in implementation science?

Answer 1

A factor that influences whether an intervention is adopted, used, or sustained.

• Can enable or constrain
• Exists whether noticed or not

Determinants explain patterns of use.

Question 2

What is a barrier?

Answer 2

A perceived obstacle reported by stakeholders.

• Subjective
• Often incomplete

Barriers are clues, not explanations.

Question 3

What is a root cause?

Answer 3

A deeper systemic condition that generates repeated problems.

• Often invisible
• Stable over time

Root causes shape multiple determinants.

Question 4

Why do teams over-focus on barriers?

Answer 4

Because barriers are easy to hear and list.

• Come from interviews
• Feel actionable

Barrier lists feel productive but stall progress.

Question 5

Why are determinants more useful than barriers?

Answer 5

Because determinants explain why barriers appear.

• More stable
• More predictive

Design should target determinants, not complaints.

Question 6

Why are root causes hard to identify?

Answer 6

Because they sit outside individual control.

• Structural
• Cultural
• Incentive-based

Root causes persist across projects.

Question 7

How do barriers, determinants, and root causes relate?

Answer 7

Barriers are symptoms; determinants are conditions; root causes are generators.

• Different abstraction levels
• Different leverage points

Confusing levels leads to weak fixes.

Question 8

Why is “lack of time” rarely a determinant?

Answer 8

Because time pressure reflects deeper system design.

• Workload allocation
• Competing priorities

“Too busy” hides structural decisions.

Question 9

Why is “lack of training” often misdiagnosed?

Answer 9

Because knowledge is usually not the constraint.

• Opportunity missing
• Workflow misfit

If people know but can’t act, training won’t help.

Question 10

What does a good determinant sound like?

Answer 10

A condition that explains when and for whom use succeeds or fails.

• Pattern-based
• Context-sensitive

“Works on day shifts but not nights” signals a determinant.

Question 11

Why are determinants more actionable than root causes?

Answer 11

Because determinants are closer to design decisions.

• Root causes may be fixed
• Determinants can often be shaped

You design against determinants.

Question 12

When is root-cause thinking still useful?

Answer 12

When patterns repeat across multiple interventions.

• Chronic failures
• Persistent resistance

Repeated pain signals a root cause.

Question 13

Why do barrier-based solutions often fail?

Answer 13

Because they treat symptoms, not systems.

• Temporary relief
• No durability

Barrier fixes decay quickly.

Question 14

What’s wrong with asking “What’s the main barrier?”

Answer 14

It assumes a single cause in a complex system.

• Oversimplification
• Misses interactions

Implementation problems are multi-determinant.

Question 15

How does human factors thinking align with determinants?

Answer 15

Both focus on constraints shaping behaviour.

• Cognitive load
• Workflow design
• Interface issues

HF insights often identify key determinants.

Question 16

Why is blaming individuals a determinant error?

Answer 16

Because behaviour is shaped by context.

• Local rationality
• System pressure

Blame hides real leverage points.

Question 17

What is a classic example of a hidden determinant?

Answer 17

Unrecognised role conflict.

• Competing expectations
• Invisible trade-offs

Role ambiguity drives workaround behaviour.

Question 18

Why do determinants often differ across sites?

Answer 18

Because context is not uniform.

• Staffing
• Culture
• Infrastructure

Same intervention, different constraints.

Question 19

What does “diagnostic depth” mean?

Answer 19

Moving beyond surface complaints to systemic conditions.

• From “what” to “why”
• From events to patterns

Depth improves strategy fit.

Question 20

Why are determinants dynamic over time?

Answer 20

Because systems adapt and pressures shift.

• Drift
• New priorities

Yesterday’s fix may fail tomorrow.

Question 21

How should barriers be used productively?

Answer 21

As entry points to determinant analysis.

• Listen first
• Probe deeper

Ask “what makes that hard?”

Question 22

What does a determinant-focused question sound like?

Answer 22

What conditions make this easy or hard?

• Not blame-oriented
• System-focused

Better questions reveal better strategies.

Question 23

Why is root-cause language risky in implementation?

Answer 23

Because it implies single, fixable causes.

• Encourages oversimplification
• Encourages blame

Systems rarely have one root.

Question 24

How does this deck prevent “training creep”?

Answer 24

By distinguishing knowledge gaps from system gaps.

• Training is rarely first-line
• Design often matters more

Training should be a last resort.

Question 25

What determinant most often limits **sustainment**?

Answer 25

Ownership. * Who maintains it * Who absorbs cost ## Footnote No owner = slow decay.

Question 26

Why is **incentive misalignment** a determinant?

Answer 26

Because incentives shape priorities. * Formal and informal * Sometimes unintended ## Footnote People optimise what’s rewarded.

Question 27

How do **determinants** guide strategy selection?

Answer 27

Each determinant suggests a different intervention type. * Design fixes design problems * Policy fixes policy problems ## Footnote Match strategy to determinant.

Question 28

What signals **shallow diagnostic work**?

Answer 28

Solutions that repeat across unrelated problems. * Always training * Always reminders ## Footnote One-size fixes signal poor diagnosis.

Question 29

How does **determinant thinking** improve OHFE credibility?

Answer 29

By shifting conversations from blame to system design. * Non-defensive * Actionable ## Footnote This is where OHFE adds strategic value.

Question 30

In one line, why distinguish **determinants**, **barriers**, and **root causes**?

Answer 30

Because solving the wrong level guarantees weak and temporary solutions. ## Footnote Understanding these distinctions is crucial for effective implementation.