Campbell and colleagues suggested that Phases 0–2 should be considered part of a larger iterative activity rather than as sequential studies, and highlighted that the insights gained during these early phases can make a valuable contribution to the development of the basic science of knowledge translation [40]. Based upon current systematic reviews, it appears that many knowledge translation studies have involved definitive trials, with little evidence of preceding theoretical or modeling research [41]. As a result, the interpretation of the current evidence base on the effectiveness and efficiency of different strategies is problematic because we lack a theoretical base for conceptualizing decision-making and behaviour change processes in different stakeholder groups. As a result, it is difficult to apply this evidence across a variety of health settings because we cannot identify which interventions are most likely, in particular settings, to be effective or efficient in improving quality. Further, we have little understanding of the causal mechanisms of different interventions. In this study, we will adopt an iterative approach (as suggested by Campbell and colleagues [40]) to the development and evaluation of a knowledge translation intervention to improve physician hand hygiene compliance.