Differences in Culture Between Medical Teams: It Matters!

Organizational culture is a system of shared assumptions, values and beliefs, which governs how people behave in organizations.  To make matters slightly more complicated, culture can vary within teams of a given organization.  This is precisely what exists in medicine between physicians and surgeons.

This study, published in Clinical Infectious Diseases, is the first of its kind to explore the difference in culture and team dynamics between physicians and surgeons with respect to antibiotic decision making.

Physicians function under a more  interdisciplinary approach, with shared decision making which includes pharmacists and infectious diseases specialists when it comes to infectious diseases concerns.  In surgery, senior surgeons are less actively engaged in antibiotic decision making. These non-operative decisions are relegated to the most junior member of the team, typically the surgical intern managing ward cases. Communication in a more vertical team structure, such as in a surgical team, is less commonly face-to-face and more commonly via messaging, with the goal of the managing intern being not to 'miss something' and to avoid blame.

How is this relevant for antimicrobial stewardship programs (ASP)? 

Forget changing culture, rather, change the message.  In other words, tailor the feedback to the specific teams.  ASPs could make the antibiotic prescribing message more convincing to surgeons by focusing on surgical outcomes and length of stay rather than antibiotic consumption rates. 

ASP interventions should strive for maximal sender-receiver impact. Service specific, bespoke ASP interventions may be the way to go.