Overarching theoretical approaches

This project offers a comprehensive investigation of Antimicrobial Stewardship (AS) and Infection Control (IC) behaviours approached as a co-construction of individual, organisational and wider contextual factors. The project examines these factors at the micro-, meso- and macro-levels using theoretical approaches from the fields of strategic management, sociology, psychology, and anthropology. To evaluate how appropriate interventions may be successfully adopted and implemented within different contexts, an organising framework of implementation is employed.

A soft systems approach is used for the evaluation of different interventions and policies by mapping interactions and consequences using qualitative and quantitative data. To connect these multi-level and multidisciplinary approaches, the Consolidated Framework for Implementation Research (CFIR) is used as an overarching organising framework as it facilitates understanding of processes of introduction and management of change within a complex healthcare system or pathway and allows for examination of behaviours.

WP4: Operational and economic evaluation: System Dynamics

Methods
The full System Dynamics (SD) methodology cycle. Starting with boundary setting, problem structuring and then capturing influence factors and ‘feedback loops’ when multiple interventions are implemented concurrently; this WP4 will employ data gathered in WP1-3 and use stakeholder workshops to validate the emergent model in England and India. The system/unit of analysis will be defined iteratively from ward, unit, hospital, primary care and community care setting.

Following model development, simulations for various scenarios will be tested, for example, 'What if intervention A is adopted by 50% of healthcare surgeons?’ or ‘What if patient numbers increase by 10% next year?’ on clinical and economic outcomes.

Expected impact

1. To identify ways of reducing overuse, underuse and misuse of antibiotics, improving quality of care and reducing waste of healthcare resources;
2. To promote the efficient design of services by finding solutions along the patient pathway for patients undergoing surgery;
3. In the long-term, to contribute to a reduction in costs to patients and society;
4. To build research capacity in low- and middle-income countries and the tools to design and evaluate solutions