Our kids deserve the very best. 2010-11 ANNUAL REPORT
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Challenging the status quo
Holland Bloorview Snapshot Holland Bloorview Kids Rehabilitation Hospital 2010-11
Average length of stay:
Number of students Medicine: 62
Clinical Technology: 22
Other: 2 Allied Health: 147
Dear Friends, Quality is about continuously challenging the status quo. It’s about respect for people. It’s about making the process better so that every child and family realizes the greatest value from our programs and services and our staff are able to provide their very best. Maintaining the highest quality of care is a journey towards excellence we strive for each day at Holland Bloorview Kids Rehabilitation Hospital. Through this journey, our remarkable staff and volunteers have led the way, demonstrating an unparalleled commitment, knowledge and enthusiasm. 2010 marked the conclusion of Holland Bloorview’s participation in the Leadership for Performance Excellence initiative offered by the Canadian Health Quality Institute, managed by the Change Foundation and funded by the Ministry of Health and LongTerm Care. Through our participation, we were able to make big strides in our quality program leading us to adopt LEAN, a proven improvement science method, as our improvement approach. Over the past year, we have applied LEAN to help make significant improvements in client access to care. Quality improvements are everywhere. Our focus on quality is embedded in our strategic plan, reflected in our core values and integrated into our annual operating plan. In September, we received full
accreditation from Accreditation Canada with no recommendations. In fact, we were compliant with more than 99 percent of the standards – a true testament to successfully integrating a quality focus in everything we do. We welcome the increased attention and focus on patient safety that was brought forward in 2010 through the introduction of the Excellence Care For All Act (Bill 46). The spirit of the legislation is directly aligned with our continued focus and commitment to quality improvement and our strategic priorities of improving access to care, and enhancing system integration and coordination. As a result of the new legislation, you can now find our annual Quality Improvement Plan and formal patient declaration of values online, created through broad client and community engagement. Our long standing commitment to Client and Family-Centred Care positions us as leaders in this important work. Through the introduction of our Family Leadership Program this past year, we are taking our committed to new heights. As our Strategic Plan, Infinite Possibilities 2007-2012 comes to a close, join us as we reflect back upon this year’s achievements in creating a world of possibility for kids with disabilities.
President and CEO
Chair, Board of Trustees
It’s about striving for excellence Holland Bloorview has a long standing commitment to quality improvement in everything that we do. As an academic teaching hospital and a provincial resource we are committed to continuously improving so that clients and families receive the best care possible.
Accreditation: Holland Bloorview’s Journey to Excellence In September 2010, Holland Bloorview’s Journey to Excellence led us to achieve full accreditation from Accreditation Canada for a period of three years. Holland Bloorview was compliant with 99 per cent of Accreditation Canada’s criteria, placing us among an elite group of highest-achieving Canadian hospitals. In addition to receiving an outstanding result in the accreditation process, Holland Bloorview was recognized for five leading practices.
ME Checking your I.D. makes staff sure that the right person is always receiving the right treatment. Staff will check your NAME and DATE of BIRTH when you: • arrive at Holland Bloorview • receive medications • have lab work or procedures done (e.g. taking blood, x-rays)
Nam e : D ate o f bir t h :
Name: Date of bi
The Best Care is Safe Care Clinical excellence does not exist without client safety. This year, Holland Bloorview made great strides in implementing initiatives designed to help us identify harm, analyze how safety incidents occur and generate solutions to prevent harm in the future. Safety Concern
What action we take
What this action does
Treatments done to the wrong person
Check two identifiers (name & date of birth) against a reference source (e.g. medical record)
Ensures the right client is always getting the right treatment
Tracking falls and trending, and educating clients, families and staff
Identifies higher risk clients and introduces proactive strategies to reduce falls
Medication errors (i.e patient is not prescribed the correct medications on admission or discharge)
A formal medication reconciliation process at admission, transfer and referral
A complete medication history is matched with new orders so an accurate picture of medications is shared with new providers. Clients are always involved in medication discussions
Healthcare associated infections
Clean Hands Protect Lives campaign
Promotes client and family awareness of hand hygiene to reduce the spread of germs
Name : D a te o f bir t h:
If staff forget to do this, just say: I.D. ME!
LEAN LEAN focuses on the client experience by evaluating programs and services. This ensures that families receive the best care and front-line staff are able to achieve their very best through the removal of obstacles and barriers that prevent pride in workmanship. Using LEAN we have embarked on a number of improvement projects to ensure we are well positioned to meet the needs of our clients in the future. We’ve reviewed access to care in our neuromotor and autism programs and piloted a coordinated system for referral for Brain Injury Rehabilitation outpatients. In a short time, we’ve already seen promising results: • In one year, the wait time for a neuromotor appointment has been reduced from 238 days to 192 days for 80 per cent of clients seen. • Increased capacity to see 20 to 26 new clients a month in the neuromotor program, a three-fold increase in attendances. • Doubled the number of autism clients diagnosed per week and the number of clients seen per month. • By the end of the first week of the coordinated system for referral pilot, the wait list was reduced from 103 to zero.
Best Practice Spotlight Organization Candidate Entering into our final year as a Registered Nurses’ Association of Ontario (RNAO) Best Practice Spotlight Organization candidate, Holland Bloorview has continued to focus our goals on enhancing the integration of evidence and best practice into clinical care with the implementation of four best practice guidelines. Our work on assessment and management of pain, one of the best practice guidelines, is also supporting a provincial research study examining the effectiveness of evidencebased guideline implementation in improved client outcomes. “Working as a team to alleviate pain and reduce the feelings of frustration and helplessness among our families, while using best practice guidelines is improving the quality of care we’re providing at Holland Bloorview” Nick Joachimides, RN.
Q UAL I TY I M P R OV E ME N T
Itâ€™s about respect for people
At Holland Bloorview, we take great pride in our partnerships with clients and families. We cannot improve quality and safety without the voice of our clients and families, partnering with staff at every level. Our long standing commitment to client and family-centred care (CFCC) is interwoven throughout our strategic plan. It guides our on-going planning, actions and decision making. Holland Bloorviewâ€™s Family Advisory Council and Youth Advisory Council, create the opportunity for staff and families to learn by sharing perspectives, knowledge and expertise. Together, we find new ways to strengthen, encourage and support meaningful partnerships. Part of our long standing commitment to CFCC means that we understand that there is always a lot more we can learn and do to improve the client and family experience. 2010 was a year of learning and action.
FOCUS ON CLIENT AND FAMILY CENTRED CARE
From Participation to Partnership: Advancing the Practice of Client and Family Centred Care On June 24 and 25, 2010, we hosted our first set of oneday education forums: Partners in Care: Advancing the Practice of Client and Family-Centred Care at Holland Bloorview, and kicked off a new chapter in our tradition of on-going learning in CFCC. The forums were facilitated by Bev Johnson, President and CEO of the Institute for Patient and FamilyCentered Care located in the United States, hosting 137 staff participants and 32 clients and families, with a panel of youth and families sharing their experiences in the health-care system.
ANSWERS to childhood disability questions In partnership with Cisco Canada, Holland Bloorview has launched a warmline to help parents and clients navigate the health-care system and find answers to questions about programs, services and resources related to childhood disability.
Inviting clients to visit from their living rooms We know that coming to the hospital can be overwhelming. To help clients and families become familiar with our physical surroundings, meet some of our staff and hear from children and families about their experiences, we are creating a virtual tour that will be available on our website or from iTunes as an iPad app.
initiative team as they were developing new strategies to enhance quality care and reduce wait times. With stories from other families as well, this led the team toward developing a scheduling system that would provide families with better, faster responses and better coordination of services across the organization.
Dear Friends, I am a mother of two sons â€“ one of whom is 11 years old, has Cerebral Palsy and has been a client of Holland Bloorview for almost 10 years. This past year, I had the pleasure of joining the Family Advisory Committee, and participating in the Family Leadership Program. This has allowed me to witness the commitment first hand, of staff, volunteers, and other families at Holland Bloorview who strive to provide and enhance quality care for clients and families. Being involved has shown me what a difference we can all make to enhancing quality when we collaborate and partner with the staff at Holland Bloorview. One of my roles, as a family advisor, was to share my family story to the LEAN
Not only was this an empowering experience for me, but I realized as I saw other Family Leadership members involved in many different initiatives that we are actually helping to shape, develop and enhance policies and resources for all clients and families at Holland Bloorview. The bonus is that itâ€™s a fun, productive and creative experience which benefits all young people and their families. I urge you to get involved with the Family Leadership Program. Families not only bring experience but wisdom to the process. The more voices, the more opportunity for clients and families to communicate and together, help to create the on-going vision for client and family-centred care at Holland Bloorview! Sincerely, Jan Magee Family Advisor
FOCUS ON CLIENT AND FAMILY CENTRED CARE
Be a family leader JOIN IN | CONTRIBUTE | SHARE Holland Bloorview Kids Rehabilitation Hospital is looking for family members to join the family leadership program and advise on hospital policies and programs, share their healthcare story or provide peer support to other families. To learn more or get involved visit: www.hollandbloorview.ca/familyleaders Contact: Laura Williams 416.425.6220 ext. 3395 or firstname.lastname@example.org
Fostering an environment of strong family leadership The newly formalized family leadership program successfully recruited 30 new family leaders and provided 104 engagement opportunities for existing Family Advisory Committee members to actively partner with Holland Bloorview staff on quality initiatives, provide valuable peer support and share health-care experiences.
It’s about working together
Around the table discussing a client’s progress: the child’s parent, a dietician, nurse, social worker, pediatrician and the list goes on. Paving the way for the next generation of health-care professionals, Holland Bloorview’s interprofessional team approach to providing care for our clients and families is what makes learning at Holland Bloorview a unique experience for the more than 475 students we train each year. Through a collaborative approach to care, the health-care team works closely with clients and families and with one another,
TEAC HI NG & L E A R N IN G
consulting on an on-going basis to ensure the highest quality of care. “At Holland Bloorview, we role model collaborative care and provide students and trainees with dynamic clinical experiences. Through our Teaching and Learning Strategic Plan, we are developing innovative approaches to clinical teaching,” says Darlene Hubley, interprofessional education leader.
Since 2009, Melissa Carter, geneticist, has been training at Holland Bloorview in Canada’s largest developmental pediatric subspecialty training program as a developmental pediatric fellow. “The integrated approach to learning at Holland Bloorview has enriched my experience. At Holland Bloorview, I had the opportunity to be part of a truly interprofessional team and witnessed first-hand the unique perspectives and contributions of each team member - in the process gaining a fuller understanding of the needs of each client we see,” says Melissa. Throughout her fellowship, Melissa has combined her skills as a geneticist with skills in developmental pediatrics in an effort to create a more holistic approach to care for children with genetic syndromes and developmental disorders. Understanding these children’s developmental needs will serve to expand clinical research and enhance care. Since the launch of Holland Bloorview’s Teaching and Learning Strategic Plan in 2009, we have engaged in improving the student and trainee experience - ensuring that dedicated time for teaching is built into quality and efficiency improvement initiatives.
Teaching and Learning Workshops and Institute day Holland Bloorview’s first annual Teaching and Learning Institute Day kicked off a series of three interprofessional teaching and learning workshops presented in collaboration with the University of Toronto, Centre for Faculty Development. 65 staff members attended, representing 18 professional groups and 17 programs and services from across the organization. “We are thrilled that so many staff members took advantage of these unique learning opportunities,” says Golda Milo-Manson, VP, Medicine and Academic Affairs. “Teaching and learning is an integral part of what we do at Holland Bloorview and these workshops are key to enhancing the trainee experience and propelling our leadership in teaching and learning related to childhood disability.”
Student Coordinator Kim Jones-Galley The Teaching and Learning Institute introduced the new role of student coordinator to help streamline student experiences across professions and departments organization-wide. A key goal of the Teaching and Learning strategic plan is to elevate the trainee experience. By centralizing student coordination services, Holland Bloorview will be able to increase efficiencies, share resources and provide an outstanding experience to students and trainees that is responsive to their needs.
It’s about extending our reach Over the last year, Holland Bloorview has been actively involved in two projects abroad – helping to respond to Haiti’s rehabilitation needs from the January 2010 earthquake and helping to create a framework for providing pediatric rehabilitation services in Doha, Qatar.
Haiti The January 12, 2010 earthquake in Haiti left many in need of rehabilitation care. Working in partnership with St. Joseph’s Healthcare System in Hamilton, Holland Bloorview sent a team of five health-care clinicians – a physician, nurse, physiotherapist, occupational therapist and speech language pathologist – to provide hands on treatment, therapy and education. The team spent most of their time just outside of Port-au-Prince at St. Charles Seminary, an organization affiliated with Healing Hands for Haiti. For a day-by-day account of the team’s work in Haiti, visit: www. hollandbloorviewinhaiti. blogspot.com
GL O B AL I M PA C T
Qatar For the past year, Holland Bloorview has been working in collaboration with SickKids International and the Hamad Medical Corporation to improve services for children who are chronically ventilated and to build rehabilitation capacity for children with congenital and acquired medical conditions. In early December, 12 children were moved from a pediatric intensive care step-down unit to a children’s rehabilitation unit, marking the completion of the first project. The unit offers more freedom for mobility, and is designed to support a variety of innovative, therapeutic programs not previously available in their acute hospital setting. Over the coming year, the team will work to develop a system of care for children with disabilities within Hamad Medical Corporation, to ensure a seamless array of pediatric rehabilitation services. “I want to come here every day!” - Twin sister of a client who was moved to the new building. “When we first started working here, we met children who had never been out of bed before. Nearly two months after the move, many of these same children are up and interacting with their families and loved ones.” - Chitra Gnanasabesan, Holland Bloorview Respiratory Therapist, working as part of the team in Qatar.
Itâ€™s about seeing things differently
When Taryn Green was six years old, she wrote The Triangle Girl, the story of a little girl who is made out of triangles, and was laughed at for being different. The little girl hopes and prays that one day she will wake up and be like everyone else.
BRINGING VISIBILITY TO DISABILITY
filmpossible Taryn, now a 28-yearold freelance film editor based in Sudbury, was Holland Bloorview’s first filmpossible filmpossible video contest winner. Taryn is not made out of triangles, but her winning video, a touching retelling of the story she wrote at age six, spreads a powerful message about embracing what does make her different: Cerebral Palsy. “It is important to embrace who you are despite your differences,” said Taryn, who no longer wishes to be the same as everyone else. “The triangle in the story represents the metaphor of differences that we all have within us.” In Canada, one in five Canadian families is raising a child with a significant emotional, behavioural or developmental disability. Still, many people do not have the opportunity 17
to spend time with kids with physical or intellectual differences, and sometimes this lack of familiarity can lead to misunderstandings or false impressions. That’s why Holland Bloorview created filmpossible, an online video contest that brings visibility to disability by using the power of social media. In the summer of 2010, filmpossible challenged Canadians of all ages and abilities to create short videos that spread awareness of childhood disability, dispel myths, showcase ability or tell a story. In its inaugural year, the contest received over 70 entries, each conveying unique messages of hope, inclusion and human potential. These messages were then spread to over 100,000 visitors to the website, and collectively received over 60,000 public votes. Bringing visibility to disability – showing both the extraordinary and ordinary aspects of life with disabilities - is important for initiating dialogue and influencing change in how disabilities are understood. “We congratulate all our winners and entrants,” said Christa Haanstra, Chief of Communications and Public Affairs at Holland Bloorview. “Through their creative and powerful works, they have brought visibility to disability and opened dialogues across Canada, between parents and children, in classrooms and boardrooms and beyond. They have helped to create awareness of a world where children with disabilities can live life to the fullest.” This contest wouldn’t have been possible without financial support from the Holland Bloorview Kids Rehabilitation Hospital Foundation, and our generous sponsors, Cisco, Mars Canada, and Gemsbok Technologies. We are also grateful to Rogers TV for their support in creating filmpossible, the original one-hour documentary about the contest that aired in May 2011.
BRINGING VISIBILITY TO DISABILITY
Filmpossible Winners First place: Taryn Green of Sudbury for The Triangle Girl Second place: Brigitte Patinaude of Ottawa, for Does it Really Matter Third place: Tammy Embrey of Port Colborne for Kiesha’s Story
Here are the stats: • 73 video entries from across Canada • 104,310 views and 62,298 votes cast • Virality factor: 6.9– 8.1 (means for every “share” on social media sites such as facebook, 6.9-8.1 people clicked through) • Media coverage in Toronto Star; CTV; CityTV; CBC Radio “Fresh Air” with Mary Ito; Today’s Parent, local media around Ontario and Canada, and blogs and online forums in the parenting and disability arena
A CONTEST BRINGING VISIBILITY TO DISABILITY
CONTEST OPENS JUNE 17, 2010 Make a short video that changes the way the world views childhood disability. Capture life experiences • Demonstrate inclusion • Tell a story • Show changes we can make
It’s as easy as 1, 2, 3!
Go online to register to enter the contest. Easy!
Create your own video and upload it to the site. Cool!
Watch the video entries. Vote for your favourites and tell your friends. Awesome!
Get your video ready and enter for a chance to win $5,000 cash and other great prizes!
www.filmpossible.ca It is free to enter - there is no purchase necessary. Contest opens June 17, 2010 and entries must be received no later than August 31, 2010 at 11:59pm EST. Some restrictions apply. Contest rules will be posted in full when the contest launches.
Holland Bloorview gratefully acknowledges the support of filmpossible sponsors for 2010
It’s about asking questions Creating a world of possibilities for kids with disabilities starts with enhancing their health and well being. To make this goal a reality, researchers in the work closely with front-line staff across the hospital, focusing their work on three areas: • Creating breakthrough technologies that boost independence • Examining social, economic, environmental and policy barriers • Evaluating clinical practices
Trainees: Total external funding:
Peer-reviewed funded projects:
Ratio of external to internal funding:
Peer-reviewed publications per full-time scientist:
Peer-reviewed grants per full-time scientist:
Trainees per full-time scientist:
2010 proved to be a very successful year: • Full-time scientists increased the number of publications by 20 per cent and the number of peer reviewed grants awarded increased by 48 per cent (see chart). • Launched the inaugural Pursuit Award, recognizing PhD students around the globe for outstanding achievements in childhood disability research. • Played an important role in NeuroDevNet, a newly founded Canadian network focused on early brain development of children with cerebral palsy, autism and fetal alcohol syndrome.
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Research Funding By Source 2010 International: 11% Tri-council agencies: 42%
Provincial: 9% Donations: 5% Royalties: 10% Industry: 4%
Take a peak at what a few of our researchers have been up to: The impact of bullying on kids with disabilities
takes 10-minutes to complete, can provide consistent results whether administered by a parent or clinician.
Young children often find it challenging to express their thoughts and feelings, especially when they are being bullied. In comparison with their peers, children with disabilities face an increased risk of being bullied and victims experience more negative physical, mental and social consequences. According to a recent study led by scientist Sally Lindsay, children with disabilities also experience physical and social exclusion from their teachers and peers.
“There is more of a focus on communicative participation and changes in the children’s behaviour in the community,” says Nancy Thomas-Stonell principal investigator. “That’s why it is so important that outcome measures capture the real world impact of therapy. We hope this is the first of many studies that evaluate the broad impact of speech therapy in the preschool population.”
“Inclusive activities and opportunities are needed to build awareness around childhood disabilities and create peer support,” says Sally. “Our research aims to help educators and policy makers develop effective antibullying and social inclusion interventions for children.”
Taking FOCUS (Focus on the Outcomes of Communication Under Six) Although speech-language therapy has been used with preschool children for many years, to date there are few outcome measures to show the efficacy of therapy on communication skills in the real world. To address this gap in knowledge, Holland Bloorview researchers have undertaken a three-year study, a first of its kind in Canada, to validate a speech-language pathology outcome measurement tool for the preschool population. The tool is being tested to evaluate the real world changes in preschool children’s communication skills after therapy. Early results of the study have shown that FOCUS, which only 22
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The study is being done across Canada with strong interest in the study and its results from around the world.
Interactive games change the face of physical activity Video game consoles such as Nintendo Wii and Microsoft Xbox 360 (Kinect) encourage kids to get up and exercise in the comfort and safety of their own home. At Holland Bloorview, researchers are following 16 children with cerebral palsy playing sports and dance related video games using Nintendo Wii. The amount of energy used by the children is measured by monitoring patterns in their breathing and movements. “This type of activity isn’t meant to replace outdoor sports and activities - it provides additional opportunities for kids to be physically active in a safe environment, which is especially important for children with disabilities,” says lead scientist, Elaine Biddiss. “We hope to see continued research in this area to encourage positive physical activity and provide fun alternative options for children with cerebral palsy.”
Spotlight on Tom Chau
Transformational Canadian As one of the country’s leading biomedical engineers, Tom Chau was honoured in 2010 as one of 25 Transformational Canadians, presented by the Globe and Mail in partnership with CTV and Cisco Canada. In this award, Tom joins other scientists, thinkers, humanitarians, environmentalists, educators, and artists such as Stephen Lewis, James Cameron, Samantha Nutt, Jim Balsilie and David Suzuki.
Pediatric Rehabilitation Engineering: From Disability to Possibility launches In December, the first compendium of work with a specific focus on children in the field of rehabilitation engineering was published by Taylor & Francis Group, CRC Press. This book, co-edited by Tom Chau, signifies an important milestone in the growth of pediatric rehabilitation engineering; this once emerging field is gaining recognition as an important part of the health and well-being of children and youth with disabilities.
International Recognition for Holland Bloorview’s VMI A team of researchers led by Tom Chau received international recognition for a device that brings music to life for kids with disabilities. The team proudly received the prestigious international da Vinci Award® for the creation of the Virtual Musical Instrument (VMI) in the recreation and leisure category.
Photo credit: Paul Stoloff
MS society representative joins Pierre Duez, Eric Wan, Andrea Lamont and Tom Chau of Holland Bloorview as they accepted the da Vinci Award at the special awards event at the Henry Ford Museum in Dearborn, Michigan. Photo credit: Paul Stoloff
Building infinite bridges “’I want a hug’ was the first thing Jacob said to me using his adapted iPod, and when I reached over and gave him a hug, his face lit up and he knew – he had been understood,” says Marcy White, parent of 8 year-old Jacob. Jacob was born with Pelizaeus-Merzbacher disease (PMD), a rare central nervous system disorder that affects his mobility and ability to communicate. “If I could have one wish for my son, it wouldn’t be for him to walk or feed himself - it would be for him to be able to communicate his wants and needs,” says Marcy. In Dr. Tom Chau’s Infinity Lab at the Bloorview Research Institute, novel communication channels for non-verbal kids to express themselves and indicate personal preferences are created. Tom’s dream for the Infinity Lab is to provide every non-verbal child and teen in Canada with a means of communication. Through a new partnership with the Toronto District School Board the pace of progress in the Infinity Lab is being accelerated. This two-year pilot project at Sunny View Public School brings a communications assessment lab onsite, using cutting-edge technology to improve communications pathways and increase chances for academic success for children with the most complex disabilities in the school system.
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“By conducting research onsite and in real time, children at Sunny View, like Jacob, can benefit from work being done immediately. But, there’s also the potential for this work to benefit many more children in schools across the school board and potentially around the world, as new solutions are developed, new knowledge is shared and teachers and therapists are trained in using these new technologies,” says Marcy. The project helps build capacity among students, parents, therapists and teaching staff by providing training and assistance, so they can support students in using these innovative strategies and tools, within the Sunny View School community and beyond. Championed by passionate parents from the Sunny View Youth Involvement Foundation, the project is being funded solely through philanthropic support driven by the Holland Bloorview Kids Rehabilitation Hospital Foundation.
Awards & Honours Elaine Biddiss The Forchheimer Prize (International Society for Prosthetics and Orthotics; with Tom Chau) for most outstanding paper on objective clinical assessment, clinical evaluation or clinical measurement published in the journal Prosthetics and Orthotics International in 2007-2009.
Tom Chau Transformational Canadian presented by the Globe and Mail, CTV and CISCO Canada. The Transformational Canadians program celebrates 25 living citizens who have made a difference by immeasurably improving the lives of others. International da Vinci Award (for Virtual Music Instrument) for accessibility and universal design in the recreation and leisure category. National Multiple Sclerosis Society (USA) The Forchheimer Prize (International Society for Prosthetics and Orthotics; with Elaine Biddiss) for most outstanding paper on objective clinical assessment, clinical evaluation or clinical measurement published in the journal Prosthetics and Orthotics International in 2007-2009.
Darcy Fehlings Honorary Member of the European Academy of Childhood Disability.
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Peer reviewed publications (2010) Adams A, Theodore D, Goldenberg E, McLaren C, McKeever P. Kids in the atrium: comparing architectural intentions and children’s experiences in a pediatric hospital lobby. Social Science & Medicine 2010;70:658-667. Alves N, Chau T. Automatic detection of muscle activity from mechanomyogram signals: a comparison of amplitude and wavelet-based methods. Physiological Measurement 2010;31:461-476. Alves N, Chau T. The design and testing of a novel mechanomyogramdriven switch controlled by small eyebrow movements. Journal of NeuroEngineering and Rehabilitation 2010;7:22. Alves N, Chau T. Uncovering patterns of forearm activity using multi-channel mechanomyography. Journal of Electromyography and Kinesiology 2010;20:777-786. Alves N, Falk TH, Chau T. A novel integrated mechanomyogramvocalization access solution. Medical Engineering & Physics 2010;32:940-944. Alves N, Sahota B, Sejdić E, Chau T. The effect of sensor location on the classification of single-site forearm mechanomyograms. Biomedical Engineering Online 2010;9:23.
Boutis K, Constantine E, Schuh S, Pecaric M, Stephens D, Narayanan UG. Pediatric emergency physician opinions on ankle radiograph clinical decision rules. Acad Emerg Med 2010;17:709-717. Chan J, Falk TH, Teachman G, MorinMcKee J, Chau T. Evaluation of a non-invasive vocal cord vibration switch as an alternative access pathway for an individual with hypotonic cerebral palsy – a case study. Disability and Rehabilitation: Assistive Technology 2010;5:69-78. Chang MD, Sejdić E, Wright V, Chau T. Measures of dynamic stability: detecting differences between walking overground and on a compliant surface. Human Movement Science 2010;29:977-986. Damouras S, Chang M, Sejdić E, Chau T. An empirical examination of detrended fluctuation analysis for gait data. Gait & Posture 2010;31:336-340. Damouras S, Sejdić E, Steele CM, Chau T. An online swallow detection algorithm based on the quadratic variation of dual axis accelerometry. IEEE Transactions on Signal Processing 2010;58:3352-3359.
Andrysek J. Lower-Limb prosthetic technologies in the developing world: a review of literature from 1994-2010. Prosth Orth Int 2010;34:378-398.
Daudji A, Eby S, Foo T, Ladak F, Sinclair C, Landry MD, Moody K, Gibson BE. Perceptions of disability among South Asian immigrant mothers of children with disabilities in Canada: implications for rehabilitation service delivery. Disability & Rehabilitation 2010 Jul 3 [Epub ahead of print]. 2011;33:511-521.
Biddiss E, Irwin J. Active video games to promote physical activity in children and youth. Archives for Pediatric and Adolescent Medicine 2010;164:664-672.
Durocher E, Gibson BE. Ethical considerations of a discharge planning case study. Australian Occupational Therapy Journal 2010;57:2-7.
Blain S, McKeever P, Chau T. Bedside computer access for an individual with severe and multiple disabilities: a case study. Disability & Rehabilitation: Assistive Technology 2010;5:359-369.
Fairley J, Sejdić E, Chau T. An investigation of stride interval stationarity in a pediatric population. Human Movement Science 2010;29:125-136.
Blain S, Power S, Sejdić E, Mihailidis A, Chau T. A cardiorespiratory classifier of voluntary and involuntary electrodermal activity. Biomedical Engineering Online 2010;9:11.
Fairley J, Sejdić E, Chau T. Investigating the correlation between pediatric stride interval persistence and gross energy expenditure. BMC Research Notes 2010;3:47.
Fairley J, Sejdić E, Chau T. The effect of treadmill walking on stride interval persistence in children. Human Movement Science 2010;29:987-998. Falk TH, Tam C, Schwellnus H, Chau T. Grip force variability and its effects on children’s handwriting legibility, form and strokes. Journal of Biomechanical Engineering 2010;132:114504. Falk TH, Chan J, Duez P, Teachman G, Chau T. Augmentative communication based on real-time vocal cord vibration detection. IEEE Transactions on Neural Systems and Rehabilitation Engineering 2010;18:159-163. Falk TH, Guirgis M, Power S, Blain S, Chau T. On the use of peripheral autonomic signals for body-machine interface control. Physiological Measurement 2010;31:1411-1422. Fehlings D, Novak I, Berweck S, Hoare B, Stott N, Russo R. Botulinum toxin assessment, intervention and follow-up for paediatric upper limb hypertonicity: international consensus statement. European Journal of Neurology 2010;17:38-56. Fehlings D, Stevenson R. Paediatric osteopenia in childhood disability: evidence-informed clinical practice guidelines. European Academy of Childhood Disability, Brussels, Belgium. Developmental Medicine and Child Neurology 2010;52:77-78. Gan C, Gargaro J, Kreutzer J, Boschen K, Wright V. Development and preliminary evaluation of a structured family system intervention for adolescents with brain injury and their families. Brain Injury 2010;24;651-663. Georgiades S, Papageorgiou V, Anagnostou E. Brief report: repetitive behaviours in Greek individuals with autism spectrum disorder. Journal of Autism and Developmental Disabilities 2010;40:903-906. Gibson BE, Stasiulis E, Gutfreund S, McDonald M, Dade L. Assessment of children’s capacity to consent for research: a descriptive qualitative study of researchers’ practices. Journal of Medical Ethics (In Press).
Hollander E, Chaplin W, Soorya L, Wasserman S, Novotny S, Russoff J, Feirsen N, Anagnostou E. Divalproex sodium vs placebo for the treatment of irritability in children and adolescents with autism spectrum disorders. Neuropsychopharmacology 2010;35:990-998.
King G, Specht J, Bartlett D, Servais M, Petersen P, Brown H, Young G, Stewart S. A qualitative study of workplace factors influencing expertise in the delivery of children’s education and mental health services. Journal of Research in Interprofessional Practice and Education 2010;13:265-283.
Ibey R, Chung R, Benjamin N, Sarginson A, Littlejohn S, Salbach N, Wright V. Development of a challenge assessment for high functioning children with an acquired brain injury. Pediatr Phys Ther 2010;22:268-276.
King G, Tam C, Fay L, Pilkington M, Servais M, Petrosian H. Evaluation of an occupational therapy mentorship program: effects on therapists’ skills and family-centered behavior. Physical & Occupational Therapy in Pediatrics (In Press).
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King, G. Family-centred service: a look at concepts, measures, evidence and implications. Mariani Foundation Paediatric Neurology Series (In Press). Kingsnorth S, Blain S, McKeever P. Physiological and emotional responses of disabled children to therapeutic clowns: a pilot study. Evidence-Based Complementary and Alternative Medicine 2010 Feb 4 [Epub ahead of print]. 2011:732394. Klejman S, Andrysek J, Dupuis A, Wright V. Test-retest reliability of discrete gait parameters in children with cerebral palsy. Arch Phys Med Rehabil 2010;91:781-787. Lee J, Sejdić E, Steele C, Chau T. Effects of liquid stimuli on dual-axis swallowing accelerometry signals in a healthy population. Biomedical Engineering Online 2010;9:7. Leung B, Chau T. A multiple camera tongue switch for a child with severe spastic quadriplegic cerebral palsy. Disability & Rehabilitation: Assistive Technology 2010;5:58-68. Leung B, Duez P, Yates M, Chau T. Text entry via character stroke disambiguation for an adolescent with severe motor impairment and cortical visual impairment. Assistive Technology 2010;22:223-235. Lindsay S. Exploring the role of family history and lay understanding of genetics on chronic disease selfmanagement. Journal of Nursing and Healthcare of Chronic Illness 2010;2:135-143.
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Pursuit Awards Holland Bloorview Kids Rehabilitation Hospital is pleased to announce the winners of the inaugural 2011 Pursuit Award under the category of Natural Sciences and Engineering. First: Dr. Christopher Heier, Children’s Memorial Research Center, Department of Pediatrics, Northwestern University Second: Dr. Rebecca Clark, Division of Medical Sciences, John Radcliffe Hospital, University of Oxford Third: Dr. Natasha Alves-Kotzev, Institute of Biomaterials and Biomedical Engineering, University of Toronto Funded by Holland Bloorview Kids Rehabilitation Hospital Foundation donors David and Anne Ward and the Bloorview Research Institute, the Pursuit Award aims to recognize PhD students around the globe for their outstanding achievements in childhood disability research. “The research undertaken by the three Pursuit Award finalists was extremely interesting, thought provoking and clinically relevant for the clients of Holland Bloorview and the wider clinical community,” says Virginia Wright, Interim Director, Bloorview Research Institute. “The future of childhood disability research is highly dependant on new ideas and innovations and we feel it’s very important to encourage the work of PhD students and to bring together young minds to share their ideas and stimulate discussion.” The 2012 Pursuit Award category is health research. Holland Bloorview will begin accepting submissions early next winter.
2011 Category: Natural Sciences & Engineering e Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital is pleased to launch the Pursuit Award. e award recognizes PhD students from across the globe for their outstanding achievements in childhood disability research. Universities with doctoral programs may nominate one candidate. e PhD thesis topic of the nominee must be childhood disability.
e Award will be presented yearly under the following categories:
Deadline for submission is February 1, 2011, 5 pm EST
2011 - Natural Sciences and Engineering 2012 - Health Research 2013 - Social Sciences
Holland Bloorview Kids Rehabilitation Hospital is Canada’s largest children’s rehabilitation hospital, fully aﬃliated with the University of Toronto. e Bloorview Research Institute - an international leader in childhood disability research - houses a multidisciplinary group of scientists conducting research that enhances the health and well being of children and youth with disabilities and their families.
e top three candidates will present at the awards ceremony in Toronto, Canada and compete for ﬁrst prize - $7,500.
O UR VAL UE S IN A C T ION
Values Spotted in Action Our values: Client and Family-Centred Care, Caring, Innovation, Excellence, Partnership and Respect support our vision of creating a world of possibility and propel the quality of our care.
PARTNERSHIP: Working in partnership with clients, families, staff, volunteers and key external partners, we take a team approach to clinical care, education and research Raheema Visram, Application Specialist, Information Systems
Readily available throughout rapid improvement events related to Holland Bloorview’s LEAN initiatives, Raheema showed great collaboration and partnership. Raheema was quick to make system improvements and sought out opportunities to create efficiencies using technology that impacted the success of the initiatives. “LEAN initiatives seek to maximize the quality of care for our clients by helping our health-care providers focus on the client. The success of this project, like all others, relies on several people from different disciplines working together and providing their expertise. It’s rewarding to know that I have contributed to improving client care at Holland Bloorview.” – Raheema
EXCELLENCE: Striving for excellence, we are committed to safety, accountability, evaluation and continuous quality improvement Bobby Hancock, Senior Director, Facility Management
Holland Bloorview’s Building Services celebrated the completion of the extensive re-lamping project lead by Bobby in 2010. Through this project, over 10,000 lights were replaced with energy efficient bulbs and carefully recycled. As a result, Holland Bloorview was recognized for our corporate commitment to environmental excellence. “This project was a real team effort, with support from several different staff members and teams. Projects like the re-lamping initiative help to remind staff and families of our effort to keep our facility at the leading-edge of energy conservation initiatives.” – Bobby
CLIENT AND FAMILY-CENTRED CARE: Applying the principles of partnership, respect and communication, we are committed to a family-centred approach in all we do Ari Rivera, Assistive Technology Consultant, Communications and Writing Aids Service
When an interpreter was unavailable to provide translation for a family, Ari willingly made himself available and as a trained volunteer staff interpreter, he stepped in to provide Spanish interpretation during a client appointment enabling the clinic staff and the family to communicate with ease. Ari’s eagerness to help out ensured we were able to provide the best client and family-centred care, despite a language barrier. “Anyone with the capacity to assist their fellow colleagues, clients and their families always should.” – Ari
O UR VAL UES IN A C T ION
CARING: Providing exemplary care, we are dedicated to enhancing the quality of life of our clients and their families Carolynn Gludish, Registered Nurse, SODR inpatient unit
Carolynn celebrates both small and large rehabilitation milestones with clients and encourages them to achieve their full potential. Ensuring that her clients and families receive the highest quality care with a healthy dose of fun, Carolynn serves as an excellent role model for students and others on her team. “We come into people’s lives during their most trying moments. In caring for our clients we offer light in darkness and hope in despair. As nurses, we work with our heads, our hands and our hearts.” – Carolynn
RESPECT: Embracing diversity, we seek to empower people and treat everyone with empathy and respect Ricardo Torres-Moreno, Director, Clinical Technology
Ricardo actively listens and supports his team and their decisions, engendering trust and mutual respect. Ricardo leads by example, inspiring his team and seeking their input, ensuring that team members have all the right tools to perform their duties to the best of their abilities. “I seek to bring out the best in others and to further develop the creative talent of the Clinical Technology staff. I’m privileged to be part of such a talented and dedicated group of health-care professionals.” – Ricardo
INNOVATION: Fostering a culture of inquiry and innovation, we aspire to lead the way in clinical care, education and research in the field of childhood disability Salma Kassam, Occupational Therapist
Salma’s creative approach to therapy was evident as she worked with Magicana, to introduce the world of magic to Holland Bloorview’s clients, under the direction of professional magicians and volunteers. The Magic Hands program provides clients with a unique and invaluable opportunity to work on their personal goals in the rehabilitation process through magic. “In occupational therapy, we value the meaningfulness of activity and the magic hands program is a great way to show how a real life activity can be therapeutic and fun.” – Salma
At Holland Bloorview we are dedicated to providing exemplary care and service and enhancing the quality of life of clients, families, volunteers and staff. Our outstanding staff, like Raheema, Bobby, Ari, Carolynn, Ricardo and Salma, bring the values to life.
A Year in Review Governor General and Lieutenant Governor Visit Holland Bloorview On the 2010 International Day of Persons with Disabilities, Holland Bloorview was proud to host the Right Honourable David Johnston, Governor General of Canada, and his wife, Mrs. Sharon Johnston, along with the Honourable David C. Onley, Lieutenant Governor of Ontario, and his wife, Mrs. Ruth Ann Onley. Our guests were amazed by hands-on demonstrations in the Bloorview Research Institute and touched by a special singing of O Canada by students at the Bloorview School.
Holland Bloorview named one of Greater Toronto’s Top Employers Holland Bloorview was proud to be recognized as one of Greater Toronto’s Top Employers 2011 by the Globe and Mail in partnership with Mediacorp. This special designation recognizes the Greater Toronto employers that lead their industries in offering exceptional places to work.
No Limits Campaign Launches The Holland Bloorview Kids Rehabilitation Hospital Foundation launched the $80 million No Limits Campaign for Childhood
A Y EAR I N RE V IE W
Disability. The campaign was kicked off with a $26.2 million gift from the Holland family. In recognition of this unprecedented giving, we renamed our organization Holland Bloorview Kids Rehabilitation Hospital. The goal of the No Limits campaign is to make sure there are always funds available to do more and do better for children with disabilities.
Holland Bloorview receives NHCC Change-Maker award Nominated by Muscular Dystrophy Canada, Holland Bloorview was one of the first-ever recipients of Neurological Health Charities of Canada’s Change-Maker Award. Presented to leaders who demonstrate innovation, inclusion and integration for the benefit of Canadians living with a brain condition, other award winners include the Baycrest Centre and the Globe and Mail.
The Bigioni Family raises $1 million for respite care programs at Holland Bloorview Vito and Sandra Bigioni reached their goal of raising $1 million for Holland Bloorview’s respite care programs which provide both high quality medical care and recreation activities for children, so that families feel comfortable taking a break knowing that their child is receiving excellent care in a safe and stimulating environment.
How We Measure Up: 2010-2011 Holland Bloorview is always looking for better ways to track our performance and communicate how we are doing. Here is an at-a-glance report on our performance. To determine our ratings, Holland Bloorview invited the input of representatives from Erinoakkids Centre for Treatment and Development, Institute for Clinical Evaluative Sciences, GTA Rehab Network, Credit Valley Hospital, Holland Bloorview’s Board of Trustees, and Holland Bloorview’s Family and Youth Advisory Committees. Guideline: Fair = H(1) GOAL
Good = H H(2)
Excellent = H H H (3)
10% point improvement
12% point improvement
2.5 point improvement
2.6 point improvement
Impact on High Quality Safe Care Improve inpatient rehabilitation outcomes
Improvement in clients’ functional abilities from admission to discharge using WeeFIM® Instrument: • Average improvement in clients’ functional abilities1 • % of clients with a 10% point improvement or greater in functional abilities1
Improve participation for kids with disabilities
Improvement in performance of participation-based goals after therapeutic intervention using the Canadian Occupational Performance Measure (COPM)2: • Average improvement in client performance (out of 10 points)
(Note: international benchmark is 2.0 point improvement) Achieve inpatient and outpatient rehabilitation therapy goals
Achievement of goals set by the client and/or therapist using Goal Attainment Scaling: T-score between 45-55 35% 30%
T-Score of 51 36% 35%
• Enabling and partnership (out of 7) • Providing general information (out of 7) • Providing specific information (out of 7) • Coordinated and comprehensive care (out of 7) • Respect and supportive care (out of 7)
5.7 4.6 5.6 5.8 5.9
5.6 4.6 5.5 5.8 5.9
Improve the client experience
• % of clients and families who rate Holland Bloorview excellent or good2, 3 • % of clients and families who rate Holland Bloorview excellent2, 3
Ensure timely access to services
Wait in days for new clients seen at Holland Bloorview : • Child Development Program Neuromotor clients** • Child Development Program Autism clients** • Writing Aids clients** • Augmentative Communication clients** • Inpatient Rehabilitation clients**
80% seen in 137 days 80% seen in182 days 90% seen in 61 days 90% seen in 122 days 90% seen in 4 days
80% seen in 187 days 80% seen in 282 days 90% seen in 84 days 90% seen in 180 days 90% seen in 10 days
Overall infection rate compared to Holland Bloorview’s average rate for the previous 36 months (per 1000 inpatient days)
Number of medication related adverse events (mild to moderate) compared to medication doses at Holland Bloorview in 2009-10
5 adverse events on 226,231 doses
4 adverse events on 217,065 doses
Provide client and family centred care
Ensure the safety of the client and family
• 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) Number of categories in Holland Bloorview’s ‘Tell Us What You Think Survey’ for family feedback that achieve or exceed average scores found in literature3 and also exceed past performance2:
Client adverse events at Holland Bloorview in 2010-11 associated with serious harm to the client • # of client adverse events causing serious harm • # of days without serious harm
PER F O R M AN C E R E P ORT
Guideline: Fair = H(1) GOAL
Good = H H(2)
Excellent = H H H (3)
• # of medical trainees (per physician full time employee [FTE]) • # of allied health and nursing students (per allied health and nursing FTE) • # of research students (per research FTE)
6.6 1.0 9.9
6.5 1.1 9.0
Number of students who participated in the interprofessional education experience
Building Capacity Lead education in childhood disability
Students training at Holland Bloorview:
Percentage of allied health and nursing students satisfied with their clinical experience • % of student responses of very good or excellent
Advancing Knowledge Enhance the output and impact of research
Number of peer reviewed publications per full time scientist (FTE)
(Note: Other clinical research institutes standard is 2.0) Number of peer reviewed grants per FTE scientist
(Note: Other clinical research institutes standard is 2.0)
Finances Ensure a sound financial position
Current ratio of short-term assets and liabilities4
Year end financial position
Staff turnover rate compared to 2008-095
Staff average sick time compared to 2009-106
Employee commitment to the organization as a great place to work7
Other teaching hospitals 56% positive response
70% positive response
Human Resources Offer staff a satisfying, healthy, and safe workplace
Based upon peer-reviewed literature. Average improvement is not adjusted for acuity. Targets for these key strategic priorities were set based on improvement in performance seen in 2009-10 and setting stretch goals ‘Tell Us What You Think’ survey families/clients incl. Measure of Process of Care, CanChild Centre for Childhood Disability Research (2004) 4 Based upon Toronto Central LHIN standards 5 Based upon Ontario Hospital Association Labour Market Survey (2008-09) 6 Based upon Ontario Hospital Association Survey (2009-10) 7 Compared to other teaching hospitals, NRC Picker Survey 1 2 3
*Unless otherwise indicated, benchmarks are internal performance targets. Where there is no agreed-upon industry/literature benchmark or where Holland Bloorview outperformed the industry/literature benchmark in 2009-10, internal performance targets are set to actual results reported in How We Measure Up: 2009-10. **Actual results are not within range of the benchmark. Holland Bloorview has made an active commitment to improvement science methodologies designed to help us reach wait time benchmarks.
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Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8
Holland Bloorview Hospital annual report 2010-11