How does the organisational structure affect patient safety initiatives?

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study.
Health Services Delivery Research 2015;3(40)

• Analysis to identify the contextual factors pertinent to the local implementation of the 1000 Lives+ patient safety programme in Welsh NHS hospitals identified areas of conflict across the multiple organisational layers within the service which may impede implementation. 
• The analysis shows how, for specified programme interventions (e.g. surgical checklists), hospital and environmental features combine to derive varied outcomes seen as either more or less successful by stakeholders. 
• However high-status professional individuals, typically board-level managers and consultant medical or surgical health-care practitioners, play a pivotal role in reconfiguring other actors’ belief systems to support local implementation.