While there is sound evidence for specific research translation strategies (eg audit and feedback), there have been mixed results in many translation or implementation trials. This presentation will describe experiences across a number of translation trials to illustrate some of the potential problems which affect the outcomes of such trials. These include difficulties with intervention fidelity, site-based variation, lack of engagement, inertia, and technology. The presentation will draw on those and other studies to explore and illustrate the potential role of inspiration (both the idea and the inspirational leader), perspiration (persistence over time and across problems) and evidence (lack, use or misuse of evidence) in plotting a way forward for research translation studies.