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Strengthening strategic management approaches to address antimicrobial resistance in global human health: a scoping review
  1. Raheelah Ahmad1,2,
  2. Nina Jiayue Zhu1,
  3. Andrew J M Leather3,
  4. Alison Holmes1,
  5. Ewan Ferlie4
  6. On behalf of the ASPIRES study co-investigators
    1. 1NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, Imperial College London, London, UK
    2. 2Health Group, Management Department, Imperial College Business School, Imperial College London, London, UK
    3. 3King’s Centre for Global Health and Health Partnerships, King's College London, London, UK
    4. 4King’s Business School, King's College London, London, UK
    1. Correspondence to Dr Raheelah Ahmad; raheelah.ahmad{at}


    Introduction The development and implementation of national strategic plans is a critical component towards successfully addressing antimicrobial resistance (AMR). This study aimed to review the scope and analytical depth of situation analyses conducted to address AMR in human health to inform the development and implementation of national strategic plans.

    Methods A systematic search of the literature was conducted to identify all studies since 2000, that have employed a situation analysis to address AMR. The included studies are analysed against frameworks for strategic analysis, primarily the PESTELI (Political, Economic, Sociological, Technological, Ecological, Legislative, Industry) framework, to understand the depth, scope and utility of current published approaches.

    Results 10 studies were included in the final review ranging from single country (6) to regional-level multicountry studies (4). 8 studies carried out documentary review, and 3 of these also included stakeholder interviews. 2 studies were based on expert opinion with no data collection. No study employed the PESTELI framework. Most studies (9) included analysis of the political domain and 1 study included 6 domains of the framework. Technological and industry analyses is a notable gap. Facilitators and inhibitors within the political and legislative domains were the most frequently reported. No facilitators were reported in the economic or industry domains but featured inhibiting factors including: lack of ring-fenced funding for surveillance, perverse financial incentives, cost-shifting to patients; joint-stock drug company ownership complicating regulations.

    Conclusion The PESTELI framework provides further opportunities to combat AMR using a systematic, strategic management approach, rather than a retrospective view. Future analysis of existing quantitative data with interviews of key strategic and operational stakeholders is needed to provide critical insights about where implementation efforts should be focussed, and also how to build contingency at the strategic level for agile responses to macro-level environmental influences.

    • health policy
    • review
    • public health
    • infections, diseases, disorders, injuries

    This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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    • Handling editor Peter MacGarr Rabinowitz

    • Collaborators On behalf of the ASPIRES study co-investigators: Raheelah Ahmad, Gabriel Birgand, Enrique Castro-Sánchez, Esmita Charani, Puneet Dhar, Ewan Balfour Ferlie, Mark Ian Hampton, Alison H Holmes [PI], Andy Leather, Mohamed Reda Lebcir, Marc Mendelson, Jules Ndoli Minega, Franco Sassi, Nick Sevdalis, Sanjeev Singh, Carolyn Clare Tarrant.

    • Contributors Inception of the study: RA and EF. RA, NJZ carried out data collection. RA, NJZ, EF, AJML carried out data analysis.NJZ,AJML,EF contributed to the manuscript drafts with input from AH for finalisation. The ASPIRES Study group contributed to validation of the research questions, comment on early findings and high level expert input including identification of relevant grey literature.

    • Funding RA, ECS, EC, AH, NJZ were part-funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in collaboration with Public Health England and Imperial College Healthcare NHS Trust (HPRU-2012-10047). RA is supported by a NIHR fellowship in Knowledge Mobilisation (KMRF2015-007). ECS is NIHR Senior Nurse and Midwife Research Leader, and recognises the support of the NIHR Imperial Patient Safety Translational Research Centre. NS is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust. NS is a member of King’s Improvement Science, which is part of the NIHR CLAHRC South London and comprises a specialist team of improvement scientists and senior researchers based at King’s College London. Its work is funded by King’s Health Partners (Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, King’s College London and South London and Maudsley NHS Foundation Trust), Guy’s and St Thomas’ Charity, the Maudsley Charity and the Health Foundation. NS is also supported by the NIHR Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, King’s College London (GHRU 16/136/54). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • Competing interests Nick Sevdalis is the director of the London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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