From safety science to operational reality: competing institutional logics in the translation of national patient safety recommendations

Summary

National patient safety investigation bodies conduct system-level investigations and produce recommendations intended to improve patient safety. However, evidence that such recommendations translate into meaningful improvement is often weak. This study examined how recommendations produced by the Health Services Safety Investigations Body (HSSIB) are produced by investigators and received by the national organizations to whom they are directed. HSSIB investigates patient safety concerns across the NHS in England and in independent healthcare settings where safety learning could help to improve NHS care.

Funded by the NIHR Patient Safety Research Collaboration: Greater Manchester, this study analysed 22 published investigation reports, ran two focus groups with 12 HSSIB investigators, and carried out interviews with 11 senior representatives from national bodies including NHS England, the Care Quality Commission, the General Medical Council, and several medical royal colleges.

Content

The study found that HSSIB investigators approach their work through a safety science mindset, focused on understanding how work actually happens on the ground, learning without blame, and thinking about problems as system-wide risks. Recipient organisations, meanwhile, approach the same recommendations through a managerial mindset, weighing up cost, feasibility, competing priorities, and what can realistically be resourced and delivered.

When these two ways of thinking collide, the researchers found four consequences:

1. Recommendations get softened during negotiation to make them more palatable;

2. Organisations struggle to prioritise them among a crowded field of competing demands from multiple bodies;

3. It becomes unclear who within a large organisation is actually responsible for acting on the recommendations;

4. HSSIB’s main way of holding organisations to account, which involves publishing its findings and their responses, carries little real force against the regulatory and financial pressures that actually drive organisational behaviour.