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A multilevel neo‐institutional analysis of infection prevention and control in English hospitals: coerced safety culture change?
Author(s) -
Kyratsis Yiannis,
Ahmad Raheelah,
Iwami Michiyo,
CastroSánchez Enrique,
Atun Rifat,
Holmes Alison H.
Publication year - 2019
Publication title -
sociology of health and illness
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.146
H-Index - 97
eISSN - 1467-9566
pISSN - 0141-9889
DOI - 10.1111/1467-9566.12897
Subject(s) - psychological intervention , situated , context (archaeology) , public relations , action (physics) , repertoire , sociology , psychology , nursing , medicine , political science , paleontology , physics , quantum mechanics , artificial intelligence , computer science , acoustics , biology
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.