Optimizing antibiotic usage in hospitals: a qualitative study of the perspectives of hospital managers

Broom, A., Gibson, A.F., Broom, J., Kirby, E., Yarwood, T., and Post, J.J. (2016) Optimizing antibiotic usage in hospitals: a qualitative study of the perspectives of hospital managers. Journal of Hospital Infection, 94 (3). pp. 230-235.

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Background: Antibiotic optimization in hospitals is an increasingly critical priority in the context of proliferating resistance. Despite the emphasis on doctors, optimizing antibiotic use within hospitals requires an understanding of how different stakeholders, including non-prescribers, influence practice and practice change.

Aim: This study was designed to understand Australian hospital managers' perspectives on antimicrobial resistance, managing antibiotic governance, and negotiating clinical vis-à-vis managerial priorities.

Methods: Twenty-three managers in three hospitals participated in qualitative semi-structured interviews in Australia in 2014 and 2015. Data were systematically coded and thematically analysed.

Findings: The findings demonstrate, from a managerial perspective: (1) competing demands that can hinder the prioritization of antibiotic governance; (2) ineffectiveness of audit and monitoring methods that limit rationalization for change; (3) limited clinical education and feedback to doctors; and (4) management-directed change processes are constrained by the perceived absence of a ‘culture of accountability’ for antimicrobial use amongst doctors.

Conclusion: Hospital managers report considerable structural and interprofessional challenges to actualizing antibiotic optimization and governance. These challenges place optimization as a lower priority vis-à-vis other issues that management are confronted with in hospital settings, and emphasize the importance of antimicrobial stewardship (AMS) programmes that engage management in understanding and addressing the barriers to change.

Item ID: 49159
Item Type: Article (Research - C1)
ISSN: 1532-2939
Keywords: Antimicrobial resistance | Antimicrobial stewardship | Hospital management | Qualitative research
Funders: Australian Society of Infectious Diseases, Australian Research Council (ARC)
Date Deposited: 06 Jun 2017 05:58
FoR Codes: 42 HEALTH SCIENCES > 4206 Public health > 420605 Preventative health care @ 100%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920204 Evaluation of Health Outcomes @ 100%
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