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


OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
School of Social Sciences, University of New South Wales, Sydney, NSW, Australia. Electronic address: a.broom@unsw.edu.au.
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A
Broom
School of Social Sciences, University of New South Wales, Sydney, NSW, Australia.
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AF
Gibson
Department of Medicine, Sunshine Coast Hospital and Health Service, Nambour, QLD, Australia; School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
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J
Broom
School of Social Sciences, University of New South Wales, Sydney, NSW, Australia.
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E
Kirby
School of Medicine, The University of Queensland, Brisbane, QLD, Australia; Cairns Clinical School, James Cook University, Cairns, QLD, Australia; Department of Medicine, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia.
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T
Yarwood
Department of Infectious Diseases, Prince of Wales Hospital, Sydney, NSW, Australia; Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW, Australia.
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JJ
Post
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D016134:Organizational Policy; D011216:Practice Management, Medical
D000900:Anti-Bacterial Agents
Antimicrobial resistance; Antimicrobial stewardship; Hospital management; Qualitative research