Article Text

Download PDFPDF

Original research
What factors in the workplace enable success in antimicrobial stewardship in paediatric intensive care? An exploration of antimicrobial stewardship excellence through thematic analysis of appreciative inquiry interviews with healthcare staff
  1. Emma Roche,
  2. Alison Jones,
  3. Adrian Plunkett
  1. Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Adrian Plunkett; adrianplunkett{at}


Objectives Antimicrobial resistance (AMR) is a major global health problem. Efforts to mitigate AMR prioritise antimicrobial stewardship (AMS) interventions. These interventions typically focus on deficiencies in practice and providing negative or normative feedback. This approach may miss opportunities to learn from success. We aimed to identify factors that enable success in AMS practices in the paediatric intensive care unit (PICU) by analysing the data obtained from interviews with staff members who had achieved success in AMS.

Design Qualitative study design using thematic analysis of appreciative inquiry interviews with healthcare staff.

Setting 31-bedded PICU in the UK between January 2017 and January 2018.

Participants 71 staff who had achieved success in AMS in the PICU.

Results Six themes were identified: (1) cultural factors including psychological safety, leadership and positive attitude are important enablers for delivering good clinical care; (2) ergonomic design of the physical environment and ready availability of tools and resources are key elements to support good practice and decision-making; (3) expertise and support from members of the multidisciplinary team contribute to good care delivery; (4) clarity of verbal and written communication is important for sharing mental models and aims of care within the clinical team; (5) a range of intrinsic factors influences the performance of individual HCPs, including organisation skill, fear of failure, response to positive reinforcement and empathetic considerations towards peers; (6) good clinical care is underpinned by a sound domain knowledge, which can be acquired through training, mentorship and experience.

Conclusion The insights gained in this study originate from frontline staff who were interviewed about successful work-as-done. This strengths-based approach is an understudied area of healthcare, and therefore offers authentic intelligence which may be leveraged to effect tangible improvement changes. The methodology is not limited to AMS and could be applied to a wide range of healthcare settings.

  • paediatric intensive & critical care
  • quality in health care
  • infection control
  • health & safety

Data availability statement

Anonymised data are avaialble on reasonable request. All data in this study consist of field notes from staff interviews. The source data are not available for dissemination.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Anonymised data are avaialble on reasonable request. All data in this study consist of field notes from staff interviews. The source data are not available for dissemination.

View Full Text


  • Twitter @lfecommunity

  • Contributors AP conceived, designed and supervised the study. Staff interviews were conducted and supervised by AJ. AP, AJ and ER analysed the data and interpreted the themes. ER wrote the first draft of the manuscript. AJ and AP edited the manuscript. AP is the guarantor.

  • Funding The original study was funded by a Health Foundation Innovation Grant (Health Foundation Innovating for Improvement grant "Innovating for Improvement Round 5"), but the present secondary analysis did not receive any funding.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.