Clinician's resistance to antibiotic control measures: A qualitative study

Antimicrobial resistance (AMR) has become a serious issue worldwide. The World Health Organisation now ascribes the third leading cause of death globally to AMR (WHO, 2011d, 2008). One potential solution to the issue lies in the introduction of clinical decision support systems (CDSS) within hospitals to monitor and control inappropriate prescription by clinicians. However, clinicians often display resistance to using such systems, leading to an ineffective take-up within the clinical setting. One such system, called GUIDANCE, was introduced into a major hospital in Melbourne, Australia some years ago. This thesis uses the qualitative theory-building methodology advocated by Strauss and Corbin (1990, 1998) to analyse the emergent phenomenon of ‘inappropriate prescription: clinicians’ resistance to control measures’. An in-depth study was conducted at a hospital over the period 2009-2012, involving 46 interviews with various clinicians, attendance at management meetings, and analysis of relevant documentation. The study found that, while the extant literature argues that inappropriate prescription of antibiotics causes and exacerbates the problem of antimicrobial resistance, clinicians in general tend to show resistance to the adoption of control measures based on clinical decision support systems. The phenomenon and core category of ‘inappropriate prescription: clinicians’ resistance to control measures’ is examined in the thesis in terms of its associated context, conditions, strategies, and consequences. The thesis contributes to the theoretical and practical literature in relation to the nature of resistance to CDSS. Emphasis is placed on the psycho-social variables that constitute the essence of the resistance process. The thesis contributes to the literature by presenting a framework of an aligned system of clinicians’ non-resistance and argues that such a system could avoid the deleterious effects of psychological maladjustment that may otherwise be encountered within the context of clinicians’ resistance to control measures. The essence of any attempt to eliminate the potency of resistance to change must be based on simultaneous efforts to negotiate a new and revised personal compact for clinicians that reflects mutual acceptance of the changing perceptions of the role of clinicians in the evolving nature of healthcare systems worldwide.