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.