Introducing antimicrobial stewardship in Vancouver Coastal Health’s community of care was a challenge that required a cultural transformation amongst health care professionals. That changed when infectious disease physician Josh Douglas joined the team at Lions Gate Hospital (LGH).
Josh created new services for patients and innovated the way quality improvement is delivered to smaller hospitals, using a hub-and-spoke model to make LGH a center of excellence with locally relevant services on other sites. With patience and kindness, he brought antimicrobial stewardship to a thriving program by providing daily feedback to prescribers and was able to grow the acceptance rate by physicians from 60% to 90%.
With a calm and gregarious personality, Josh has overcome silos and built relationships between professional groups, creating a culture of care and safety. He has been a key champion for Clinical Systems Transformation, using his skill and knowledge in infectious diseases to support the physician group to build the best possible system to document and treat infections, making treatment easier for all health care team members.
Josh presented a proposal for a local antimicrobial stewardship program at LGH and helped secure funds for a trial period. Within a year of starting the program, he became the leader for antimicrobial stewardship, the representative for infection control and the go-to expert for infections in the entire coastal community of care. He built an outpatient intravenous antibiotic therapy clinic that allows patients to go home sooner, and begun consulting on blood infections caused by staphylococcus, an organism known to cause serious disease that can come back if not treated properly.
He also supported the pharmacy team in advising reduced antimicrobial spectrum at LGH and other sites and ensured that all pre-programmed orders follow best practices. During the first year of the stewardship program, there was such a reduction in the use of antibiotics that the hospital’s pharmacy has been able to mix them in-house instead of ordering a large pre-mixed volume, resulting in better care for patients at a lower cost.
Josh built his team from the ground up, and now there are three infectious disease physicians across the coastal community of care. He takes the time to meet physicians at their place of work to discuss antimicrobial stewardship and figure out how best to serve patients and physicians in smaller hospitals. He has created referral systems for complex cases and worked through the medical advisory committee to ensure that patients with dangerous infections are seen by an expert in treating infections and have their results quickly communicated to those who need them.
Along the way, Josh is always cheerful and calm in the face of adversities. This even keel is what makes him such an inspiration for his nominator, and it’s the reason why he has managed to quickly build such an effective team and improve care throughout his region for patients with infectious diseases.
