Table 4 Motivation themes and key quotes

Staff have mixed appreciation for AMS within their own practice

“Well I think there are still a lot of positives. I think it’s a really good program and it’s such an advance on what we had, which was just uncontrolled whatever anyone wanted. So, there’s a lot of positives to it.” (ID physician, FG1)

“In the acute casualty area and so on, there may be a role and I don’t know, it depends on the level of training that people come through, ‘cause in our time there was a different training, there were fewer antibiotics, and maybe there is a need for that, but I don’t know.” (Endocrinologist, FG2)

Lack of staff engagement with the AMS program

“The therapeutic guidelines … a lot of doctors even now, still don’t even know it exists. … they can find it if they can be bothered looking for it. But people are a bit lazy you know, they aren’t going to do it.” (Clinical microbiologist 2, FG1)

“I presume there’s an intranet that [the guidelines] might be available on, but I don’t use it” (Anaesthetist, FG2)

“Pharmacist: I don’t know whether people have even seen, but the AMS pharmacist and AMS team put together [a document] which recommends the standard prophylactic surgical stuff and that is on the intranet, and it is a guide that is supposed to be what [the hospital] supports as an organisation, but like you said, there’s no accountability to that document

NUM2: I’ve never seen it

NUM3: It’s definitely stuck up around theatre, but so is a lot of stuff.” (FG3)

Staff want to receive more feedback and monitoring data

“I think there is an unaddressed issue that there’s no monitoring of the ID physicians’ management. So, they’re not actually answerable to each other. … So that’s regarded as success, is referral to an ID physician, and occasionally we’ve had cases where we’ve not agreed with what they’ve done and they’re also not subject to their own internal peer review. And I think that if we had that it would hugely strengthen the whole program” (Clinical microbiologist 1, FG1)

“I’d like to be pulled up if I’m doing the wrong thing, but again no one’s ever done that to me.” (Cardiologist, FG2)

“We all question as clinicians, oh that’s not right, but the patient still gets it. Cos there’s no … system or processes to say well actually no, that’s inappropriate. Like there’s no sort of big brother” (Executive 1, FG3)

“And like you said the standard [antimicrobials] isn’t tracked so you can’t, aside from doing an actual audit, you can’t track the baseline stuff. It’s only the overuse of say Tazocin that we can see because we dispense it. Then we can track it and then the AMS pharmacist can go and say no.” (Pharmacist, FG3)

“I think the general antibiotic dispensing is something that needs to be looked at. ‘Cause it’s only sort of the drugs that are like prescribed from dispensing are the ones they look at, whereas it’s the everyday, every joint, that are prescribed.” (NUM 2, FG3)

Cost is a driving force of AMS and antimicrobial prescribing

“The other thing that is a factor, from a business model more than anything else, the drugs that are in that category start to become more expensive, so as a private organisation we absolutely care because the fund may or may not pay for it. And they also obviously result in people being in hospital for longer, so not only is the pharmacy cost increased but the actual physical cost of that patient becomes an issue for a department, separate to the whole resistance issue.” (Pharmacist, FG2)

“with our patient when she was on the really expensive drugs, there was a lot of debate going on about it and who would pay, there was a lot of cross-questioning done to the infectious diseases doctor and the surgeon. That’s the only time I’ve really seen them question big time, like the medical director was involved, like one patient, ‘cause of the cost.” (NUM2, FG 3)

“I think we’re slowly making headway but we’ve still got a way to go. But [improvements to AMS are] all expensive.” (Clinical microbiologist 1, FG1)

“we’ve got health funds who are saying, if there’s a hospital acquired infection or a complication we’re not going to pay, because you should have done something about it.” (Executive 1, FG3)