Conceptual Foundations and Clinical Frameworks of Stewardship
Conceptual frameworks underpinning antimicrobial stewardship demonstrate that optimal prescribing cannot be achieved solely through static educational dissemination or rigid restrictive formularies. Within secondary care, clinical decision-making functions as a complex behavioural negotiation shaped by perceived risk, diagnostic ambiguity, and institutional norms [2]. Structured toolkits, such as those historically endorsed by national public health bodies, position stewardship as an integrated continuum of core restrictive policies and supplemental enabling strategies designed to guide clinical judgment at critical prescribing intervals [1]. However, the efficacy of these frameworks depends heavily on how information and oversight are communicated back to frontline healthcare teams. The Clinical Performance Feedback Intervention Theory clarifies that performance feedback operates through sequential cognitive and behavioural cycles, wherein clinicians must receive actionable, credible data to recognise discrepancies between actual practice and established targets [4]. When healthcare professionals perceive feedback as punitive or divorced from acute clinical realities, the feedback cycle breaks down, preventing meaningful modifications in prescribing behaviour. Consequently, effective institutional stewardship requires harmonising national clinical benchmarks with local social architectures, ensuring that guidance mechanisms support clinicians during active decision-making rather than imposing post-hoc bureaucratic compliance [1, 4].