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inspiring innovation

2013 – 14 ANNUAL REPORT


“As I conclude my time as CEO at Holland Bloorview, I want to thank all the children, youth, families, employees, students, trustees, volunteers and donors that I have had the honour to work with in the past 18 years,” says Sheila. “You have inspired me to lead Holland Bloorview to new heights. I am leaving my role knowing that the future looks bright for children with disabilities here and around the world.” 2

2013 - 2014 ANNUAL REPORT


Transform Care | Lead the System | Accelerate Knowledge | Inspire our People

Dear friends, Innovation creates hope for the future. Defined as the art of introducing change or something new, innovation is in our DNA at Holland Bloorview. If you ask anyone at Holland Bloorview what their inspiration is, the answer is unanimous: the children, youth and families who we work with every day. Our commitment to innovation, quality and excellence has put us on the international stage this year. From launching one of the first pediatric concussion research centres, to being honoured with four prestigious workplace awards, to seeing many of our employees being recognized for their outstanding contributions, 2013-2014 has been a stellar year. One of our proudest accomplishments came in October 2013, when Holland Bloorview was awarded Exemplary Standing from Accreditation

Canada, having achieved or exceeded 100 per cent of the national safety and quality standards. This remarkable rating exemplifies our commitment to excellence, and clearly demonstrates our leadership in the field of childhood disability. The external recognition of our leadership and achievements motivates us to do even better. More importantly, it’s an affirmation for the families and children that walk through our doors that they are getting the best care available. Innovation transcends all aspects of our work. In this report, you’ll read about how advancements in our research, teaching and learning, client and family engagement, community partnerships and even employee recruitment are breaking new, innovative ground.

Our Strategic Plan, Leadership in Childhood Disability, provided a roadmap for the past couple of years, and will continue to guide us in the coming three years. With a clear focus on our four key strategic pillars: Transform Care, Lead the System, Accelerate Knowledge and Inspire our People, we are creating an inspiring place where we can offer a world of possibilities for our clients and families every day.

Sheila Jarvis President and CEO

Julia Hanigsberg Chair, Board of Trustees

INSPIRING INNOVATION

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A MESSAGE FROM THE CHAIR A teaching hospital fully affiliated with

Under the leadership of Sheila Jarvis, Holland Bloorview has become an international beacon in the field of childhood disability. 1

Earlier this year, Sheila announced her intention to step down as CEO after 18 years. The organization that Sheila agreed to lead many years ago is unrecognizable from what Holland Bloorview is today. From the historic merger of two organizations into a single leading children’s rehabilitation hospital, to gaining fully affiliated teaching hospital status with the University of Toronto, to the opening of a state-of-theart facility, to opening the Bloorview Research Institute and paving the way for international impact in the field, to launching the Teaching and Learning Institute, our progress has been truly astounding. On behalf of the Board, clients, families, employees, students, volunteers and donors – thank you Sheila. As a tribute to Sheila, we have highlighted a few of her many accomplishments through this photo collection.

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Julia Hanigsberg Chair, Board of Trustees

Photos 1. Holland Bloorview’s state-of-the-art facility opens in 2006. 2. In 2002, Holland Bloorview gains teaching hospital status, fully affiliated with the University of Toronto. 3. In 2010, a historic $20 million donation is received from the Holland family. Bill Holland is pictured. 4. The Bloorview Research Institute is created in 2005, fostering unprecedented research investment in the field of childhood disability. 5. Holland Bloorview’s Teaching and Learning Institute is launched in 2010. 6. Holland Bloorview successfully achieves Exemplary Status from Accreditation Canada in 2010 and 2013. 7. Six University of Toronto Research Chairs are created with donor support. 8. One of the first concussion research centres in the world for children and youth is established in 2013. 9. Holland Bloorview has received a number of awards recognizing our outstanding workplace.

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SNAPSHOT 2013 – 2014

Holland Bloorview TEACHING AND LEARNING STATS 83% of students rated their experience as excellent or very good 79% of students strongly agreed that the feedback they received from their supervisor was helpful 89% of students indicated that they often or very often had the opportunity to apply new knowledge during their placement 46% of staff contribute to the academic agenda

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30% of students involved in interprofessional education

65,467

527

54.7 days

6,551

Outpatient visits

Inpatient admissions

Average length of stay

Total clients

907

80%

1010

112

Total employees

Employee engagement rate

Active volunteers

Family leaders

2013 - 2014 ANNUAL REPORT

Number of students 508

Number of students

508

Nursing

194

Clinical (other)

172

Research

75

Medicine

67


SNAPSHOT 2013 – 2014

Bloorview Research Institute NUMBER OF SCIENTISTS: 29

EXTERNAL RESEARCH FUNDING BY SOURCE: $5.6 MILLION

(15 full-time equivalents) Clinical investigators Clinician scientists Senior clinician scientists Scientists Senior scientists

SCIENTISTS AND INVESTIGATORS AT THE BLOORVIEW RESEARCH INSTITUTE

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Tom Chau VP research and director, Bloorview Research Institute

2 2 6 7

Senior scientists Barbara Gibson Gillian King Patricia McKeever Steve Ryan Virginia Wright Unni Narayanan

NUMBER OF TRAINEES: 114 Post-doctoral fellows PhD students Master’s (doctoral stream) students Undergraduate students Clinical master’s/MD students

PEER REVIEWED PUBLICATIONS: 77 2013-2014: 2012-2013: 2011-2012: 2010-2011: 2009-2010:

77 49 46 66 45

12 24 20 31 27

Provincial

$2,266,194.96

41%

Donations

$959,226.29

17%

Tricouncil grants

$758,117.83

14%

Subgrant collaborations

$629,678.09

11%

National

$418,871.28

8%

International

$242,864.46

4%

Canadian Foundations,

$176,740.40

3%

Societies and Associations Industry

$129,671.75

2%

Royalties

$7,875

0.1%

Scientists Amy McPherson Azadeh Kushki Elaine Biddiss Jan Andrysek Nancy Thomas-Stonell Sally Lindsay Clinician scientists Evdokia Anagnostou Nicholas Reed

Clinician investigator Jessica Brian Clinical study investigators Laura McAdam Molly Malone Sharon Smile Shauna Kingsnorth Clinical team investigators Peter Rumney Keith Adamson Pam Green Kim Bradley Golda Milo-Manson Ryan Hung Sarah Keenan

Senior clinician scientists Darcy Fehlings Michelle Keightley

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Transform Care | Lead the System | Accelerate Knowledge | Inspire our People

Family Engagement Committee INSPIRATION THROUGH PARTICIPATION

Caleb Jones and his mother Susan have been coming to Holland Bloorview for over a decade. Diagnosed with cerebral palsy at two years old, Caleb, now 13, receives therapy from a multidisciplinary team of experts. Right from the beginning, Susan has been an active part of her son’s care, attending every swim therapy session, every speech therapy appointment and every follow-up visit. Engaging families has always been a top priority at Holland Bloorview, but the hospital is now taking that engagement to the next level. Holland Bloorview’s most important stakeholders – our clients and families – are inspiring innovation by getting involved in each step of the research process. “You simply can’t conduct research in isolation anymore,” says Dr. Tom Chau, VP of research and director of the Bloorview Research Institute (BRI). “Applied research requires engagement from all stakeholders, especially those who depend on the results to improve their quality of life.”

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The BRI – Canada’s only hospital-based childhood disability research institute – has established a Family Engagement Committee (FEC). This is a groundbreaking move, opening up client and family involvement beyond participation in studies or focus groups. “The parent perspective brings real value to the research process, especially at Holland Bloorview because of the applied nature of the research,” says Gideon Sheps, a parent of a child with autism. He is the founding co-chair of the FEC, alongside Nadia Tanel, manager of research operations with the BRI. Established in late 2012, the FEC is modelled after the hospital’s groundbreaking Family Advisory Committee. It is made up of 10 family leaders and 10 hospital staff. The committee meets monthly and follows a formal leadership structure with family and staff co-chairs, a vice-chair, Geoffrey Feldman, and a secretary, Kate Wilson.

Every committee member brings their unique perspective to the table, but each has one thing in common: a desire to work alongside the hospital’s scientists – world leaders in areas of applied research for acquired brain injury, autism, prosthetic devices and communications technologies, among other fields – to bring about real change in the lives of children affected by childhood disability. From Gideon’s perspective, it’s a win-win scenario. “Researchers tap into the wealth of knowledge that families bring, but it also helps create broader awareness of the research that is being done at Holland Bloorview.” Family and youth members undergo a rigorous recruitment and training process so that they can represent the diverse populations at the hospital. Committee members contribute in many ways, such as identifying possible research topics and helping to ensure research information is understandable for families.


What does family input look like? For Susan and Caleb, they were able to review an early prototype for an interactive waiting room entertainment system called ScreenPlay. The technology generates large, colourful images on a projection screen when kids move across a pressuresensitive carpet. Caleb and his older brother Jonah suggested that the carpet be divided into different tiles to help kids get a better sense of where their bodies were in space. It was a great idea that helped make the device a mainstay in the second floor waiting area at Holland Bloorview. The FEC continues evolving. To date, the 20-person committee has focused primarily on understanding the scope and creating a framework of family engagement in research practices. Going forward, the committee will facilitate family engagement including examining ways for virtual family participation and sharing research findings with families in accessible, understandable ways, including using the hospital’s website and social media channels.

Elaine Biddiss, Bloorview Research Institute scientist, with Caleb, client

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Interviewing using simulation INSIGHTFUL INTERVIEWING Holland Bloorview is leading the way to more effective recruiting practices for health-care professionals by introducing an innovative approach to hiring. To hire seasonal staff for the 2013 Spiral Garden summer program, an integrated outdoor, art garden and play experience, Holland Bloorview piloted an interview circuit instead of the traditional hiring methods.

Marcela Gatica, volunteer resources coordinator (left), with Carolyn, volunteer (middle), and Laura, volunteer candidate (right)

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2013 - 2014 ANNUAL REPORT


Transform Care | Lead the System | Accelerate Knowledge | Inspire our People

“The traditional way of interviewing takes a lot of time and resources, and we don’t always find the staff that instinctively know how to engage effectively with children with disabilities,” says C.J. Curran, the hiring manager for Spiral Garden. “We wanted to see our potential summer staff in a real life setting. That’s why we created an interview circuit.” Holland Bloorview’s concept, called the Interview Simulation Cycle, builds on the research by the Michael G. DeGroote School of Medicine at McMaster University that shows that Multiple Mini Interviews (MMI) give a more authentic and complete representation of the candidate. C.J. collaborated with colleagues from the Teaching and Learning Institute and Human Resources and Organizational Development departments to create interview stations to evaluate communication, interpersonal skills, teamwork and conflict resolution abilities.

There were eight stations, and each miniinterview lasted five minutes, with a two-minute preparation period preceding the interview. Holland Bloorview added role play simulation that included client and family participation within the interview circuit. A combination of clients, employees and parents were the interviewers and raters, and were equal partners in decision-making. At one station, real life scenarios from the Spiral Garden program were used to role play with the candidates. “The top candidates became evident very quickly,” says C.J. “Their interpersonal and communications skills came through immediately, based on how they approached each scenario.” Holland Bloorview’s experience using an interview circuit shows great promise. Eighteen candidates were interviewed in three hours, with extraordinary results. The employee

satisfaction evaluation completed after the summer showed that ratings on all measures including teamwork, collaboration and communication doubled over the year before. Not surprisingly, seven out of 10 employees hired last year are returning this summer. Administratively, there was an 83 per cent reduction in direct interview time, and a 30 per cent increase in efficiency related to pre and post interview activities. The initial results of the Holland Bloorview pilot show that the Interview Simulation Cycle has the potential to be a leading technique for recruiting health care professionals. From C.J.’s perspective, it is an ideal way to see the candidates’ potential beyond the hard skills. “The interview circuit gives you immediate insight into interpersonal skills – skills like conflict resolution, teamwork and creativity – which are critical in health care.”

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Transform Care | Lead the System | Accelerate Knowledge | Inspire our People

An inspiring place to work A YEAR OF RECOGNITION

“I come to work every day committed to making a difference in the lives of children with disabilities,” says Lindsey Stewart, registered practical nurse, Brain Injury Rehab Team (BIRT). “I’m extremely appreciative that Holland Bloorview offers a work environment that supports employees to learn, be innovative and show their passion through their work.” It’s not only the employees that appreciate Holland Bloorview’s commitment to supporting our people, recognizing their accomplishments and offering opportunities for growth and development. This past year, Holland Bloorview was recognized with four prestigious workplace awards. “We are honoured to be recognized,” says Sheila Jarvis, CEO at Holland Bloorview. “The awards are an acknowlegement and recognition of our team of dedicated employees, who create a world of possibilities for our clients and families every day.” 12

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Being recognized for our excellence sends a powerful message to the children, youth and families that come to Holland Bloorview. It is a confirmation of the high quality, compassionate care that we provide each day. Our top honours this year included: • Canada’s 10 Most Admired Corporate Cultures 2013 award: This program recognizes best-in-class Canadian organizations for having a culture that has helped them enhance performance and sustain a competitive advantage. •C  anada’s Top Employers for Young People 2014 award:
 This special designation recognizes employers that offer the nation’s best benefits for younger workers. •G  reater Toronto’s Top Employers 2014 award: 
This special designation recognizes Greater Toronto employers that lead their industries in offering exceptional places to work.

•Q  uality Healthcare Workplace Award, Gold 2013 (Ontario-wide):
 This program recognizes organizational efforts to improve healthcare workplaces in ways that contribute to providers’ quality of work life and the quality of the care and services they deliver. At Holland Bloorview, we know that providing an inspirational workplace is key to our success as a leader in childhood disability. We work hard to offer an exceptional work environment that encourages our employees to bring their best to work every day. We are proud that our employees are among the best and provide outstanding care to our clients and families.


This year, a number of employees and Holland Bloorview projects were also honoured with awards for excellence. Darlene Hubley, interprofessional education (IPE) leader at Holland Bloorview, received the Individual Award of Merit for Excellence in Interprofessional Education Teaching from the University of Toronto Centre for Interprofessional Education. This award is given to a team or individual that demonstrates enthusiasm, commitment and knowledge for interprofessional education. Dr. Golda Milo-Manson, vice president of Medicine and Academic Affairs, received an exceptional service award from the Royal College of Physicians and Surgeons of Canada. She was recognized for her work in strengthening specialty education to help meet society’s needs, and her tireless work on a number of the Royal College’s committees driving initiatives such as accreditation, examination and credentials for specialists entering the health-care field.

Holland Bloorview’s BLOOM Blog, a blog about parenting kids with disabilities, was awarded first place in the Activism and Social Justice category of the 2013 Canadian Weblog Awards, and also ranked as high as 33rd in the top 150 non-profit blogs by Top NonProfits in 2013.

Canada’s Top 40 Research Hospitals This year, the Bloorview Research Institute was recognized as one of Canada’s Top 40 Research Hospitals. This annual list is published by Research Infosource, an organization dedicated to highlighting Canada’s most innovative universities, corporations, hospitals and colleges.

Holland Bloorview Employee Appreciation Day

Holland Bloorview employees celebrate the win of Canada’s 10 Most Admired Corporate Cultures 2013 Award

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Sonja, client, with her mom Nikolett (right) and registered practical nurse Emily Nesterov

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Anthony, former client, age 19, with his health-care provider at Sunnybrook Health Sciences Centre

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2013 - 2014 ANNUAL REPORT


Transform Care | Lead the System | Accelerate Knowledge | Inspire our People

Easing the transition to adult services Celebrating your 19th birthday is a milestone, but for some youth, it doesn’t always come with the same excitement that it does for other teenagers. For youth with disabilities, turning 19 means the safety-net of the pediatric healthcare system is no longer available to them. It marks the inevitable transition to the adult health-care system.

adult system. Anthony is a 19-year old Fitness and Health Promotion student at Humber College, who has spina bifida. Ever since he was six-months old, Anthony has come to Holland Bloorview for most of his health-care needs related to spina bifida. Over those years he developed bonds with his health-care team.

“When people think about transitioning to adult services, they often just think about it as the transfer of care,” says Connie Castillo, nurse practitioner in the Spina Bifida Adolescent Clinic. “The truth is, it’s so much more than that.”

When asked about the transition process, Anthony explains, “It involves building a rapport with new health-care providers, but it can also involve education. With Connie’s help, there’s a team approach to the transition so everyone gets comfortable with the new relationships.”

The Spina Bifida Adolescent Clinic is a pilot project funded by the Toronto Central Local Health Integration Network (TC-LHIN). The initiative is built on a partnership between Holland Bloorview and the Anne Johnson Health Station (AJHS) to effectively transition clients with spina bifida from pediatric to adult health care.

Connie starts working with youth who have spina bifida when they are age 13 or 14. Many youth with spina bifida also have cognitive issues, and are simply not ready to transition on their own at age 18 or 19. Through this partnership, Connie can follow these clients after they transition until they are 25 years old.

The project is designed to set up young adults, like Anthony Protomanni, for success in the

“We work with the clients to prepare them and assist them to gain the skills they need,

to advocate for themselves and manage their medical care independently,” she says. “We want to help them function better in society and the community.” When Anthony was having health issues, he and his mother Barbara turned to Connie to help direct them to the right care providers. Anthony particularly appreciates the lasting relationship he has enjoyed with Holland Bloorview employees. “Without Connie, I would feel lost,” he says. “I think I would have slipped into bad habits, because I wouldn’t be able to find people to help me. She’s there to support me through the transition.” This connection is not lost on Connie. She immediately points to it when asked to identify the most rewarding part of her role. “Being able to ease the anxiety of the youth and their parents, about the transition,” she says.

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Transform Care | Lead the System | Accelerate Knowledge | Inspire our People

Technology enables Zoey Faith to go home Amanda Mintenko and Mathew Lamarche wanted what all parents want – a happy and caring home for their kids. But staying home became a challenge when their daughter Zoey Faith was born with spina bifida, paralysis of her vocal chords and apnea, which required around the clock care, including monitoring of a breathing tube. Zoey Faith’s journey began with a year-long stay in Toronto – seven months at SickKids Hospital and four months at Holland Bloorview. Doctors in their hometown of Thunder Bay were concerned because the local hospital had never treated a ventilator-dependent child. They suggested the family may need to re-locate to Toronto to get Zoey Faith the treatment she required. It was a stressful time. Thanks to Holland Bloorview’s innovative transition plan, Zoey Faith and her family are together again – in their Thunder Bay home – enjoying each other’s company and giving her the care she requires. A unique approach to knowledge-sharing and communications 18

2013 - 2014 ANNUAL REPORT

technology brought together Toronto and Thunder Bay in a circle of care that addressed the family’s needs. By using Ontario Telemedicine Network’s videoconferencing, team members in Thunder Bay attended family meetings throughout Zoey Faith’s entire stay at Holland Bloorview. “The technology was amazing,” said Holland Bloorview respiratory therapist Robert Gagnon. “I could easily zoom in with the camera and move it around to show detailed equipment examples as I was explaining specifics.” Amanda and Mathew were trained on all aspects of their daughter’s care, including how to quickly care for their daughter’s tracheotomy, ventilator and stomach-feeding tube. Equipped with this experience, they helped train via videoconferencing the nurses and respiratory therapists in Thunder Bay on the equipment and daily physiotherapy activities. “Having the family show Zoey Faith’s care right at the bedside at Holland Bloorview helped the

Thunder Bay team visualize what they need to do,” says Maryanne Fellin, Holland Bloorview clinical resource leader. “It allowed the Thunder Bay team to get to know the family, see how Zoey Faith would react in a real setting and then have a discussion during the videoconference.” The day for Zoey Faith to return home finally came. Amanda and Mathew went home first to get everything ready, and Zoey Faith – then one year old – flew to Thunder Bay with a Holland Bloorview nurse and respiratory therapist. The entire family greeted her arrival and was thrilled to have her home. Zoey Faith is now comfortable and happy in her home surroundings. Amanda is the primary caregiver, and they have seven hours of nursing care every night so the parents can sleep. Even with the in-house support, Amanda and Mathew like knowing that Holland Bloorview is only a phone call away. Amanda explained, “If I have a question, I’ll call and speak to a respiratory therapist and they’ll share their insights.”


Zoey Faith, client, with Joy Vergara, registered practical nurse

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Family leadership Everywhere you look at Holland Bloorview, you can see the impact of the family voice. Family members are equal members of the team at Holland Bloorview, and their involvement ranges from participating in the hiring process, to providing input into program changes, to fundraising in support of new initiatives to help families. Here are just a couple of examples of the huge impact that family leaders have at Holland Bloorview. Becky Quinlan: Developing meaningful teaching tools Becky Quinlan, a parent of a Holland Bloorview client, along with other family leaders were actively involved in developing four simulation scenarios on client and family centred care that are now embedded into new employee orientation.

Becky Quinlan, family leader

The scenario development started with a daylong creative process in which participants like Becky shared their personal stories. Over the course of the following year, these stories were refined and developed into simulation scenarios, through further engagement with Becky and members of both the Client and Family Integrated Care and Teaching and Learning Institute teams. These scenarios, based on authentic family experiences in the health-care system, were

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developed to ensure new employees understand the four core principles of client and family centred care: dignity and respect, collaboration, participation and information sharing. “Understanding the four principles and the desired behaviours associated with them will help improve the consistency of care,” says Becky. For Becky, being included in the simulation development process means that Holland Bloorview is committed to putting client and family centred care into action. “I’ve learned how dedicated everyone at Holland Bloorview is at keeping families part of the process and planning. I’ve been fully engaged,” she says, adding “I feel my voice is completely valued here.”


Client and Family Integrated Care By the numbers (April 1, 2013 – March 31, 2014): 112 registered volunteer family leaders are involved in: • 35 standing committees • 17 special projects • 6 external partnerships • 29 external presentations • 7 poster presentations at conferences

• 21 education sessions for parents • 44 inpatient parent talk sessions • 51 articles reviewed through the health literacy program

242 S potlight awards given to employees by families 4569 T otal hours contributed by family leaders since 2011

Fred Char: Fundraising to improve the care experience Fred Char is a passionate advocate, fundraiser and supporter of Holland Bloorview. His daughter, Krystal, has been an inpatient ever since a severe seizure left her without the use of her torso or limbs many years ago.

Fred Char, family leader, with his daughter Krystal

With so much history at Holland Bloorview because of his commitment to being an active part of his daughter’s care, Fred agreed to become a member of the Family Advisory Committee (FAC) in 2009. His FAC participation sparked his interest in getting even more engaged. It started with his active involvement in creating inpatient welcome kits to support families new to Holland Bloorview. His support went beyond being a family leader on this project. He also fundraised over $10,000 to pay for the kits.

One of Krystal’s favourite activities is music. “Music gives Krystal a means of expression and independence,” says Fred. She has been able to benefit from Holland Bloorview’s Virtual Music Instrument, and can play it by moving her shoulder. Fred and Krystal are also research participants in a music therapy study looking at the synergy between a parent and child through music. Most recently, Fred raised another $10,369 to support the Therapeutic Recreation and Life Skills program. He gets a real sense of accomplishment in partnering with Holland Bloorview. As Fred says, “It’s very empowering and amazing.”

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NEWS HIGHLIGHTS

A year in review AN INSPIRING YEAR

Maureen Campbell, accreditation coordinator, and Daniel Scott, therapeutic playroom coordinator

Accreditation success In October 2013, Holland Bloorview achieved the highest rating possible from Accreditation Canada. We achieved an overall rating of 100 per cent, following an intensive on-site review, because we met or exceeded all of the required organizational practices and standards. Accreditation Canada, a national, voluntary peer-review organization, conducts surveys of health-care organizations and measures their quality and safety practices against standards of excellence. 22

2013 - 2014 ANNUAL REPORT

“Our top accreditation standing is a clear recognition of our commitment to providing the best possible care for our young clients and their families every day,” said Sheila Jarvis, Holland Bloorview’s President and CEO. In addition to our Exemplary Standing, Accreditation Canada also recognized Holland Bloorview earlier in 2013 for four leading practices in the health-care field: • The client/family voice in decision-making: our Family Leadership Program • A value-based employee recognition program, integrated with client and family care experience • Use of simulation education to facilitate adoption of point of care technology

• Medication management in a non-clinical environment

Anxiety Meter for autism Holland Bloorview is developing an innovative solution for helping kids with Autism Spectrum Disorder (ASD). It is estimated that 40 per cent of kids diagnosed with ASD also suffer from an anxiety disorder. Under the guidance of Dr. Azadeh Kushki of the Bloorview Research Institute, Holland Bloorview is developing the Anxiety Meter, a smartphone or tablet-based device that aims to help children with autism recognize their own anxiety levels and manage symptoms. The Anxiety Meter will be an effective tool for warding off the debilitating symptoms that exacerbate the effects of ASD.

Disney trip for Holland Bloorview clients In June 2013, 36 children from Holland Bloorview joined more than 35 children from SickKids Hospital for a one-day trip of a lifetime. The kids were flown to Walt Disney World thanks to the support of the Sunshine Foundation of Canada and the Ontario Automotive Recyclers Association. “It was incredible to see all these kids forget about their daily challenges and have the chance to be princes and princesses for the day. It was wonderful to be part of such a magical day in these kids’ lives,” said Breanne Mathers, Holland Bloorview child life specialist.


NEWS HIGHLIGHTS

For the children who were unable to make the trip, Disney princesses Cinderella and Ariel came to Holland Bloorview taking photos and signing autographs with the kids. It was a magical day all around.

Creating better access to child development services Holland Bloorview led the way in streamlining child development services in the GTA community, to better serve children with complex medical conditions such as cerebral palsy, spina bifida, Duchenne muscular dystrophy, autism or other developmental concerns. The Child Development Clinic at North York General Hospital (NYGH) transitioned its assessment and diagnosis services to Holland

Bloorview on April 1, 2014. The children from NYGH’s wait list and catchment area will now be seen by Holland Bloorview’s Child Development Program. In addition, Holland Bloorview merged two former satellite clinics – the North York General Hospital Branson site and the St. Joseph’s Hospital site – and launched our Eglinton West Satellite Child Development Clinic. By bringing these clinics together, waitlists will be reduced, offering families more flexibility around appointments by providing access to two teams in the new space.

Dr. Nick Reed, clinician scientist, and Dr. Michelle Keightley, senior clinician scientist, lead of the Concussion Research Centre

Pediatric Concussion Research Centre launched In October 2013, Holland Bloorview launched our Concussion Research Centre, one of the first in the world dedicated to studying concussions in children and youth. The centre is generously funded through grants from the Canadian government and a $1 million gift from the Trillium Automobile Dealers Association (TADA). “Until now, concussion research has largely focused on adults,

but we know that the brains and bodies of youth and children are continually developing,” says Dr. Michelle Keightley, senior clinician scientist, Bloorview Research Institute. “This makes them significantly more vulnerable to the effects of a concussion.” Through the work of this centre, Holland Bloorview hopes to transform the way kids’ concussions are managed locally, nationally and internationally.

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NEWS HIGHLIGHTS

Hospital-University endowed research chair appointments Holland Bloorview and the University of Toronto announced four chair appointments and renewals, with generous support from the Holland Bloorview Kids Rehabilitation Hospital Foundation and its donors. Dr. Barbara Gibson was appointed the Bloorview Kids Foundation Chair in Childhood Disability Studies. Dr. Gibson’s research examines quality of life, community participation and social inclusion of children with disabilities. Dr. Darcy Fehlings not only received a renewed appointment as the Bloorview Children’s Hospital Foundation Chair in Development Paediatrics, but also became a full professor in the Department of Paediatrics at the University of Toronto. As both a senior clinician scientist leading BRI’s Cerebral Palsy Discovery Lab and the physician director of the 24

2013 - 2014 ANNUAL REPORT

Child Development Program at Holland Bloorview, Dr. Fehlings researches interventions for children with cerebral palsy, and aims to help children with physical disabilities achieve the highest quality of life. Dr. Michelle Keightley was named the inaugural holder of the Holland Family Chair in Acquired Brain Injury. Funded by the Holland family, this hospital-university endowed research chair will support groundbreaking research in the field of acquired brain injury. Dr. Keightley, who leads the Concussion Research Centre in the Bloorview Research Institute and co-leads the hospital’s Centre for Leadership in Acquired Brain Injury, was chosen for her focus on identifying, assessing and managing various forms of acquired brain injury in children and youth. Dr. Tom Chau, VP of research and director of the Bloorview Research Institute, was recently appointed

as the Chang Family Foundation Chair in Access Innovations. The mission of the hospital-university endowed Chair is to improve quality of life for children who are unable to speak or move, and to increase accessibility to care and devices for non-verbal children on a larger scale. Dr. Chau was selected for his expertise in developing novel access pathways for children who are non-verbal.

scheduling their first appointments in most non-physician clinics. Also, we now aim to call families within two days from when we receive their referral for non-physician appointments, so they are kept informed about the process. While these changes are a step in the right direction, the hospital continues to review our appointment services to identify further improvements.

Improving how we schedule appointments Holland Bloorview is committed to ensuring scheduling appointments is as easy as possible for our clients and families. Over the past year, we streamlined how we schedule appointments to help reduce the anxiety felt by clients and families trying to navigate the scheduling process. We created a central point of access for families when they are

Health Quality Ontario Champion Family voices come first at Holland Bloorview, and the hospital’s commitment to involving families has been recognized as a Health Quality Ontario (HQO) Champion. Over the years, Holland Bloorview set out to rejuvenate our Family Leadership Program by analyzing best practices for client and family centred care, identifying


key areas for family involvement and creating unique roles for family leadership functions. The Family Leadership Program is now a transformational partnership that is flourishing with families participating in decision making across the hospital.

Onsite legal assistance available A new legal assistance program offered at Holland Bloorview has helped 59 low and moderateincome clients and families since September 2013. Through a medical-legal partnership between Pro Bono Law Ontario (PBLO) and Holland Bloorview, onsite legal advice is available on non-medical issues that may impact a child’s health or a family’s capacity to care for their child. The onsite lawyer can provide free legal information, basic legal

advice, a brief service or a referral to offsite legal assistance on topics such as housing, education, immigration and employment law-related needs. Depending on the case, offsite legal assistance may include a referral to a legal aid clinic or lawyer who is willing to also provide free legal assistance.

Engaging our employees Every two years, Holland Bloorview seeks feedback through an employee engagement survey to ensure we are providing an exceptional workplace that meets the needs of our outstanding employees. A positive employee experience is associated with improved clinical outcomes, better workplace safety and increased recruitment and retention rates, all areas in which Holland Bloorview strives to excel.

Visit our new website at www.hollandbloorview.ca

In 2013, Holland Bloorview had an exceptional overall employee engagement rate of 80 per cent, well above the health-care sector benchmark of just over 50 per cent. In fact, Holland Bloorview was rated consistently higher than the health-care benchmark for every workplace dimension in the survey. Employee feedback informs organizational action plans that help us continually improve our work environment.

Launch of the new website Holland Bloorview launched an upgraded, accessible and userfriendly version of our website: www.hollandbloorview.ca in March 2014. This new site makes it easier for clients and families, and all stakeholders, to find information about our programs and services and learn about exciting news and developments at Holland Bloorview.

INSPIRING INNOVATION

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‘How We Measure Up’ report Holland Bloorview is always looking for better ways to measure our performance and communicate how we are doing. Here is an at-a-glance report of our performance. Our ratings were determined through input from representatives from the Provincial Council for Maternal and Child Health (PCMCH), GTA Rehab Network, Institute for Clinical and Evaluative Sciences (ICES) and Holland Bloorview’s Family and Youth Advisory Committees. For 10 years the ‘How We Measure Up’ report (HWMU) has been a critical element of our quality improvement program. It provides an external lens on our performance and ensures we are establishing targets that lead to improved quality, clinical care, academic and research excellence. Guideline: Fair = H (1) Good = H H (2) Excellent = H H H (3)

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2013 - 2014 ANNUAL REPORT

STRATEGIC GOAL

MEASURES

BENCHMARK

Transform Care

Achievement of goals set by the client and/or therapist using Goal Attainment Scaling:

ACTUAL

SCORE

T-score between 45-55 35% 30%

53 42.7% 33.3%

HHH

Generate, adopt and share new evidence for clinical care to achieve outstanding client and family outcomes.

• Average achievement score for goals set by client and/or therapist1 • % of goals achieved to expectations (T-Score between 45 and 55) • % of goals exceeding expectations (T-Score above 55)

Provide exceptional client and family-centred care, embracing authentic partnerships with families and ensuring the ‘voice of the client’ is heard.

% of families who rate Holland Bloorview excellent or good2

95%

96.2%

HHH

% of family leaders who rate their experience as an authentic partnership3

90%a

88%

HHH

% of complaints with initial contact and interview commencing within 2 business days

95%

100%

HHH

5.5 5.5 5.5 5.5 5.5

5.8 5.0 5.8 6.0 5.7

Annual infections per 1000 inpatient days4

3.4 per 1000

3.09 per 1000

Reported medication adverse events (mild to moderate) per 1000 inpatient days5

0.3 per 1000

0.29 per 1000

% complete medication reconciliation on inpatient admission

100%b

97.8%

HHH

% complete medication reconciliation on outpatient clinic visit

95%

97.7%

HHH

% compliance to hand hygiene across 4 moments of care6

95%

Moment 1 – 91.7% Moment 2 – 97.3% Moment 3 – 94.6% Moment 4 – 91.4%

HHH

Total margin (a comparison of consolidated revenues versus expenses)7

0.5%

1.1%

HHH

1.0

1.26

HHH

Harness emerging technologies and the latest processes to improve efficiency and enhance the quality of care to children with disabilities. Build, strengthen and grow our Centres for Leadership in Acquired Brain Injury, Child Development and Participation and Inclusion.

Average rating within each category of the CanChild Measures of Processes of Care (MPOC). The MPOC is the tool for family feedback that Holland Bloorview uses as part of their client and family satisfaction tool “Tell Us What You Think”2 • • • • •

Co-ordinated Care (out of 7) General Information (out of 7) Partnership (out of 7) Respectful Care (out of 7) Specific Information (out of 7)

Current ratio of short term assets and liabilities8

HH

HH HH

Benchmark notes: a. This is an internal target based on our own survey tool. The lowest acceptable performance score is 81%. b. The target is the theoretical maximum. The lowest acceptable performance score is 85.5%. c. The target for wait times in fiscal year 2014/15 will be reduced to reflect the improvement. d. Staff engagement is measured every two years and is an aggregate of six questions. Holland Bloorview’s response rate was 77%.


STRATEGIC GOAL

MEASURES

BENCHMARK

Lead the System Create new, innovative models of care in collaboration with system partners to support improved navigation and timely access to appropriate services for children with disabilities. Forge new linkages with partners in community, health and education sectors to facilitate seamless transitions to adulthood. Advocate for a provincial focus on equity in access and removal of barriers for children with disabilities and their families.

Wait in days for new autism clients9

Wait in days for new neuromotor clients

Wait in days for new augmentative communication clients

Wait in days for new writing aids clients

Wait in days for new inpatient rehabilitation clients

Conduct transformational research in paediatric rehabilitation, with a focus on areas of strategic clinical importance, such as brain science. Become a recognized leader in attracting and training the very best of the next generation of experts in childhood disability by embracing best practice models in teaching and learning and providing an exceptional student experience. Generate new linkages with academic, industry and system partners to accelerate knowledge generation, translation and evaluation, and commercialization of innovations.

Inspire our People Foster meaningful engagement among employees, clients and families to co-create models of collaboration and shared decision-making. Create an environment where the spirit of inquiry is demonstrated everywhere, every day. Become a magnet hospital for clinical, education and research talent. Build a culture that empowers employees to engage in teaching, learning and research initiatives that advance the care of children with disabilities.

SCORE

80% seen in 182 daysc

Q1 - 133 days Q2 - 131 days Q3 - 139 days Q4 - 147 days

HH

80% seen in 137 daysc

Q1 - 84 days Q2 - 102 days Q3 - 98 days Q4 - 106 days

HH

90% seen in 121 daysc

Q1 - 60 days Q2 - 56 days Q3 - 76 days Q4 - 89 days

HHH

90% seen in 61 daysc

Q1 - 64 days Q2 - 56 days Q3 - 37 days Q4 - 41 days

HHH

90% seen in 3 daysc

Q1 - 0 days Q2 - 0 days Q3 - 0 days Q4 - 0 days

HHH

2.7036 (LHIN) 1.4840 (Peer)

4.2280

HHH

50%

55%

HHH

90%

83.2%

HH

5.5

5.1

HH

23.6

24

HHH

$400,000

$374,416

2.3

3.7

HHH

% of staff that indicated they were engaged and committed to Holland Bloorview - using the staff engagement survey17

52% d

80%

HHH

Employee turnover rate18

7.12%

5.8%

HHH

80%

97%

HHH

Average Electronic Medical Record Adoption Model (EMRAM) Score10

Accelerate Knowledge

ACTUAL

% of professional health discipline and nursing students that rate their clinical experience as excellent11 % of professional health discipline and nursing students who indicated they participated in inter-professional education on the TAHSN-E survey (sometimes, often and very often)12 Number of peer reviewed publications per investigator13 H index (measuring research impact)

14

Research funding by investigator

15

# of research students per investigator16

% of eligible employees with academic status appointments (professional health disciplines –speech language pathology, occupational therapy, physical therapy)

HH

Measure notes: 1 Based upon peer-reviewed literature on Goal Attainment Scale (GAS) goals. Average improvement is not adjusted for acuity. 2 Results are from the ‘Tell Us What You Think’ patient satisfaction survey using the CanChild Measure of Processes of Care (MPOC). The response rate in 2013/14 was over 16% with responses from over 649 surveys. 3 The Family Leadership Program has over 110 families who are surveyed twice a year to measure level of authentic partnership. 4 Infections are ‘hospital acquired infections’. 5 Based on the World Health Organization scaling of adverse events. 6 Hand hygiene measures 4 moments in the care process. 7 Target based on Toronto Central Local Health Integrated Network (TC-LHIN) standards. 8 A ratio that measures whether or not a firm has enough resources to pay its debts over the next 12 months. 9 The measure for wait in our autism population went from 187 days to 147 days while referrals doubled. 10 Ontario Hospital Association derived benchmark. Scale 0-7. 11 There is no industry benchmark that measures ‘excellent’ only. The industry benchmark for very good and excellent is 75-80%. 12 An internal target has been set this year while the Toronto Academic Health Sciences Network Education (TAHSN-E) survey is being formalized. 13 Number of peer-reviewed publications benchmark is a median value of all other TAHSN hospitals from 2011. Per investigator is based on BRI FTEs (15). 14 The H-index measures both the productivity and impact of the published work of a scholar. Our goal is to reach a minimum H-index of 38 by 2018. The current target is based on a linear extrapolation leading to 2018. 15 Total amount of research funding by investigator is the median value of all other TAHSN hospitals from 2011. Per investigator is based on BRI FTEs (15). 16 The number calculates FTE (15) scientists and investigators to number of Masters, PhD and post doctoral fellows. Average value across TAHSN hospitals from 2011. 17 Our target reflects the survey provider’s health industry average. 18 Turnover rate is based on the Ontario Hospital Association benchmarking survey from 2012. A full explanation of our measures is available on our website.

INSPIRING INNOVATION

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Transform Care | Lead the System | Accelerate Knowledge | Inspire our People

A TEACHING HOSPITAL FULLY AFFILIATED WITH

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Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8 T: 416-425-6220 F: 416-425-4531 E: info@hollandbloorview.ca足足 www.hollandbloorview.ca

2013 - 2014 ANNUAL REPORT Writing, Project Management: Christa Haanstra, clarityhub.ca | Design: Sara Purves www.rubinered.ca | Principal photography: William Suarez www.williamsuarez.ca


Inspiring Innovation