The modern hospital executive, micro improvements, and the rise of antimicrobial resistance. (September 2021)

• Record Type: Journal Article
• Authors: Broom, Alex; Kenny, Katherine; Kirby, Emma; Davis, Mark; Dodds, Susan; Post, Jeffrey; Broom, Jennifer
• Is Part Of: Social science & medicine. Volume 285(2021)
• Publication Date: 2021-09
• Subjects: Antimicrobial resistance -- Antimicrobial stewardship -- Sociology -- Qualitative -- Australia; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2021.114298
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Antimicrobial resistance (AMR) is now recognised as a social, cultural, economic and political phenomenon, positioning the social sciences as central in responding to this global health threat. Yet efforts to address AMR within hospital settings, for example through antimicrobial stewardship (AMS) programs, continue to focus primarily on the prescribing practices of individual clinicians, often with little effect. There has been less attention to the role of healthcare administration, and managerialism therein, in explaining the limited progress to date in reining in antimicrobial misuse. To explore this, drawing on interviews with senior executives and managers from two Australian hospitals, we examine how these stakeholders navigate between management practice and AMR solutions, revealing that antimicrobial optimisation is frequently obscured by accountability structures attuned to other agendas. This has led, we argue, to the institutionalisation of micro-improvements that frequently 'tick the box' of having an AMS program, yet do little to effectively counteract rising AMR. Our analysis illustrates how sociological attention to the structural and ideological settings within which prescribing behaviour is carried out will be crucial to any attempts to successfully rein in AMR. Highlights: Behavioural approaches to antimicrobial misuse are having only minimal effects. Managerial principles are ubiquitous in healthcare service provision. Current accountability structures lend themselves to micro-improvements. Ideology must front and centre of the examination of continued rise of AMR.