Sample: Assignment On Strategic Management And Sustainability Of Sainsbury

Background

Otitis media (OM) is one of the most common reasons for consultation in children in primary care worldwide. It occurs in approximately 80% of children under five years of age, with a global prevalence of 10.85%, and a significant percentage experience recurrences (Mustafa et al., 2017). In the UK, OM contributes a substantial proportion of primary care consultations, resulting in considerable pressure on general practice services, particularly during the winter months (Ward, 2022). Although generally self-limiting, antibiotics are often prescribed for OM, with evidence showing that up to 87% of children attending with OM are prescribed antibiotics in the UK (Venekamp et al., 2014). Clinical research suggests that antibiotics do not significantly impact most cases, at least within the first 24 to 48 hours following symptom onset. It has been suggested that most doctors opt out mainly due to concerns about diagnosis, possible complications, and demands from parents (AbdEl-Aty et al., 2024).

The majority of uncomplicated OM cases are advised to either delay or avoid antibiotics by major clinical guidelines (NICE, 2018). Delayed prescribing is a strategy in which the clinician prescribes medication and instructs the caregiver to use it if the condition worsens or does not improve within a time frame. Delayed prescribing is supported by evidence and promotes shared decision-making between caregivers and clinicians. In addition, the World Health Organisation highlights halting the unjustified use of antimicrobials to help bring down the rising trends of antimicrobial resistance (AMR), which is a public health crisis set to compromise the efficacy of modern medicine (WHO, 2023). Rather than being dispensed with by these guidelines, however, antibiotic prescription for OM is disproportionately high in most settings. This discrepancy between best practice advice and current prescribing habits emphasises the necessity of specific quality improvement (QI) interventions that enable guideline compliance, reduce the risk of antimicrobial resistance (AMR), and improve outcomes in children and their families.

Rationale for Quality Improvement and Identified Gaps

Although for years, when paediatric acute otitis media (AOM) is considered, cautious prescribing of antibiotics has been pushed, common practice still shows that antibiotics are overused. It is clear from UK prescribing audits that most children with an acute otitis media (AOM) infection tend to receive antibiotics despite the NICE factsheet recommending procedures that do not involve antibiotics or quick antibiotic treatment for mild AOM infections (Williams et al., 2018). On the other hand, Venekamp et al. (2023) found in their research that late antibiotic therapy reduced antibiotic use and improved children's health without causing any major complications. The misuse, however, is a part of the expanding global risk of antimicrobial resistance (AMR) and has been emphasised in the WHO's global action plan, which demands speedy system-level changes to enhance prescribing practices (WHO, 2023).

While the evidence base in the literature is robust for the clinical effectiveness of delayed prescribing, its implementation in routine general practice varies. A high-quality qualitative evidence base identifies systemic and behaviour-related barriers to its adoption, and these include clinician discomfort with clinical uncertainty, perceived parental pressure, and workflow constraints (Rinaldi et al., 2025; Van et al., 2019). Notably, Boiko et al. (2020) highlighted in their qualitative interviews with UK GPs that most prescribers issue antibiotics to ensure perceived trust and satisfaction, regardless of patient needs. In contrast, parents in another study consistently reported being open to alternatives as long as they received clear communication and reassurance (Hayfa et al., 2023). These conflicting perspectives indicate a fundamental misalignment in clinician-patient communication, compounded by the absence of formal instruments to support guideline-consistent decision-making.

Even with the presence of quantitative audits and qualitative data, fewer studies combine these results within an iterative, action-oriented intervention. This is where the use of a Quality Improvement (QI) approach, specifically the Plan-Do-Study-Act (PDSA) cycle, offers a practical solution. Based on Deming’s System of Profound Knowledge, the PDSA model enables small-scale testing and real-time adaptation of change, addressing complex, contextual obstacles in primary care (Taylor et al., 2014). In contrast to more control-oriented and standardised traditional research designs, PDSA enables ongoing learning and improvement and is well-suited to respond to the subtle, behavioural causes of prescribing. Yet, accounts of sustained PDSA-led interventions aimed at paediatric antibiotic use are limited, representing an essential research gap that this proposal will fill by adopting a theory-informed, practice-embedded approach to quality improvement (QI) that incorporates stakeholder engagement, continuous evaluation, and ethical stewardship.

Project Aims

The primary aim of this project is to improve antibiotic prescribing in children presenting with otitis media in primary care by implementing a structured, delayed prescribing intervention using the Plan-Do-Study-Act (PDSA) model over 1 year. The aim addresses the problem of a frequent gap between NICE recommendations and how antibiotics are prescribed in practice, causing unnecessary AMR and potentially undesirable drug effects. For this reason, decisions in the project will be based on research, using templates for delayed prescriptions, parent leaflets and shared decision-making tools tested and improved in several PDSA cycles. Patients and medical staff will collaborate, while the project will use prescriptions and qualitative evaluations to chart its progress. Using the SMART objectives criteria, the team has developed the following objectives to reach the main aim of the project.

It is anticipated that after the 1-year intervention, the proportion of pediatric otitis media cases in which antibiotics are prescribed immediately will decrease by at least 25%. Parents' satisfaction with prescribing and the rise in clinicians' trust after using delayed prescriptions should be recognised as useful feedback.

Project Methodology

Quality Improvement Approach

The proposed project will employ the Model for Improvement and the Plan-Do-Study-Act (PDSA) cycle as the fundamental quality improvement strategy. The PDSA cycle provides an actionable, iterative process that allows for real-time testing of interventions. This aspect makes it particularly well-suited for mature primary care settings where prescribing behaviour is driven by multifaceted clinical and social determinants (Coury et al., 2017). Based on the behavioural dimension of overprescription of antibiotics among children with otitis media, an adaptive, feedback-driven model like PDSA facilitates learning through adaptation and correction of the course while improving.

The four stages of the model are plan, set the problem and aims and decide on intervention; do the needed change on a small scale; study the outcomes, gather data and examine results; and act on evidence to make the strategy better (Katowa et al., 2021). The cycle will allow researcher to review delayed prescribing templates, prepared leaflets and education for clinicians. The study of inappropriate antibiotic use for otitis media in children was guided by the Fishbone Diagram (Cause and Effect), which shows the main reasons for this issue. The fishbone diagram shows what results in inappropriate prescribing of antibiotics for otitis media in children. It groups causes into factors related to the patient, the clinician, the health care system and other related parts of the context. Literature points out that both following instructions and better communication assist in stopping the misuse of drugs (AbdEl-Aty et al., 2024).

Justification of QI Approach

The reason for choosing the PDSA cycle as the main QI methodology is its strong evidence base and the fact that it fits well with problems in primary care. It has been proven by Mukwato (2021) and Frost et al. (2021) that PDSA interventions, done with audit and feedback, are clinically effective in influencing physicians’ behaviour. By utilising PDSA cycles in antimicrobial stewardship, clinicians enhance their approach to prescribing antimicrobials without centralised guidance (Dorzin et al., 2017). According to John (2022), although PDSA cycles are frequently employed to manage patient experiences, they tend to be conducted poorly. It shows that there is a need for good planning and documentation in order to maintain the validity of the assumptions of the model. But critics also maintain that PDSA does not adhere to clinical trials' stringent standards, hence determining a direct cause is challenging (Knudsen et al., 2019). Yet, when applied to enhancing local practice rather than pursuing generalisability, it is a strength, allowing for instant feedback and a response to local circumstances. This change in behaviour on the part of the project, like requesting clinicians to minimise short-term prescribing, is also consistent with Deming's System of Profound Knowledge that underlies the PDSA model (Yasser et al., 2023).

Improvement Plan

The primary aim of this quality improvement project is to introduce and evaluate a delayed prescribing program for children's AOM within a primary care environment over 12 months. This intervention aligns with NICE (2018) NG91 guidance and aims to reduce the unwanted use of antibiotics through targeted stewardship and involvement of parents.

Plan Stage (P)

To begin with, the Plan stage will involve a retrospective audit of antibiotic prescribing behaviour over the past six months as a baseline, using methodologies endorsed by Cassim et al. (2024). A workshop for GPs will be organised to familiarise clinicians with delayed prescribing principles, supported by NICE (2018) and NHS Scotland (2025) guidelines. Tools like a template for a standardised delayed prescription and a parent leaflet of information, drawn from Dube et al. (2023) and Frost et al. (2021), will be developed.

Do Stage (D)

At the Study phase, immediate and delayed prescription rate comparisons will be collected monthly through EMR analytics (Chen et al., 2020). GP reflections and short parent feedback sheets will be obtained in order to assess acceptability and use of the intervention and what the potential barriers are, including time limitation or parental expectations (Hunt et al., 2021). Ethical concerns like informed consent and justice of care will be consistently monitored as per Goldstein (2021) and Hall et al. (2020).