1. HOSPITAL ANTIBIOTIC POLICY: FROM PAPER TO ACTION:FILLING THE EXECUTION GAP Dr. Anil Gurtoo Professor, Deptt. of Medicine, Lady Hardinge Medical College, New Delhi.

2. SITUATION ANALYSIS Although idealized Hospital Antibiotic Policies (HAP) do exist on paper, they rarely ever get executed at the point of care, leading to the emergence of an: execution gap: the disconnect between “what-is-said” and “what-is-done”.

3. GAP-ANALYSIS So why don’t the existing Antibiotic Policies work? a)Lack of clearly communicated goals. b)Lack of Leadership support. c)Top down approaches. d)Lack of participative approaches e)Poorly coordinated information systems. f)Lack of systems integration. g)Too clinician-centric approaches disconnected from other sectors. h)Silo-mentality and inter-departmental turf issues. i)Lack of antibiotic use – susceptibility data. j)Supply side distortions.

4. THE CHALLENGE To narrow and close the “execution gap and create an: Efficient and Effective HAP that really works on ground.

5. THE VISION To create a culture of Rational Decision Making and Antibiotic use.

6. THE MISSION To challenge and change the existing “business-as-usual” approach to Antibiotic Policy by creating an: Effective and Adaptable Change Design.

7. DESIGNING A FRAME-WORK OF EXECUTION: The 3 critical elements in the design pathway Development Dissemination Implementation

8. DESIGNING A FRAME-WORK OF EXECUTION: The Two – Instruments of implementation Educational (Motivational) Regulatory (Restrictive Protocols)

9. DESIGNING A FRAME-WORK OF EXECUTION:

10. SYSTEMS The workability or otherwise of HAP can be conceptualized as a function of the integrated working of 3 inter-dependent systems: 1.Administrative Governance System: Comprising the decisional chain. 2.Clinical Governance System: comprising the implementing chain. 3.Information Processing Systems.

11. CULTURE BUSINESS – AS – USUAL Routinization of antibiotic use New is better Fever is synonymous with bacterial infection CULTURE SHIFT Antibiotics are non-renewable resources Multi-disciplinary team work Generic prescribing

12. PROCESS Alignment : between mission & systems Synergies : between systems Ethical Processes

13. STRUCTURES The efficacy of HAP is a function of horizontal and vertical integration of 3 structures: Administrative structure Financial structure Clinical structure

14. HUMAN RESOURCE a. Training and b. Teamwork Training by way of regular: CME ‘s and workshops. Formation of ‘Cross-functional’ Teams: comprising of clinicians, pharmacologists, microbiologists, pharmacists, nurses and store officer. Communication Teams Antibiotic Therapeutic Teams Audit Teams Hospital Infection control teams. Clinical Rounds: with Pharmacologist in attendance

15. OUTCOME MEASURES CONTINUAL GOAL ASSESSMENT AUDIT GOALS Antibiotic Susceptibility Data Antibiotic Prescribing Data Costs & ADRs Pharmacy Stock Data

18. Thank You