The social dynamics of antibiotic use in an Australian hospital

Broom, Alex; Broom, Jennifer; Kirby, Emma; Adams, Jon

doi:10.1177/1440783315594486

Cited by 32 publications

(59 citation statements)

References 38 publications

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“…Reputation could also be harnessed as a means of sanction [4]: currently, there exist minimal reputational risks of over-prescribing [72]. Public shaming and consequent normative pressure have been demonstrated to be highly effective [4]: the publication of household water usage in Cape Town reduced water consumption by over a half [73].…”

Section: Use Social and Reputational Incentives And Sanctionsmentioning

confidence: 99%

Optimizing antibiotic prescribing: collective approaches to managing a common-pool resource

Tarrant

Colman

Chattoe-Brown

et al. 2019

Clinical Microbiology and Infection

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Background: Antimicrobial resistance (AMR) is one of the greatest threats in 21st century medicine. AMR has been characterized as a social dilemma. A familiar version describes the situation in which a collective resource (in this case, antibiotic efficacy) is exhausted due to over-exploitation. The dilemma arises because individuals are motivated to maximize individual payoffs, although the collective outcome is worse if all act in this way. Objectives: We aim to outline the implications for antimicrobial stewardship of characterizing antibiotic overuse as a social dilemma. Sources: We conducted a narrative review of the literature on interventions to promote the conservation of resources in social dilemmas. Content: The social dilemma of antibiotic over-use is complicated by the lack of visibility and imminence of AMR, a loose coupling between individual actions and the outcome of AMR, and the agency relationships inherent in the prescriber role. We identify seven strategies for shifting prescriber behaviour and promoting a focus on the collectively desirable outcome of conservation of antibiotic efficacy: (1) establish clearly defined boundaries and access rights; (2) raise the visibility and imminence of the problem; (3) enable collective choice arrangements; (4) conduct behaviour-based monitoring; (5) use social and reputational incentives and sanctions; (6) address misalignment of goals and incentives; and (7) provide conflict resolution mechanisms. Implications: We conclude that this theoretic analysis of antibiotic stewardship could make the problem of optimizing antibiotic prescribing more tractable, providing a theory base for intervention development.

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Section: Use Social and Reputational Incentives And Sanctionsmentioning

confidence: 99%

Optimizing antibiotic prescribing: collective approaches to managing a common-pool resource

Tarrant

Colman

Chattoe-Brown

et al. 2019

Clinical Microbiology and Infection

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“…1 Given the urgent need to optimise antibiotic use, the question thus emerges, what are the logics of practice and what limits change? As part of addressing this problem, social scientists have become increasingly intrigued by the social, interprofessional and organisational dynamics of antibiotic mis-use (Broom et al, 2014(Broom et al, , 2015a. That is, how antibiotic decisions in hospitals may be shaped by the dynamics of risk, benevolence, immediacy, uncertainty and so on (Broom et al, 2014(Broom et al, , 2015aCharani et al, 2013), thus, evading practice improvement strategies.…”

Section: Introductionmentioning

confidence: 99%

“…As part of addressing this problem, social scientists have become increasingly intrigued by the social, interprofessional and organisational dynamics of antibiotic mis-use (Broom et al, 2014(Broom et al, , 2015a. That is, how antibiotic decisions in hospitals may be shaped by the dynamics of risk, benevolence, immediacy, uncertainty and so on (Broom et al, 2014(Broom et al, , 2015aCharani et al, 2013), thus, evading practice improvement strategies. Such explorations of the social dynamics of antibiotics have so far centred on clinicians in (direct) caring relationships (Broom et al, 2014;Charani et al, 2013), despite broader recognition of hospital managers' centrality in enacting -or as it may be, limiting -organisational change through their influence (Dent, 2003;Kuhlmann et al, 2013;Parand et al, 2014;Spehar et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Medical authority, managerial power and political will: A Bourdieusian analysis of antibiotics in the hospital

Kirby¹,

Broom²,

Gibson

et al. 2017

Health (London)

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Antibiotic resistance poses a significant global threat, yet clinically inappropriate antibiotic use within hospitals continues despite the implementation of abatement strategies. Antibiotic use and the viability of existing antibiotic options now sit precariously at the nexus of political will, institutional governance and clinical priorities 'at the bedside'. Yet no study has hitherto explored the perspectives of managers, instead of focusing on clinicians. In this article, drawing on qualitative interviews with hospital managers, we explore accounts of responding to antimicrobial resistance, managing antibiotic governance and negotiating clinical and managerial priorities. We argue that the managers' accounts articulate the problematic nexus of measurement and accountability, the downflow effects of political will, and core tensions within the hospital between moral, managerial and medical authority. We apply Bourdieu's theory of practice to argue that an understanding of the logics of practice within the 'hospital management classes' will be critical in efforts to protect antibiotics for future generations.

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“…73 Conversely, a major motivator of junior doctor prescribing is the avoidance of criticism and, as such, choosing broader antibiotic regimens are perceived to carry a lesser risk of reproach. 74 Current AMS programmes that target junior medical staff often fail to recognise the difficulties in challenging this ingrained cultural hierarchy. 71,72,74 As medical personnel value autonomy, 75 the success of AMS initiatives is maximised when developed within a framework of collaboration and collegiality.…”

Section: The Bundles Of Carementioning

confidence: 99%

“…74 Current AMS programmes that target junior medical staff often fail to recognise the difficulties in challenging this ingrained cultural hierarchy. 71,72,74 As medical personnel value autonomy, 75 the success of AMS initiatives is maximised when developed within a framework of collaboration and collegiality. 76 Ultimately, for AMS to be effective, initiatives need the sustained endorsement of senior clinicians and engagement by the hospital leadership.…”

Section: The Bundles Of Carementioning

confidence: 99%

Healthcare‐acquired infections: prevention strategies

Fernando

Gray

Gottlieb

2017

Internal Medicine Journal

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Healthcare‐acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health‐care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi‐resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence‐based antimicrobial use; infection prevention strategies, to control MRO – particularly methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant Enterococcus spp. (VRE) and, more recently, multi‐resistant Gram‐negative bacteria; enhanced institutional investment in hand hygiene; hospital cleaning and disinfection; and the development of prescribing guidelines and standards of care. AMR surveillance and comparisons of prescribing are useful feedback activities once effectively communicated to end users. Successful implementation of these strategies requires cultural shifts at local hospital level and, to tackle the serious threat posed by AMR, greater co‐ordination at a national level. HAI prevention needs to be multi‐modal, requires broad healthcare collaboration, and the strong support and accountability of all medical staff.

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The social dynamics of antibiotic use in an Australian hospital

Cited by 32 publications

References 38 publications

Optimizing antibiotic prescribing: collective approaches to managing a common-pool resource

Optimizing antibiotic prescribing: collective approaches to managing a common-pool resource

Medical authority, managerial power and political will: A Bourdieusian analysis of antibiotics in the hospital

Healthcare‐acquired infections: prevention strategies

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