Big Ambition: Holland Bloorview 2012-13 Annual Report

Big Ambition2012 – 13 ANNUAL REPORT

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Dear friends,

It has been an exciting year for Holland Bloorview Kids Rehabilitation Hospital. In June 2012, we began our focus on the goals of our new five-year strategic plan, Leadership in Childhood Disability. We are proud of our accomplishments in year one, and prouder still to have set a strong foundation for continued success. The theme of this annual report, Big Ambition, reminds us that leadership in childhood disability takes courage, imagination and planning.

We begin year two feeling confident about the road ahead, but we know that the future will have its challenges, including financial pressure. In response, we are finding ways to reduce costs and work more efficiently. We are improving the sustainability and continuity of healthcare by building and strengthening partnerships with home and

community care providers. How do we maintain our “big ambition” while we wrestle with a changing healthcare environment? We take our inspiration from our clients.

Every day, our clients show us that so much is possible, no matter the obstacle. Take the example of Heba, a teen with muscular dystrophy. Heba has adapted to many challenges in her life, including losing the ability to walk, losing the ability to look down and learning to breathe with a ventilator. These limitations did not stop Heba from realizing her dream of designing and making clothes. Working together with therapists at Holland Bloorview, Heba learned to use a sewing machine controlled by an adaptive switch. Today, Heba is studying fashion in the program and college of her choice. “I hope one day my clothes will inspire people,” Heba said. They already have.

In this year’s annual report, we invite you to explore how the ambitions of our employees, clients, families and partners are helping us to transform care, lead the system, accelerate knowledge and inspire our people every day. Guided by the theme, Inspired by kids, led by you, employees are leading quality and safety initiatives to ensure we meet and exceed all national standards in our 2013 hospital accreditation. The Board’s very own accreditation governance team is raising the bar, introducing improved evaluation processes and a new Board Chair performance evaluation.

Reflecting on this year, it is clear to us that we have the right focus and

the right people in place to fulfill our plan for leadership in childhood disability. We look forward to continued partnership with clients and families, employees, volunteers, our hospital foundation, donors, academic partners, government and community groups. We hope that you will continue to follow us in the years ahead.

What is your ambition for Holland Bloorview?

Sheila JarvisPresident and CEO

David AllgoodChair, Board of Trustees

Big Ambition

LETTER FROM SHEILA JARVIS, PRESIDENT AND CEO & DAVID ALLGOOD, CHAIR, BOARD OF TRUSTEES Highlights from the

Board of Trustees 2012–2013

•Reviewandapprovalofthefiveyearstrategicplan2012–2017

•Reviewandapprovaloftheannualqualityimprovementplan

•NewBoardmemberrecruitment

•Reviewandapprovalofthelong-termfinancialplan

•Accreditationreadiness:preparationofagovernanceteamimprovementplan

4 2012-2013ANNUALREPORT–BIGAMBITION

Nursing: 164

Professional health disciplines: 126

Research: 103

Medicine: 59

Clinical technology: 4

Other: 5

Number of students

55,977 546 52.6 days 6,713

Outpatient visits

Inpatient visits

Average length of stay*

Total clients

870 461 800 95%

Employees Students Active volunteers

Volunteer satisfaction

with experience**

* Does not include length of stay data for complex continuing care program

** Last measured in 2011

80+

Family leaders

Holland Bloorview Snapshot 2012 – 2013

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Bloorview Research Institute Indicators 2012

Scientists: 18*

Trainees:

Undergraduatestudents: 32

Master’s(doctoralstream)students: 24

PhDstudents: 18

Post-DoctoralFellows: 5

Totalexternalfunding: $4.1million

Peer-reviewedfundedprojects: 53

Peer-reviewedpublications: 59

External research

funding by source 2012

Donations: 26%

Tri-council agencies: 25%

International: 16%

National: 12%

Provincial: 11%

Subgrant collaborations: 8%

Industry: 1%

Royalties: 1%

* Does not include Clinical Study Investigators (CSI) appointed in March 2013

The Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital is pleased to announce the winners of the 2013 Pursuit Award. The award recognizes recent PhD graduates from across the globe for their outstanding achievements in childhood disability research. The award is funded by Holland Bloorview Kids Rehabilitation Hospital Foundation donors David and Anne Ward and the Bloorview Research Institute.

PursuitAward–2013WinnersDr. Amy Houtrow, “Children with Disabilities and Impacts on Families” (University of California, San Francisco)

Dr. Jane McCormack, “The extent and experience of childhood speech impairment” (Charles Sturt University, Australia)

Dr. Danielle Levac, “The use of motor learning strategies within usual and Virtual Reality-based physiotherapy interventions for children with acquired brain injury” (McMaster University, Hamilton)

Scientists in the Bloorview Research Institute

Tom Chau VP Research and Director, Bloorview Research Institute

Seniorscientists:Barbara GibsonGillian KingPatricia McKeeverPatty RigbySteve RyanVirginia Wright

Scientists:Amy McPhersonAzadeh KushkiElaine BiddissJan AndrysekNancy Thomas-StonellSally Lindsay

Clinicianscientists:Evdokia AnagnostouMichelle Keightley

Clinicianinvestigators:Jessica BrianDarcy FehlingsUnni Narayanan

Clinicalstudyinvestigators:Laura McAdamMolly MaloneRyan HungSharon SmileShauna Kingsnorth

Bloorview Research Institute Snapshot 2012 – 2013


“Withelectronicdocumentationwegetamoreholisticviewofeachclientinamuchmoreefficientway.”– Katrine, registered nurse

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

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Anewelectronichealthrecordsystembuiltfromtheimaginationandwisdomofclinicians,clientsandfamiliesrolledoutinOctober2012.

Theambition: Katrine, a registered nurse in the child development program, looks for opportunities to share her experiences to help improve her practice environment. In 2012, her ambition was to help make documentation processes in outpatient areas more responsive to the needs of clients and families and more efficient for clinicians.

Like many of her colleagues, Katrine saw limitations to paper charting and exciting opportunities in new technology. “With the paper chart it is time consuming and difficult to search for information, and you can’t easily compare

and synthesize new information from a discussion. It’s also hard to have all the information in front of you when you need it, such as during a phone call,” says Katrine. When Katrine heard about plans for the implementation of an electronic health record, she joined the documentation change team to help share her ideas and put her ambition into action.

Ambitioninaction:As part of the documentation change team, Katrine had the chance to propose and test templates for a new set of electronic screens that would make input and retrieval of client information faster and more accurate. Family leaders on the team worked alongside Katrine and others. “Family leaders really challenged us to think of documentation in a different way,” says Katrine. “We could try to solve the problem together

by experimenting with our different ideas.” Using iPads or computers-on-wheels, clinicians now document client information electronically during sessions. Katrine is a designated “super user” who helps teach the technology to clinicians and listens to feedback from colleagues, clients and families.

What’snext: Katrine says there is always room for improvement with new technology. “We are still

learning, discussing and re-adjusting electronic screen designs to improve accessibility of information, efficiency, patient safety and quality.”

New learning from the roll-out of the outpatient electronic health record will inform improvement plans for the inpatient electronic health record that has existed since 2010.

Katrine’s ambition: A paperless health record


The electronic health record is:

• Improvingaccesstotimelyandaccuratedocumentation

• Increasingstandardizationforcertaincarepractices

• Reducingduplication

• Allowingbetterinformationsharingforclientsandfamilies

• Increasinginter-professionalcollaboration

• Improvingqualityandpatientsafety

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Lackofinformationandfamiliaritywiththeadultsystemcanleavesomeclientsandfamiliesfeelinglostorisolatedwhenitcomestimetomovefrompediatrictoadultcare.HollandBloorviewiscommittedtobuildingstrategicpartnershipsthatleadtoimprovedtransitionsforyouth.

Theambition: Eighteen-year-old Eric’s ambition is to study bio-medical engineering at university. “I got interested in the field because I wear orthotics and I understand the difference that stronger equipment can make,” says Eric, who has spina bifida.

“I’m interested in designing orthotics and have learned a lot about the mechanics and how they work through my appointments here.”

Like many young adults, when Eric thinks about his future, his main focus is not on his medical appointments or coordination of care. His hope is simply that navigating the healthcare system as an adult will continue to be a positive experience, not a source of stress or anxiety. His parents feel the same way. “For many years we’ve just known exactly where to go to get help on a number of issues, so losing that makes me a bit apprehensive,” says Diane, Eric’s mother. “At the same time, moving on to the adult system is an important step for Eric and an opportunity for him to play a greater role in his own care.”

Ambitioninaction:In partnership with the Anne Johnston Health Station (AJHS), a not for profit community health centre in midtown Toronto, we are leading the implementation of an improved transition model for youth with spina bifida. This new model is based on the strengths of the LIFEspan model of care, a partnership with the Toronto Rehabilitation Institute that supports transitions for youth with acquired brain injury and cerebral palsy. Funded by the Toronto Central LHIN, the new transition model for young adults with spina bifida was developed in collaboration with Holland Bloorview clients and families, the Spina Bifida and Hydrocephalus Association of Ontario and SickKids.

Under the new model, all clients and families with spina bifida will be better prepared for transition to adult services. Toronto-based clients with spina bifida and their families will have their care transferred to a team at the AJHS.

What’snext: The new model, which includes supports such as improved information transfer processes, education and planning materials and a new adolescent medicine clinic, will be fully implemented by 2014. A nurse practitioner, shared between Holland Bloorview and the AJHS, will be the key link for transitioning youth and will build capacity around ongoing care issues for young people with spina bifida.

Eric’s ambition: Smooth transition and transfer of care to the adult system


9Transform Care | Lead the System | Accelerate Knowledge | Inspire our People 2012-2013ANNUALREPORT–BIGAMBITION

“Idon’thavealotofconcernsaboutmovingon,butIwanttofeellikethere’saplaceformeinthesystem.”– Eric, client in spina bifida program


“Untilnow,concussionresearchhaslargelyfocusedontheadultpopulation,butweknowthatthebrainsandbodiesofyouthandchildrenarecontinuallydeveloping,whichappeartomakethemmorevulnerabletotheeffectsofconcussion.”– Michelle, clinician scientist, acquired brain injury


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Whilescientistshavedeveloped“return-to-activity”guidelinesforadultswhohavesufferedamildtraumaticbraininjuryinsports,therearenosuchevidence-basedguidelinesforchildrenandyouth.

Michelle’sambition: Brain injury clinician scientist, Dr. Michelle Keightley, studies acquired brain injuries like strokes and concussions. Her ambition is to improve our understanding of how the youth brain recovers following mild traumatic brain injury in order to better inform the recovery process, including more accurate assessment and rehabilitation protocols. With funding from the Holland family gift, Michelle was appointed in 2012 to co-lead the development

of Holland Bloorview’s new Centre for Leadership in Acquired Brain Injury.

Ambitioninaction:Since 2012, Michelle and her team have been heading up the BrainFit Lab at the Bloorview Research Institute, where they are the first to study body strength in real-world environments post-concussion in youth and children. Together, they have identified the need to re-consider how children and youth with concussions are rehabilitated. “We hope to apply this research in a clinical setting to reduce re-injury and ensure adequate rehabilitation time before returning kids to school, sports or other activities.”

What’snext: One approach to further inform when the brain and body are ready to re-engage in sports and

other activities may be through monitoring neurophysiological parameters, such as an individual’s heart rate variability (HRV). Michelle and her team are honoured to be the recent recipients of funding from the Canadian Institute for Health Research to explore the role of HRV in recovery. The research will be conducted in the BrainFit Lab and will include youth with mild traumatic brain injury as

well as non-injured youth. If HRV is shown to be effective for determining readiness to return to activity, future research may include the creation of a wearable device that helps to detect when it is safe for kids to get back in the game.

Michelle’s ambition: Returning kids to safe play after mild traumatic brain injury

So far, Michelle’s team’s research shows that:

• Concussedyouthhockeyplayersmayhavereducedupperandlowerbodystrength.Thisreducedstrengthmaybeakeyfactorinthelikelihoodforinjuryandfutureconcussion.

• Post-concussedyouthwhowerenolongerexperiencingsymptomsshowedpoorermentalperformancecomparedtotheirnon-concussedpeerswhenbackontheiceandperformingmultipletasksatonetime.


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Holland Bloorview’s ambition is to attract, recruit and retain an outstanding team, driven to achieve more for kids with disabilities and their families. Meet some of the talented and passionate people who joined us this year.

Kimberley Client and family relations facilitator

Trained as a lawyer and a family mediator, Kimberley’s background is in social justice law, with a particular focus on bioethics and child advocacy. As the client and family relations facilitator, Kimberley is responsible for the complaints and issue

resolution process at Holland Bloorview. She is also involved in identifying trends in client experience, participating in quality improvement initiatives based on client and family feedback and facilitating employee capacity-building initiatives.

Kimberley’s ambition is to have a career that is centred on

meaningful work that makes a real difference in the lives of children and their families. “This is a dream job,” says Kimberley. “The organization’s efforts to build authentic partnerships with families is completely aligned with my commitment to client and family-centred care.”

Connie Executive assistant to the senior director of information systems

Connie recalls her first visit to Holland Bloorview very clearly. Walking into the hospital, she was struck right away by the cheerfulness in the building. “Everyone was so friendly,” says Connie. “I think the employees here are happy because there is so much meaning in their work. Whether you’re a nurse on the front line or working in

systems like me, you are making a difference in the lives of others.” Connie’s ambition is to be part of making a client’s day, every day – whether it starts with a smile on the elevator, giving directions in the hallway or a thumbs up. What makes Connie’s day? Being part of a team that is improving access to information and quality of care for clients, families and employees.

Our ambition: To bring in the best

13Transform Care | Lead the System | Accelerate Knowledge | Inspire our People

DavidRegistered nurse, specialized orthopedic & development rehabilitation team (SODR)

A registered nurse on the SODR unit, David provides care to clients from birth to age 18 with a variety of musculoskeletal, developmental or neuromotor conditions. David first heard of Holland Bloorview when he graduated from his nursing program and began working with medically complex kids in the community. He says, “I immediately knew this was a place I saw myself working and making a difference.” So far, David has been most impressed by the hospital’s commitment to collaboration with clients and families at every level of care. He strives to role model

a family-centred approach in everything he does. Now that he is settled in, David’s ambition is to provide his colleagues, especially new employees and students, with the support, warmth and helpfulness that made his transition so positive.

“Junior” Therapeutic clown

Suzanne is thrilled to introduce “Junior” to Holland Bloorview’s therapeutic clown program. Working in pairs, therapeutic clowns make rounds to clients in their rooms, halls or other gathering places. Using music, rhythm, movement and physical comedy, clowns connect with clients in the moment. While the clowns aim to bring lightness and joy to their interactions, above all else they seek to mirror each client’s emotional state (whatever it may be) so that the clients can express themselves safely and without judgement. Clowns also partner with clinicians, providing positive distraction during care procedures and assist during physiotherapy, education and child life sessions.

Suzanne’s experience with Holland Bloorview stretches back a decade when she worked as a lifeguard in the pool and was inspired by the hospital’s inclusive spirit. Today, “Junior’s” ambition is to keep up with Holland Bloorview’s other famous therapeutic clowns, Dr. Flap and Nurse Polo, and to learn as much as possible from Holland Bloorview’s imaginative clients.

2012-2013ANNUALREPORT–BIGAMBITION

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Leading the way in client and family-centred care


BIG AMBITION

HollandBloorview’scommitmenttoregularandmeaningfulengagementofclientsandfamiliesbringsusclosertotransformingcare,leadingthesystem,acceleratingknowledgeandinspiringourpeople.

BLOOMhaileda“must-read”and“mustsee”Selected from hundreds of submissions, BLOOM, Holland Bloorview’s magazine and blog for parents of children with disabilities, was listed as a “must-read” on the New York Times Motherlode blogroll. In 2012, BLOOM caught the attention of readers from 150 countries around the world.

On the local stage, Holland Bloorview’s new BLOOM speaker

series brings families together with leading thinkers on childhood disability for popular evening events. This year, must-see speakers included Globe and Mail columnist and father to a child with disabilities, Ian Brown, and former Olympic medalist and stepparent to a daughter with autism, Silken Laumann. BLOOM is made possible through the generosity of the Coriat family.

Launchofthechildren’sadvisorycommittee(CAC)Holland Bloorview’s children’s advisory committee launched in 2012 for clients aged 3–15 and their siblings. Providing input through a unique play-based model, the CAC has already improved the design of the Ronald McDonald Playroom and participated in taste testing to help improve inpatient food services. Holland

Bloorview’s active engagement of younger children is unique in the pediatric hospital field.

NewcomplimentsandcomplaintsmanagementprocessWith the hiring of a new client and family relations facilitator, Holland Bloorview has launched a new process for collecting, managing and supporting client and family feedback. Feedback postcards are now available throughout the hospital to support families in sharing their ideas, providing compliments or initiating dialogue around concerns.

BRIfamilyengagementcommittee(FEC)The new Bloorview Research Institute family engagement committee launched this year as a formal way to gather family input on research initiatives. The FEC includes eight family

leaders and works to engage families in research questions, grant reviews and dissemination of research findings.

HealthliteracygetspriorityHealth literacy is the ability to read, understand and use health information. A new health literacy team composed of employees and family representatives from a number of areas of the hospital has begun working together formally to ensure that written documents use plain language and take full advantage of other health literacy strategies. A new health literacy review process should make it easier for clients and families to find health information, understand what they find and make decisions about their care.


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Holland Bloorview’s family leadership program leads the way:

• Familyleaderssitonmorethan35committeesand17workinggroups

• Familymentorsco-facilitatepeersupportgroupsandprovide1:1peersupportMondaytoFridayintheFamilyResourceCentre

• “Familyasfaculty”teachaboutfamily-centredcareatnewemployeeorientationandpresentatprovincial,nationalandinternationalconferences

• Familyadvisorycommittee(30familyleaders)meetmonthlyandtietheiragendatothestrategicplan

• Newchildren’sadvisorycommitteeallowskidstosharetheirideastoo!

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Leadership in the Teaching and Learning Institute

Dr. Golda Milo Manson, VP Medical and Academic Affairs

Dr. Kathryn Parker, Director of academic affairs and simulation lead

Darlene Hubley, Interprofessional education leader

Kimberlea Jones-Galley, Student coordinator

Dr. Shauna Kingsnorth, Evidence to care lead

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Teaching and Learning empowers possibility

AsafullyaffiliatedteachinghospitaloftheUniversityofToronto,teachingandlearningisessentialtoHollandBloorview’svisionofaworldofpossibility.Withexpertiseininterprofessionaleducation,optimalstudentexperience,simulationenhancededucation,facultydevelopmentandevidencetocare,theTeachingandLearningInstituteempowerseveryonetoreachtheirfullpotential.

Herearesomeexamples:

Simulation:Electronicdocumentationatpoint-of-careSimulation-based learning is a powerful tool because it allows healthcare providers

the opportunity to recreate challenging situations and to learn from these experiences in a safe and controlled environment. To ease the transition to an electronic health record this fall, clinical employees from outpatient services participated in the hospital’s largest ever simulation program, designed to recreate the experience of using tablet technology to document client and family information at the point-of-care.

This simulation, which involved actors from the University of Toronto Standardized Patient Program, was an opportunity for clinicians to observe, listen, discuss and problem solve how technology can be integrated in practice. Clients, families, students, administrative and clinical leaders were involved in the creation of the simulation exercise.

EvidencetoCare:KnowledgetranslationspecialisthiredEvidence to Care (EtC) is the nucleus for optimizing Holland Bloorview’s role in transforming research evidence into high quality care. EtC aims to be a go-to hub for advancing systematic reviews, clinical practice guidelines and evidence-informed best practices in childhood disability. This year, the EtC team hired a knowledge translation specialist to help raise clinicians’ awareness of research findings and facilitate the use of those findings in practice.

KnowledgeConnectionsroundslaunchedOpen to all hospital employees, the new ‘Knowledge Connections’ rounds at Holland Bloorview are a regular opportunity to showcase how research, education and clinical care can work together. We now include family leaders in ‘Knowledge Connections’ so that the family voice is always heard

through questions and comments. Recent topics have included HIV and rehabilitation, the experience of meaningful family partnerships, and the potential for the waiting room to promote therapeutic change and transformation.

TeachingandLearningDay:TheimportanceoffacultydevelopmentHolland Bloorview’s second annual teaching and learning day was focused on the importance of faculty development. Throughout the day, participants were encouraged to find their “element” as teachers - the place where natural aptitude meets personal passion and inspiration. Guest speakers included Dr. Yvonne Steinert from McGill University, and Dr. Ivan Silver from the Centre for Addiction and Mental Health, who discussed the various ways in which employees can contribute to the hospital’s academic agenda.

BIG AMBITION


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An ambitious year

yEAR IN REVIEW AT HOLLAND BLOORVIEW

OlympiansdelightclientswiththeirvisitsHolland Bloorview clients and families were treated to two exciting visits following the 2012 Olympic Games. Canadian olympians and paralympians dropped in to sign autographs, play games and answer questions about their experiences.

FOCUSbecomestheprovincialstandardHolland Bloorview is partnering with the Ontario Ministry of Children and Youth Services (MCYS) to roll out Dr. Nancy Thomas-Stonell’s FOCUS© (Focus on the Outcomes of Communications Under Six), an outcome measure developed to evaluate the impact of speech and language therapy for preschool children. MCYS has begun deployment of the FOCUS measure as the Ontario provincial standard. FOCUS is innovative for its emphasis on real-world

changes in communication for children following therapy.

ResearchexploressocialpressurestowalkHolland Bloorview is encouraging discussion about the impact of social pressure to walk for children with cerebral palsy and their families. A study by Dr. Barbara Gibson, senior scientist, shows that emphasis on walking therapy for kids with cerebral palsy needs to be balanced with other goals. Most parents reported independent walking was their primary goal, but Dr. Gibson says there is room for ongoing discussions about priorities to ensure that other important areas of life are also given due focus.

HollandBloorviewearnstwo“topemployer”distinctionsFor the third year in a row, Holland Bloorview was named one of the Greater Toronto’s Top Employers for 2012 in an editorial

report published in the Globe and Mail in partnership with Mediacorp. In addition, Holland Bloorview was recognized as one of Canada’s Top Employers for Young People in a competition organized by the editors of Canada’s Top 100 Employers.

ResearchunderwayonroboticassistedwalkingtherapySenior scientist Dr. Virginia Wright, and clinician investigator Dr. Darcy Fehlings, are co-leading a two and a half year study to evaluate the impact of the Pediatric Lokomat Pro, a robotic gait training device for kids with cerebral palsy. Supported by CIBC, this is one of the first randomized trials using the Lokomat with children and aims to develop guidelines for its clinical use. The Lokomat was donated to Holland Bloorview by the THREE TO BE foundation and KRG Children’s Charitable Foundation.

ExploringoxytocintherapyforautismIn partnership with the University of Illinois at Chicago, Holland Bloorview’s Dr. Evdokia

Anagnostou, clinician investigator, is examining the impact of oxytocin hormone therapy on social functioning in teens with autism. The cross-border clinical trial funded by the U.S. Department of Defense builds on previous adult studies showing that oxytocin plays a role in social memory, trust and attachment.

If the clinical trials support this outcome in teens with autism, Dr. Anagnostou believes oxytocin therapy could have significant implications for existing social skills interventions.

HospitalFoundationlaunchesChangeforKidsHalloween 2012 marked the first year of the Holland Bloorview Foundation’s exciting Change for Kids program, which is all about celebrating Halloween while giving trick-or-treaters the chance to help kids with disabilities. The program engaged thousands of participants who bought coin cards and entered over 102,000 PIN codes online for a chance to win prizes. Change for Kids raised over $300,000.



BrothersJoeyandKevinwerethrilledtomeetOlympicchampionCarolHuynh.Whenaskedabouttheirexperience,Joeysaid,“Carolwasreallyniceandletmeholdhermedals.Iwassurprisedthatthebronzewasheavierthanthegold.”

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“Screenplayisanexcitingintersectionoffamily-centredcare,engineering,artandhealthresearch–aone-of-a-kindcollaborativeprojectwithstrongpotentialtoenhancetheclientandfamilyexperience.” – Dr. Tom Chau, VP Research

and Director, Bloorview

Research Institute

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ScreenPlaymakesanartofwaitingScreenPlay, a large projection wall controlled by a pressure-sensitive floor, is a new one-of-a-kind installation in Holland Bloorview’s second floor waiting area. A fun and interactive way to battle waiting room boredom and reduce pre-clinic stress, kids of all ages and abilities can use ScreenPlay. ScreenPlay was developed by scientist Dr. Elaine Biddiss and her team in collaboration with students from OCAD University. With funding from the Canadian Institute for Health Research, the team is currently evaluating the impact of ScreenPlay on clients and families. The initial idea for the project was inspired by the memory of the late Dr. Tammy Kagan-Kushnir and funded with the support of the Holland Bloorview Kids Rehabilitation Hospital Foundation.

BloorviewResearchInstituteappointsclinicalstudyinvestigatorsThe appointment of clinical study investigators (CSIs) in the Bloorview Research Institute

gives clinicians the opportunity to lead research projects. Created in 2012, CSI appointments are part of Holland Bloorview’s commitment to expanding capacity in pediatric rehabilitation research and fostering integration of clinical and research priorities. New clinical team investigator appointments are opening in 2013 to give clinicians the opportunity to collaborate with BRI scientists.

Researchteamidentifiesoptimalactivitysettingsforseverelydisabledyouth Dr. Gillian King, senior scientist, and her team completed a study of optimal environments for severely disabled youth in 2012, funded by a grant from the Canadian Institute for Health Research. The team asked youth to participate in leisure activity settings of their choice and looked at the nature of their experiences and the environmental qualities of the settings. They found that youth with severe disabilities enjoyed participating in the activities and had a sense of choice, control and social belonging. The team’s findings challenge

the misconception that youth with severe disabilities do not have positive experiences. This finding can also help providers maintain sight of the importance of creating a sense of belonging, fun, choice and control when developing interventions, rather than focusing too narrowly on building specific skills.

Medicalstudentsexposedtofamily-centredcarethroughhomevisitsTwenty medical students from the University of Toronto participated in an educational intervention that gave them a unique first-hand view of the family side of life with a disability. Following an education session on family-centred care led by parents from Holland Bloorview’s family leadership program, each student participated in a two-hour visit in the home of a family leader. All participating families had a child with a physical or developmental disability. Survey and qualitative data collected following the visits showed positive change in students’ understanding of family centred care and disability related

issues. “It reminded me to always consider the ‘whole picture’ when caring for patients – the need to consider their social, emotional, and cultural environments, and not just their medical condition,” said one participant. All families felt the experience was meaningful and valuable for their families. Families felt strongly that students learned how complex care can be for a child with a disability, while still appreciating that children with disabilities “are also just kids.”

Over100entriesforfilmpossibleHolland Bloorview’s online video and photo contest brought visibility to disability once again this year. Grand prize video winner, For Abbey, was submitted by Clarence Porter of Hamilton, ON. The video honours his granddaughter, Abbey, who wears a prosthetic on her right leg. filmpossible is made possible with the support of the Holland Bloorview Kids Rehabilitation Hospital Foundation and Cisco. Prizes were donated by Cisco, Muir Detlefsen & Associates and GemsBok Technologies.

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STRATEGICGOAL MEASURES BENCHMARK ACTUAL SCORE

TransformCare

Generate,adoptandsharenewevidenceforclinicalcaretoachieveoutstandingclientandfamilyoutcomes.

Provideexceptionalclientandfamily-centredcare,embracingauthenticpartnershipswithfamiliesandensuringthe‘voiceoftheclient’isheard.

Harnessemergingtechnologiesandthelatestprocessestoimproveefficiencyandenhancethequalityofcaretochildrenwithdisabilities.

Build,strengthenandgrowourCentresforLeadershipinAcquiredBrainInjury,ChildDevelopmentandParticipation&Inclusion.

Improvement in clients’ functional abilities from admission to discharge using the WeeFIM® instrument:

• Averageimprovementinclients’functionalabilities1

• %ofclientswitha10%pointimprovementor greater in functional abilities1

10%pointimprovement40-60%

10.2%41%

H H

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

• Averageachievementscoreforgoalssetbyclientand/ortherapist1

• %ofgoalsachievedtoexpectations(T-Scorebetween45and55)• %ofgoalsexceedingexpectations(T-Scoreabove55)

T-score between 45-5535%30%

51.538.4%35.6%

H H H

%ofclientsandfamilieswhorateHollandBloorview excellent or good2 95% 98.2% H H H

%offamilyleaderswhoratetheirexperienceas an authentic partnership

80% 87.9% H H H

%ofcomplaintswithinitialcontactandinterviewcommencing within 2 business days

80% 100% H H H

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-ordinatedCare(outof7)• GeneralInformation(outof7)• Partnership(outof7)• RespectfulCare(outof7)• SpecificInformation(outof7)

5.55.55.55.55.5

5.854.825.705.925.58

H H

Annual infections per 1000 inpatient days 3.4 per 1000 2.5 per 1000 H H H

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

0.3 per 10000.14 per 1000 H H H

%completemedicationreconciliationoninpatientadmission 90% 99.3% H H H

%completemedicationreconciliationonoutpatientclinicvisit 90% 96.5% H H H

%compliancetohandhygieneacross4momentsofcare 90% Moment 1 – 90.5%

Moment 2 – 99.5%

Moment 3 – 94.3%

Moment 4 – 89.0%

H H H

Total margin (consolidated)3 0.5% 0.51% H H H

Current ratio of short term assets and liabilities4 1.0 1.20 H H H

HollandBloorviewisalwayslookingforbetterwaystotrackourperformanceandcommunicatehowwearedoing.

Here is an at-a-glance report on our performance. To determine our ratings, Holland Bloorview invited the input of representatives from the Provincial Council for Maternal and Child Health, Erinoakkids, Grandview Children’s Centre, GTA Rehab Network, and Holland Bloorview’s family and youth advisory committees.

Guideline: Fair = H (1) Good = H H (2) Excellent = H H H (3)

How we measure up

STRATEGIC GOAL MEASURES BENCHMARK ACTUAL SCORE

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 clients

80% seen in 182 days

Q1 - 171 daysQ2 - 98 daysQ3 - 89 daysQ4 - 103 days

H H H

Wait in days for new neuromotor clients



H H H

Wait in days for new augmentative communication clients



H H H

Wait in days for new writing aids clients

90% seen in 61 days


H H

Wait in days for new inpatient rehabilitation clients

90% seen in 3 days


H H H

Average Electronic Medical Record Adoption Model (EMRAM) Score5

2.3948 (LHiN)1.1794 (Peer)

4.2280 H H H

Accelerate Knowledge

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.

% of professional health discipline and nursing students that rate their clinical experience as excellent6

50% 51% H H H

% of Holland Bloorview students involved in inter-professional education (iPE) each year7

Benchmark = 20%Target = 25%

37% H H H

Number of peer reviewed publications per investigator8 5.5 3.3 H

H index (measuring research impact)9 20 20 H H H

Research funding by investigator10 $400,000 $229,355 H

# of research students per investigator11 2.3 3.3 H H H

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.

Employee turnover rate 12 7.12% 8.9% H H

% of employees who give the organization an overall excellent or very good grade on patient safety (using the Patient Safety Culture Survey)13

75% 78.1% H H H

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

80% 90.9% H H H

1 Based upon peer-reviewed literature. Average improvement is not adjusted for acuity.2 Results are from the ‘Tell Us What You Think’ survey, a tool that captures patient satisfaction by using the CanChild Measures of Processes of Care (MPOC). 3 Percent by which total corporate (consolidated) revenues exceeded or fell short of total corporate (consolidated) expenses, excluding the impact of facility amortization, in a given year.4 Based on Toronto Central LHIN standards.5 Ontario Hospital Association derived benchmark. Scale 0-7.6 The industry benchmark for the overall quality of the student experience is 75-80% of students indicating that their student experience was either very good or excellent. Holland Bloorview’s results far exceed this standard (91%). To create an aspirational target, the indicator was modified to reflect “number of students indicating that their student experience was excellent”. We are currently at 51% and have set our benchmark at 50% and our target at 70%. There is no industry benchmark for “excellent only”. 7 There is no industry benchmark for the percentage of students experiencing IPE. The benchmark and target were set internally; considering numbers that were both aspirational and feasible given current resources.8 Number of peer-reviewed publications benchmark is a median value of all other Toronto Academic Health Sciences Network (TAHSN) hospitals from 2011.9 The H-index is an index that measures both the productivity and impact of the published work of a scholar. An H impact factor > 20 is used as an indicator of international impact.10 Total amount of research funding by investigator is the median value of all other TAHSN hospitals from 2011.11 Number of research students (only includes graduate students and post-doctoral fellows) – average value across TAHSN hospitals from 2011. 12 Turnover rate is based on the Ontario Hospital Association benchmarking survey from 2012 (reflecting the period of April 2011 to March 2012). 13 The Patient Safety Culture Survey (PSCS) is a required tool which Accreditation Canada utilizes to better understand organizational culture as it relates to safety.

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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: [email protected] www.hollandbloorview.ca

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Documents

Big Ambition: Holland Bloorview 2012-13 Annual Report