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The modern hospital executive, micro improvements, and the rise of antimicrobial resistance

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  • Broom, Alex
  • Kenny, Katherine
  • Kirby, Emma
  • Davis, Mark
  • Dodds, Susan
  • Post, Jeffrey
  • Broom, Jennifer
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.

Suggested Citation

  • Broom, Alex & Kenny, Katherine & Kirby, Emma & Davis, Mark & Dodds, Susan & Post, Jeffrey & Broom, Jennifer, 2021. "The modern hospital executive, micro improvements, and the rise of antimicrobial resistance," Social Science & Medicine, Elsevier, vol. 285(C).
    • Handle: RePEc:eee:socmed:v:285:y:2021:i:c:s0277953621006304
    DOI: 10.1016/j.socscimed.2021.114298
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    References listed on IDEAS

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    1. Radnor, Zoe J. & Holweg, Matthias & Waring, Justin, 2012. "Lean in healthcare: The unfilled promise?," Social Science & Medicine, Elsevier, vol. 74(3), pages 364-371.
    2. Francis Fukuyama, 2013. "What Is Governance?," Working Papers 314, Center for Global Development.
    3. Matthew A. Cooper & David Shlaes, 2011. "Fix the antibiotics pipeline," Nature, Nature, vol. 472(7341), pages 32-32, April.
    4. Clare I. R. Chandler, 2019. "Current accounts of antimicrobial resistance: stabilisation, individualisation and antibiotics as infrastructure," Palgrave Communications, Palgrave Macmillan, vol. 5(1), pages 1-13, December.
    5. Broom, Alex & Broom, Jennifer & Kirby, Emma, 2014. "Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing," Social Science & Medicine, Elsevier, vol. 110(C), pages 81-88.
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    Cited by:

    1. Nadine T. Hillock & Tracy L. Merlin & John Turnidge & Jonathan Karnon, 2022. "Modelling the Future Clinical and Economic Burden of Antimicrobial Resistance: The Feasibility and Value of Models to Inform Policy," Applied Health Economics and Health Policy, Springer, vol. 20(4), pages 479-486, July.
    2. M. Z. A. M. Jaffar & A. N. Zailan, 2021. "Antimicrobial Resistance (Amr)-Forecast For 30 Countries In Europe," Science Heritage Journal (GWS), Zibeline International Publishing, vol. 5(2), pages 44-48, November.
    3. Comer, Clémentine & Benoit, Lucile & Hellec, Florence & Fortané, Nicolas, 2023. "Demedication without demedicalization? Redefining the medical and economic boundaries of veterinary professional jurisdiction," Social Science & Medicine, Elsevier, vol. 332(C).

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