Short abstract:

The notion of ‘optimization’ is increasingly finding room in biomedicine, in spaces such as public health, healthcare, or e-health. Here I explore ‘optimization’ in the context of AMS programmes in Spain, not as a grand transformation, but as a pragmatic ethics of work and clinical care.

Long abstract:

In this paper, I draw on results from an ethnographic study of antimicrobial stewardship (AMS) programmes in the context of Spain, particularly in the public hospital. These programmes are known as Programas para la Optimización de Antimicrobianos (PROAs). In a scenario in which antimicrobial drugs are imagined and framed as scarce medicines and as depleting resources, the implementation of AMS/PROAs interventions is identified as a crucial solution to the impact of antimicrobial resistance (AMR) in human health and healthcare. The notion of ‘optimization’ is increasingly finding discursive space in how AMS programmes are imagined and enacted, including in policy documents published by the WHO or the European Union. In this research project, I critically interrogate the ‘O’ in the acronym PROA: what does such an aspiration to ‘optimization’ offer these healthcare professionals involved in designing, enacting and implementing PROA teams in healthcare settings? As some of my research participants would put it, optimization in antimicrobial stewardship is ‘knowing how to adapt decisions’, and ‘an exercise of collaboration and teamwork’, it is an aspiration to ‘use the best antibiotic for the best outcome for each patient’. I will argue that this yearning for optimization in the Spanish public hospital functions as a pragmatic ethics in the day-to-day of PROA teams. Instead of acting as a grand ambition to streamlining, efficiency and maximising available resources, here ‘optimization’ becomes a mundane, pragmatic exercise of navigating collective decision-making, where choices, judgement and regard for others find a space to be expressed and practiced.