Optimising Antibiotic Usage in Hospitals: A Qualitative Study of the Perspectives of Hospital Managers

• Published in: The Journal of hospital infection 2016-11, Vol.94 (3), p.230-235
• Main Author: Broom, Alex, Ph.D
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Antimicrobial resistance; Antimicrobial stewardship; Australia; Drug Utilization - standards; Female; Hospital management; Hospitals; Humans; Infectious Disease; Interviews as Topic; Male; Organizational Policy; Practice Management, Medical; Qualitative research
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2016.08.021

Summary Background Antibiotic optimisation in hospitals is an increasingly critical priority in the context of proliferating resistance. Despite the emphasis on doctors, optimising 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 prioritisation of antibiotic governance; (2) ineffectiveness of audit and monitoring methods which limit rationalisation for change; (3) limited clinical education and feedback to doctors; and (4) that 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 inter-professional challenges to actualising antibiotic optimisation and governance. These challenges place optimisation as a lower priority vis-à-vis other issues management are confronted with in hospital settings, and emphasise the importance of antimicrobial stewardship (AMS) programmes engaging management in understanding and addressing the barriers to change.