TABLE 28

Reducing health-care-associated infection I-CMAO configuration: infrastructural system – Welsh Government

Intervention1000 Lives+ national programme
ComponentRHAI
ContextWelsh Government
Mechanisms
  • Institutional isomorphism – coercive, mimetic and normative
  • Coherence, cognitive participation and reflexive monitoring
Agency and institutional workNormalisation: coupling to 1000 Lives+ and RHAIHabituation: decoupling to 1000 Lives+ and RHAI
  • Agency – formalisation
  • Institutional work – maintenance
  • Leadership: distributed across policy and professional domains
  • Team work: policy leads and professional engagement across aligned organisations
  • Encultured values: centred on defining RHAI and WHAIP as mandated evidence-based practices
  • Decoupling limited by structural and cultural constraints within infrastructural system, specifically pre-existing mandated WHAIP monitoring
Outcome1000 Lives+ national programme and RHAI institutionalised into policy processes via WHAIP
Exemplar transcriptions
  • Agency – formalisation
  • Institutional work – creation
  • 8:01 (T034) – Coupling
  • 8:02 (T035) – Decoupling
  • 8:28 (T020) – Decoupling

From: Chapter 8, Reducing Health-care-Associated Infection

Cover of A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study
A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study.
Health Services and Delivery Research, No. 3.40.
Herepath A, Kitchener M, Waring J.
Southampton (UK): NIHR Journals Library; 2015 Sep.
Copyright © Queen’s Printer and Controller of HMSO 2015. This work was produced by Herepath et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

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