Social dynamics of a population-level dashboard for antimicrobial stewardship: A qualitative analysis.

OBJECTIVE: To evaluate antimicrobial stewards' experiences of using a dashboard display integrating local and national antibiotic use data implemented in the U.S. Department of Veterans Affairs (VA). This paper reports early formative evaluation. DESIGN: Qualitative interviewing. SETTING: Eight VA hospitals participated with established antimicrobial stewardship (AS) programs participated in the pilot. PARTICIPANTS: Six infectious disease physicians and eight clinical pharmacists agreed to be interviewed (n = 14). METHODS: A 3-part qualitative interview script was used involving a description of local stewardship activities, a Critical Incident description of dashboard use, and general questions regarding attitudes towards the tool. An inductive open coding approach was used for analysis. RESULTS: We found 4 themes showing the complexities of using stewardship tools: (1) Data validity is socially negotiated; (2) Performance feedback motivates and persuades social goals when situated in an empirical distribution; (3) Shared problem awareness is aided by authoritative data; and (4) The AS dashboard encourages connections with local quality improvement culture. CONCLUSIONS: Social dimensions of AS tool use emerged as distinct from, and equally important as decision support provided by the dashboard. Successful stewardship tools should be designed to support both the social and cognitive needs of users.