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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 …