A multilevel neo-institutional analysis of infection prevention and control in English hospitals: coerced safety culture change?

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

HAIL: Hierarchical Adaptive Interface Layout

Abstract. We present a framework to adapt software to the needs of individuals with severe motion disabilities who use mouse substitution interfaces. Typically, users are required to adapt to the interfaces that they wish to use. We propose interfaces that change and adapt to the user and their individual abilities. The Hierarchical Adaptive Interface Layout (HAIL) model is a set of specifications for the design of user interface applications that adapt to the user. In HAIL applications, all of the interactive components take place on configurable toolbars along the edge of the screen. We show two HAIL-based applications: a general purpose web browser and a Twitter client