A tale of two digital hospitals: A qualitative study of antimicrobial
stewardship teams
Abstract
Aim: To examine and understand the work processes of AMS teams across
two hospitals that use the same digital intervention, and to identify
the challenges and enablers to effective AMS in each setting. Methods:
Employing a contextual inquiry approach informed by the Systems
Engineering Initiative for Patient Safety (SEIPS) model, observations
and semi-structured interviews were conducted with AMS team members
(n=15) in two Australian hospitals. Qualitative data analysis was
conducted, mapping themes to the SEIPS framework. Results: Both
hospitals utilised similar systems, however, they displayed variations
in AMS processes, particularly in post-prescription review,
interdepartmental AMS meetings, and the utilisation of digital tools. An
antimicrobial dashboard was available at both hospitals but was utilised
more at the hospital where the AMS team members were involved in the
dashboard’s development, and there were user champions. At the hospital
where the dashboard was utilised less, participants were unaware of key
features, and interoperability issues were observed. Establishing strong
relationships between the AMS team and prescribers emerged as key to
effective AMS at both hospitals. However, organisational and cultural
differences were found, with one hospital reporting insufficient support
from executive leadership, increased prescriber autonomy, and resource
constraints. Conclusion: Organisational and cultural elements, such as
executive support, resource allocation, and interdepartmental
relationships, played a crucial role in achieving AMS goals. System
interoperability and user champions further promoted the adoption of
digital tools, potentially improving AMS outcomes through increased user
engagement and acceptance.