Abstract
Despite committed policy, regulative and professional efforts on healthcare safety, little is known about how such macro-interventions permeate organisations and shape culture over time. Informed by neo-institutional theory, we examined how inter-organisational influences shaped safety practices and inter-subjective meanings following efforts for coerced culture change. We traced macro-influences from 2000 to 2015 in infection prevention and control (IPC). Safety perceptions and meanings were inductively analysed from 130 in-depth qualitative interviews with senior- and middle-level managers from 30 English hospitals. A total of 869 institutional interventions were identified; 69% had a regulative component. In this context of forced implementation of safety practices, staff experienced inherent tensions concerning the scope of safety, their ability to be open and prioritisation of external mandates over local need. These tensions stemmed from conflicts among three co-existing institutional logics prevalent in the NHS. In response to requests for change, staff flexibly drew from a repertoire of cognitive, material and symbolic resources within and outside their organisations. They crafted ‘strategies of action’, guided by a situated assessment of first-hand practice experiences complementing collective evaluations of interventions such as ‘pragmatic’, ‘sensible’ and also ‘legitimate’. Macro-institutional forces exerted influence either directly on individuals or indirectly by enriching the organisational cultural repertoire.
| Original language | English |
|---|---|
| Pages (from-to) | 1138-1158 |
| Number of pages | 21 |
| Journal | Sociology of Health and Illness |
| Volume | 41 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 1 Jul 2019 |
| Externally published | Yes |
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Keywords
- infection prevention and control
- neo-institutional theory
- patient safety
- safety culture
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A multilevel neo-institutional analysis of infection prevention and control in English hospitals : coerced safety culture change? / Kyratsis, Yiannis; Ahmad, Raheelah; Iwami, Michiyo; Castro-Sánchez, Enrique; Atun, Rifat; Holmes, Alison H.
In: Sociology of Health and Illness, Vol. 41, No. 6, 01.07.2019, p. 1138-1158.Research output: Contribution to Journal › Article › Academic › peer-review
TY - JOUR
T1 - A multilevel neo-institutional analysis of infection prevention and control in English hospitals
T2 - coerced safety culture change?
AU - Kyratsis, Yiannis
AU - Ahmad, Raheelah
AU - Iwami, Michiyo
AU - Castro-Sánchez, Enrique
AU - Atun, Rifat
AU - Holmes, Alison H.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Despite committed policy, regulative and professional efforts on healthcare safety, little is known about how such macro-interventions permeate organisations and shape culture over time. Informed by neo-institutional theory, we examined how inter-organisational influences shaped safety practices and inter-subjective meanings following efforts for coerced culture change. We traced macro-influences from 2000 to 2015 in infection prevention and control (IPC). Safety perceptions and meanings were inductively analysed from 130 in-depth qualitative interviews with senior- and middle-level managers from 30 English hospitals. A total of 869 institutional interventions were identified; 69% had a regulative component. In this context of forced implementation of safety practices, staff experienced inherent tensions concerning the scope of safety, their ability to be open and prioritisation of external mandates over local need. These tensions stemmed from conflicts among three co-existing institutional logics prevalent in the NHS. In response to requests for change, staff flexibly drew from a repertoire of cognitive, material and symbolic resources within and outside their organisations. They crafted ‘strategies of action’, guided by a situated assessment of first-hand practice experiences complementing collective evaluations of interventions such as ‘pragmatic’, ‘sensible’ and also ‘legitimate’. Macro-institutional forces exerted influence either directly on individuals or indirectly by enriching the organisational cultural repertoire.
AB - Despite committed policy, regulative and professional efforts on healthcare safety, little is known about how such macro-interventions permeate organisations and shape culture over time. Informed by neo-institutional theory, we examined how inter-organisational influences shaped safety practices and inter-subjective meanings following efforts for coerced culture change. We traced macro-influences from 2000 to 2015 in infection prevention and control (IPC). Safety perceptions and meanings were inductively analysed from 130 in-depth qualitative interviews with senior- and middle-level managers from 30 English hospitals. A total of 869 institutional interventions were identified; 69% had a regulative component. In this context of forced implementation of safety practices, staff experienced inherent tensions concerning the scope of safety, their ability to be open and prioritisation of external mandates over local need. These tensions stemmed from conflicts among three co-existing institutional logics prevalent in the NHS. In response to requests for change, staff flexibly drew from a repertoire of cognitive, material and symbolic resources within and outside their organisations. They crafted ‘strategies of action’, guided by a situated assessment of first-hand practice experiences complementing collective evaluations of interventions such as ‘pragmatic’, ‘sensible’ and also ‘legitimate’. Macro-institutional forces exerted influence either directly on individuals or indirectly by enriching the organisational cultural repertoire.
KW - infection prevention and control
KW - neo-institutional theory
KW - patient safety
KW - safety culture
UR - http://www.scopus.com/inward/record.url?scp=85064505950&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064505950&partnerID=8YFLogxK
U2 - 10.1111/1467-9566.12897
DO - 10.1111/1467-9566.12897
M3 - Article
VL - 41
SP - 1138
EP - 1158
JO - Sociology of health & illness
JF - Sociology of health & illness
SN - 0141-9889
IS - 6
ER -