{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:31:40Z","timestamp":1793302300729,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration","id":[{"id":"https:\/\/ror.org\/0187kwz08","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006662","name":"NIHR","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000276","name":"Department of Health and Social Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>National patient safety investigation bodies conduct system-level investigations and produce recommendations intended to drive improvement. Evidence that such recommendations translate into meaningful improvement is weak, and the reasons for this are poorly understood. This paper examines how recommendations produced by the Health Services Safety Investigations Body (HSSIB), England\u2019s independent national patient safety investigation body, are produced by investigators and received by the national organizations to whom they are directed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative multimethod design was used including documentary analysis of 22 investigation reports produced by the Healthcare Safety Investigation Branch (HSIB), predecessor to HSSIB, two focus groups with HSSIB patient safety investigators (n\u2009=\u200912) and semistructured interviews with 11 senior representatives of national organizations, recipients of HSSIB recommendations. Data were analyzed using reflexive thematic analysis, guided by institutional logics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Documentary analysis showed that HSIB recommendations were nondirective, clustering at the weakest level of the hierarchy of risk controls and favouring administrative measures. Two competing institutional logics were constructed using reflexive thematic analysis. HSSIB investigators deploy a safety science logic focusing on systems thinking, collaborative engagement and nonpunitive learning, while recipient organizations enact a managerial-operational logic prioritizing resource management and operational feasibility. Four consequences follow: (i) recommendations are attenuated through nominal coproduction; (ii) recipients navigate priority thickets in which political salience, strategic fit, and resource availability govern implementation; (iii) accountability among recipients is diffuse; and (iv) HSSIB\u2019s transparency carries limited traction within the managerial-operational logic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These conditions produce a paradox: HSSIB\u2019s structural separation from the organizations it investigates, while central to its legitimacy as a learning body, can distance it from the operational realities that govern whether recommendations are acted upon. Overcoming this paradox requires deliberate logic-building strategies that address how recommendations are framed, how accountability is constructed, and how the governance landscape is coordinated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/intqhc\/mzag146","type":"journal-article","created":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T11:24:03Z","timestamp":1789903443000},"source":"Crossref","is-referenced-by-count":0,"title":["From safety science to operational reality: competing institutional logics in the translation of national patient safety recommendations"],"prefix":"10.1093","volume":"38","author":[{"given":"Mohammad F","family":"Peerally","sequence":"first","affiliation":[{"name":"Digestive Diseases Unit, Kettering General Hospital ,","place":["United Kingdom"]},{"name":"National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester , Manchester, Oxford Road , Manchester, M13 9PL,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6691-6287","authenticated-orcid":false,"given":"Elizabeth","family":"Sutton","sequence":"additional","affiliation":[{"name":"National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester , Manchester, Oxford Road , Manchester, M13 9PL,","place":["United Kingdom"]},{"name":"School of Medical Sciences, University of Leicester ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Ferguson","sequence":"additional","affiliation":[{"name":"National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester , Manchester, Oxford Road , Manchester, M13 9PL,","place":["United Kingdom"]},{"name":"Health Services Management Centre, University of Birmingham ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran","family":"Walshe","sequence":"additional","affiliation":[{"name":"Alliance Manchester Business School (AMBS), University of Manchester ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Armstrong","sequence":"additional","affiliation":[{"name":"National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester , Manchester, Oxford Road , Manchester, M13 9PL,","place":["United Kingdom"]},{"name":"School of Health and Medical Sciences, City St George\u2019s, University of London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Expert Advisory Group to REACTION","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Carr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Lea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deinniol","family":"Owens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Rudkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"2026102914490642500_mzag146-B1","doi-asserted-by":"publisher","first-page":"1710","DOI":"10.1002\/bjs.11033","article-title":"Introducing national healthcare safety investigation bodies","volume":"105","author":"Wiig","year":"2018","journal-title":"Br J Surg"},{"key":"2026102914490642500_mzag146-B2","author":"Crown Copyright","year":"2015"},{"key":"2026102914490642500_mzag146-B3","author":"Lov om endringer i helsepersonelloven mv. 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