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Governance & Leadership

This article describes what governance and leadership means in the context of AMS programmes, including examples of existing structures.
© BSAC

Before this, you will have done the welcome to week 2 and the AMS structures step. This week we will introduce you to the foundations of an AMS programme (ASP).

You will learn about the importance of governance and leadership within a healthcare facility ASP. You will also learn the roles that make up an ideal AMS team and the importance of the microbiology laboratory within an AMS programme. You will also have the chance to discuss what areas form the foundations of an ideal AMS programme.

Don’t forget to participate in discussions using the comments section below each step.

Timeline of structures showing 5 steps

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In this activity we will be looking at STEP 2 of setting up an ASP – the setting up stage. This step involves:

  • Undertaking an assessment of what is needed to set up and implement an ASP
  • Developing an action plan that includes improving the use of antimicrobials.

In this step we will look at one of the core elements of setting up an ASP – establishing effective governance and leadership.

Governance

Governance is how the structures and processes of an organisation are controlled to ensure that high standards are maintained.

A governance structure that includes the different functions (see figure below) to effectively implement and sustain a healthcare facility ASP is essential.

What is governance in relation to AMS? What structures and tools need to be in place for an effective AMS programme at an institution level? Four text boxes labelled as antibiotic management, human resources, information management and finance.

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A useful study that outlines the importance of hospital governance in supporting AMS sustainability can be found here.

The governance structure may vary in size and complexity depending on the facility. An example of a generic healthcare facility governance system that is relevant to an LMIC setting is described in the figure below. Note that some smaller facilities may not have all the committees listed, and in some settings, there may not be a separate AMS committee and AMS team.

Example generalised AMS governance structure for healthcare facilities in low- to middle-income countries The AMS committee and AMS team are at the centre and the facility leadership, management and committees are connected to them from around the outside of the diagram.

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What is most important is to identify responsibility and accountability of the hospital management team, and of those who co-ordinate or implement the ASP.

The diagram below highlights a real-world example of a governance system from Australia. This hospital highlights the AMS committee in a central role with its connections. Although this example comes from a mature and well-resourced setting, the executive, committee, and front-line healthcare AMS team functions could be adapted for LMICs. Where there is a functioning drug & therapeutics or IPC committee, it may be feasible for AMS to be considered part of their remit. To read more on this particular example, click here.

Infographic showing an example hospital governance structure split horizontally into three levels. The hospital executive is at the top executive level. Clinical governance happens at the lower committee level and the committees are for antimicrobial stewardship, patient safety and quality, medication safety, drug and therapeutics and infection prevention and control. All the committees are connected to the AMS committee. The medical director is connected to the divisional management at this level. The lower frontline healthcare level includes the AMS team, the antimicrobial prescribers, clinical pharmacists and nursing champions. There may also be connections to AMS activities at external healthcare sites.

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This infographic is also available as a screen-reader compatible PDF.

Leadership

Leadership can be defined as a “process of social influence, occurring in a group context towards the attainment of a common goal.” “Medical leadership and management” can be described as the engagement of doctors in the leadership and management of both patient care, departments, organisations, and systems within which they work.

Leadership is particularly important to AMS. Whilst identifying clinical leaders to lead the AMS team as well as identifying “champions” within different disciplines to support the ASP, it is also important to engage with clinical managers and leaders. For example, engaging middle managers within the governance and leadership teams can prove vital to success as they are well-positioned to oversee human and financial resources necessary for AMS delivery.

Good support from the broader senior hospital leadership is also a critical contributor to the success of ASPs and can take several forms, including:

List of six forms of good support: formal statements, AMS in job descriptions, allowing time for AMS, supporting training, cross-team participation, and financial support.

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© BSAC
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How to set up an Antimicrobial Stewardship Programme

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