5 Things You Need to Know to Build Effective Models of Child, Youth and Family Engagement

Three very different hospitals. Three very different programs. Nonetheless, The Change Foundation’s recent case study of family integrated care in the Mount Sinai Hospital NICU (Toronto), Holland Bloorview Kids Rehabilitation Hospital (Toronto), and CHEO (Ottawa), shows 5 key learnings that can underpin any healthcare people engagement initiative.

1. Imitation is the sincerest form of flattery: start with what has worked elsewhere

Mount Sinai built the pilot for its family integrated care (FICare) model in their NICU on Estonia’s “humane care” to make parents/guardians an integral part of a baby’s care team. It was a natural fit as they had an active parent advisory group and had a history of working closely with families. They applied the model in a rigorously designed pilot project and then followed up with an international randomized controlled trial.

Holland Bloorview based its model on the core concepts of dignity and respect, information sharing, participation and collaboration promoted by the Institute of Patient and Family Centered Care.

CHEO relied on a lean methodology approach to co-design a renewal of its framework for child, youth and family engagement in order to better reflect the demographics of the community it serves.

2. It doesn’t happen without the right leadership

Leadership is mission critical and the ideal leadership depends on the organizational culture, strengths, and when and where obstacles will be encountered. So at Mount Sinai this was the pediatrician-in-chief and director of the Maternal-Infant Care Research Centre. At Holland Bloorview, the then president and CEO personally championed a refreshed client and family-centred care strategy and change-management framework to integrate best practices and evidence. While, at CHEO, what proved successful was partnership between the manager of patient experience and the team leader for quality improvement with the chief of staff as the executive sponsor thereby building support from physicians and clinicians.

3. Iterate, iterate, iterate: learn from mistakes, course-correct, persevere

Each program encountered challenges along the way and found unique solutions. For example, at CHEO, recruitment of youth and especially those from vulnerable populations for Family and Youth Forums proved challenging. They found success by looking outside the hospital to build relationships and trust in the community and by creating different ways to participate. Rather than a standing monthly engagement meeting, some people preferred to attend a one-time workshop on a specific issue, or participate in an online forum.

Mount Sinai didn’t anticipate that nurses would be worried about job losses and later they had concerns about the shift from “doer” to “teacher”. Enlisting the support of champions within the nursing team and among parents to educate was a key lesson learned.

At Holland Bloorview there were bumps in the road too. At first, family leaders participating on committees had experiences of feeling left out or singled out or simply not being given the information they needed to participate effectively. Change management for staff included a formal process to apply for family leaders as committee members and giving staff the tools they needed to effectively engage family leaders in the work of the hospital.

4. Start with strong foundations and invest in ongoing scaffolding

CHEO is building child, youth and family engagement into the project approval process and recognizes the need for continued support of the engagement framework. At Mount Sinai, parent education, nurse education, environmental support and psycho-social support (i.e. peer-to-peer support) are the pillars to aid continued partnership. And, at Holland Bloorview, the Client and Family Integrated Care team are the subject matter experts who focus on embedding child, youth and family leadership in all aspects of the hospital’s work. Family mentors work with new family leaders and “family as faculty” bring their experience to individuals and groups of providers.

5. This is culture change: seek out successes to celebrate

The high profile that Mount Sinai’s NICU received by demonstrating FICare’s positive impact on health outcomes and parent-child bonding generates pride amongst staff, which in turn increases their support and commitment to FICare. At Holland Bloorview one on-going form of celebration is the Spotlight recognition program that enables families to recognize staff for demonstrating client and family-centred care. Staff take pride in receiving a Spotlight and the recognition builds and reinforces client and family-centred behaviour. The best recognition can be witnessing the success first hand. CHEO is measuring and evaluating and points at an example to a plan that emerged from a series of facilitated meetings held by the Youth Representation Council: “We give our opinion, and combined with the opinions of the children and the parents, it turns into a beautiful well-designed structure.”

As parts of the healthcare system we all strive to innovate – to exercise creativity aligned to our mission and vision in order to bring value to the communities we serve and to our organization. Innovation will only thrive with an effective balance of the ideal leadership and local passion and cultural change. The Change Foundation’s case studies on successes in engagement give healthcare organizations concrete examples to follow and demonstrate the value of learning from the experiences of others and customizing to the local context.

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Julia
@Hanigsberg

CEO blog: No Boundaries Fund

Launched in 2017, the No Boundaries Fund was created to unleash the innovation and the creativity of the Holland Bloorview team. By providing small grants and a low red tape way to apply for them, we hoped to give everyone the power to launch solutions and tackle challenges they see impacting clients and families.

In 2018 we received 39 applications from staff members and 14 teams were selected for funding.

We have officially launched year 3 of the No Boundaries Fund! Staff are encouraged to submit their grant requests, up to a maximum of $5,000 per request, for a total of $50,000 of donor funding available in 2019-20.

With No Boundaries Fund grants, staff can address pressing needs, identify new and emerging solutions, pilot creative ideas and help bring our No Boundaries strategy to life. In addition, this year we have a special call-out for ideas that support inclusion of kids with disabilities in recreation and sports, and enhance the mental health strategy for children, youth, families and staff – priorities for which we have eager donors.

Your Creativity Knows No Boundaries!

Not sure what kinds of projects receive No Boundaries funding? Here are some examples:

• For some clients, especially those with neurodevelopmental disabilities, receiving dental care can be downright scary. That’s why Tanya, a dental and orthodontic hygienist with the hospital’s dental services, wanted to make the treatment room more welcoming and inviting. The grant she received enabled her department to purchase a number of items to help make treatment a little less daunting. These items included:
  • a soft bean bag so children can sit comfortably and feel more like they’re at home
  • a cordless (and practically silent) cleaning instrument, which allows her to do cleaning and polishing anywhere in the room and with a better sensory experience – even while a child is sitting in the bean bag chair!
  • a lava lamp projector that creates a kaleidoscope of shifting colours on the ceiling which helps kids sit still when in the bean bag chair

• The Survival Guide to Picky Eating is a helpful feeding workshop held at Holland Bloorview. Access to a program prior to significant impairment in eating behaviours gives families the ability to change a child’s feeding trajectory in a positive way.
  
  
• Youth with disabilities want and need to talk about sexuality, gender identity and intimacy. Holland Bloorview co-facilitated a series of workshops with Holland Bloorview Youth Leaders, Family Leaders, and community partners with the No Boundaries Fund as a catalyst.

• Having a sibling with a disability can be tough. Siblings need support, programming and recognition. Holland Bloorview offered holistic family programming by adding a monthly program designed specifically for the siblings of clients as well as a sibling recognition event at the end of the year. Using a play-based model, siblings ages 7-18 can play, relax, unwind, meet peers who have shared lived experiences, and talk about what it’s like to be a sibling of someone with a disability.

Are you inspired?

For this year’s No Boundaries Fund, grant requests can be made from March 18th, 2019 to May 10^th, 2019, by any member of the Holland Bloorview team. Remember that co-designing with clients/families always gives your plans an edge! To apply, all you have to do is email noboundariesfund@hollandbloorview.ca to submit your request. Share your idea with me for an opportunity to bring it to life.

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Julia
@Hanigsberg

CEO blog: Why I give to Capes For Kids

Starting on March 4, 2019, you may see a pretty fun sight on the streets of Toronto, in boardrooms and hallways, offices and streetcars. People of all shapes and sizes, walking, rolling, running and dancing will be wearing capes. Red and shiny, bedazzled and bejeweled, thrown together or lovingly handcrafted, the capes will have one thing in common: they all signal a commitment to making a profound impact in the lives of kids with disabilities and they’ll be for Capes for Kids.

Why? First of all, we can all use a bit more silly in the doldrums of winter and it’s hard to take yourself too seriously when you’re wearing a cape! Secondly, people of all abilities and all sizes can wear a cape! Thirdly, children with disabilities, chronic medical conditions and complex rehabilitation requirements don’t get the attention and the funding they need for care, services, technology and groundbreaking research. Fourthly, once you get to know the stories of some of these young people, you need to help:

Meet Rhea: When she was four, Rhea nearly died. What started as flu caused Rhea to develop acute necrotizing encephalitis, a rare condition that causes severe brain damage. In a coma her doctors gave Rhea little chance of survival. But she woke up and her journey began. Rhea spent almost half a year learning how to walk and talk again with Holland Bloorview’s Brain Injury Rehabilitation Team. Now Rhea is 7 and there’s no stopping her.

Our friend Penelope is a bright and delightful 4-year-old girl and would never be confused with a number, but there is one that she can’t get away from: the code 10q23.31-24.2, which represents a rare genetic disorder. Penelope has worked with her Holland Bloorview speech language pathologists for the past four years. The Speech Language Pathology team includes speech language pathologists and communicative disorders specialists who work with kids and youth to address needs that may impact speech, communication, language, swallowing, as well as the need for alternative communication. Just last week I saw Penelope so excited to take over a microphone using short sentences and asking questions!

It’s hard to select just one more story… but how about Sheriauna, whose world has opened up thanks to specialized and customized services from prosthetics services, which over the years, has worked with Sheriauna not to make a single prosthetic arm but to make a number of prosthetic devices so that she can play guitar and piano, ride a bike, ski, and swim, and for competitive dance too. They consult with Sheriauna about how she wants it to feel, look and what she wants it to do, and create solutions that are as unique as she is.

Some people ask why I give generously and fundraise for Holland Bloorview when I already “give through my work” as part of the team. The answer is pretty simple: I see first-hand the gap between what exists today and what can exist when donors come together with purpose. $10, $20 or $100 may not seem like much, but Capes for Kids raised over $1M in its first 2 years because of hundreds of caped crusaders and their sponsors and that’s enough to make a big impact in kids’ lives. It’s not too late! Join Capes for Kids for fun and for children’s lives.

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Julia
@Hanigsberg

CEO blog: Interview with Dr. Gillian Kernaghan, president and CEO of St. Joseph’s Health Care London and #LEADSFramework expert

On January 16, Holland Bloorview held its inaugural #LEADSFramework speaker series with Dr. Gillian Kernaghan, president and CEO of St. Joseph’s Health Care London. The LEADS in a Caring Environment (LEADS) Framework is an approach to health leadership that we recently adopted at Holland Bloorview. Through this framework we are supporting leaders across the hospital to model courageous leadership that embraces risk-taking and unleashes passion, creativity and growth in the organization and inspires a no boundaries ethos as described in our No Boundaries strategic plan.

During her presentation at Holland Bloorview, Gillian shared her personal approach to leadership and how she implemented the LEADS Framework at St. Joseph’s Health Care London to make a broader impact on the health system. Afterwards, I had the opportunity to interview Gillian to learn more about what we can all do to become better leaders and change agents.

Dr. Gillian Kernaghan (right) and I (left) after she spoke at Holland Bloorview about the #LEADSFramework.

1. How did you get into health care in the first place?

When I went to university I thought I might go into teaching. The lifelong learning in health care attracted me and I went into medicine. I became a family doctor in the community and then moved into health care leadership while practicing part time until I became CEO.

2. Systems transformation is a key part of the LEADS framework. It’s also part of our No Boundaries strategy at Holland Bloorview with our commitment to connect the system. Why is systems transformation such an important part of health leadership?

It is widely recognized that we need to take a systems approach if we are going to create a high-quality sustainable health care systems that meets the needs of the people we serve.  The solutions are complex and require all parts of the health care system to work together to find ways to move forward. Research shows that leadership is a critical success factor in system transformation.  Leaders who can live in the uncertainty, set direction for the future and have the courage to take steps that move us to a more desired future are needed.

3. You’ve had tremendous success implementing change throughout your career. What advice do you have for leaders to ensure they are advancing impactful and sustainable change?

There is no magic solution to create a sustainable, affordable quality healthcare system.  You have to have a long-term vision based on key principles and then relentlessly pursue change that moves you in that direction.  You need to celebrate the small wins. You need to recognize that there are no heroic leaders and it is in drawing on the strengths of a team that change happens. A leader needs to listen well to others and be able to integrate thinking to find a way forward.

4. Are there unique features of physician leadership or unique insights into leadership you have as a family doctor yourself?

Physicians are cultured to listen to a person’s symptoms and develop a plan of care.  In leadership, spending more time on listening and not quickly moving to diagnosis and solution is required. This is a cultural change for physicians.  Leadership requires you to take the long view of change and not require the regular affirmations that come in clinical practice.  Patients and their families often tell you how much they appreciate and value you…this is less common in leadership and individuals must be self-motivated to find the joy in small wins that take you to the larger goal.

5. Have you had a special mentor or influence in your professional or personal life?

This is a question that is often asked and I recall listening to Colin Powell whose answer resonated with me.  I have learned from many with whom I have worked, observed and read about what it means to be a good leader.  I have also learned what attributes I did not want to manifest in my leadership.  It is in the synthesis of all this input that I have found my authentic leadership style, character and behaviour.

6. Do you have some favourite leadership books you’d recommend?

I have had the privilege of teaching the research and work in the book Crucial Conversations and Crucial Accountability for many years.  It is a foundation in relationships and leadership.  The work on Strengths Based Leadership outlined in the book of the same name has transformed my focus from weakness based coaching to strength based coaching and recruitment.  I have been inspired  by Jim Collins book Great by Choice where he speaks to the organizations that survive and thrive through change.  Those organizations who have the wisdom to find the 10% to change and the foundational essence of the organization to take forward.

7. Personal well-being is important for all of us. How do you unwind? Is there a recent work of fiction you’ve read or a favourite TV show or movie for when you need to unwind?

I love to play especially with my three sons who are now grown and married.  We ski, kayak, bike, hike, scuba dive and generally play together.  It is not hard to unwind in the beauty of the outdoors.  As a woman of strong Christian faith my strength is found in my relationship with God both in day-to-day life and especially during challenging times.

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Julia
@Hanigsberg

CEO blog: 2019’s Healthcare Top 5

As we start the New Year here are the top 5 concepts that I think are going to be critical to meeting the enormous challenges for healthcare systems, organizations and leaders.

1) Trust

Holland Bloorview’s vice-president of programs and services Diane Savage shared the American Board of Internal Medicine Foundation (ABIM) “Trust Challenge” with me toward the end of 2018. The premise of the challenge is that in order to provide great health care teams must have a “stable foundation of trusting relationships.” If this rings true (and it does to me), then how can we as leaders in health care help to nurture and grow trust, in hospital leadership, in each other as members of teams, in the institutions that support us?

Edelman publishes an annual “Trust Barometer” which has demonstrated an erosion of trust in government, media, business and non-governmental organizations (NGOs). Most surprising is the rapid erosion in trust in NGOs with only half of the general population reporting that they trust NGOs according to the latest Canadian data.  What to do? Be clear about the change we are trying to make as healthcare institutions; share credible information grounded in evidence; and mobilize health professionals, researchers and healthcare leaders in public discourse.

We in health care have an advantage because healthcare professionals are trusted. Jane Sarasohn-Kahn (@healthythinker) shared a recent Gallup poll on Twitter looking at the most trusted professions in the US. Four of the top five are health professions with nurses at the top of the list.

But the medical profession has also been at greater scrutiny than ever for the way that relationships (and financial ties) can impact objectivity. One of the New York Times top health stories of 2018 was on conflicts of interest in medical research. How we manage the relationships for the credibility of our hospitals has been a key focus of efforts for the Toronto Academic Health Science Network over the past two years and Holland Bloorview will be advancing our efforts in disclosure and management of relationships this year.

 

2) Complexity

We have observed the increasing complexity of the clients we are seeing at Holland Bloorview over the past number of years. This is demonstrated by data we have on the proportion of our clients with multiple diagnoses, the increased medical acuity of many of our inpatients, and the proportion of our client families that are experiencing economic precariousness and other social determinants of health.

What we are seeing is consistent with what we know are the pressures on hospitals across the city and the province and has motivated initiatives such as Complex Care Kids Ontario (sponsored by the Provincial Council on Maternal and Child Health ) and Connected Care (created by SickKids and funded by the Toronto Central Local Health Integration Network), as well as the Kids Health Alliance , of which Holland Bloorview is a founding member.

A recent synopsis of two studies caught my eye with their special relevance to what we are requiring of our nursing professionals and the health human resource challenges of this increased patient complexity. As we know, complex children are being cared for not only in specialty hospitals but also in the community (home, school, other residential settings) where kids should be spending their lives. But we don’t yet have a truly coordinated high quality system of child and family centered care for this small but growing population.

Managing this level of complexity requires work at all levels of our hospital. Much of what we at Holland Bloorview think is required is contained in our No Boundaries strategy that asks us to personalize pathways for our clients, to use our research and academic mandate for rapid impact – to discover for action, and to connect the system in order that care can be more integrated. But I hear all the time from clinicians in particular that we aren’t as clear as we ought to be about how to make the No Boundaries strategy live in their work, and to support them with the quantity and complexity of their work.

 

3) Empathy

Marilyn Monk, Executive Vice President at SickKids recently tweeted a Harvard Business Review article that makes the case that for organizational change to be successful it has to be grounded in empathy. In other words, understanding the team’s perspective is critical to change that is sustainable and lasting. You can’t get insight without asking (and that means everyone) and creating transparency.

There are some great thinkers who have made empathy a focus in 2018. For example, on my reading list are Brian Goldman’s The Power of Kindness and Brené Brown’s Dare to Lead. In the waning days of 2018, I discovered Nathalie Martinek on Twitter (@NatsforDocs) who is writing about and working on “burnout culture and disconnected medicine.” I’ve also noticed that the concept of “moral distress” (the conflict between the “right” thing to do and scarce resources) which has been in the nursing literature for more than three decades is starting to be used in the context of medicine and I’m hearing a similar tone in conversations I’m having with professionals in the health disciplines I talk to at Holland Bloorview.

We are proud to have been the first hospital in Canada to implement the Schwartz Center Rounds® to enhance compassionate care, improve teamwork and reduce caregiver stress. There are also plans to increase access to the quality of engagement provided by Schwartz Center Rounds® with a “pop up” version for individual clinical teams.

How will we advance empathy while faced with system constraints?

 

4) Equity, Diversity and Inclusion

We are investing in equity, diversity and inclusion this year at Holland Bloorview. We know that part of the complexity in our clients’ lives is impacted by social determinants of health. We also wonder if there are clients that we are not serving as effectively as we could, or ways our programs could take equity, diversity and inclusion into consideration in design and delivery.

Research funders are requiring a greater degree of attention to equity, diversity and inclusion. We are rising to this challenge in our research institute.

We also are paying attention to equity, diversity and inclusion in the Holland Bloorview team. Do we at Holland Bloorview represent the diversity that we see in Toronto? We are in good company with the University of Toronto Faculty of Medicine, also deeply invested in this issue and finding ways to widen the pathways into medicine and other healthcare professions.

We want everyone who works at Holland Bloorview to feel comfortable bringing his or her whole selves to work – a critical part of the authentic culture of compassion that we know is also critical to providing child and family centred care.

We are grateful that we will have leadership in all elements of this important work at Holland Bloorview with our new Executive Lead of Equity Diversity and Inclusion, Meenu Sikand.

 

5) Wellness

All of these roads lead to the wellness of our team. I know from talking to colleagues across health care that burnout among healthcare professionals is one of our most pressing concerns. The Institute for Healthcare Improvement (IHI) describes the challenge this way:

With increasing demands on time, resources, and energy, in addition to poorly designed systems of daily work, it’s not surprising health care professionals are experiencing burnout at increasingly higher rates, with staff turnover rates also on the rise.

Burnout leads to lower levels of staff engagement, patient experience, and productivity, and an increased risk of workplace accidents. Lower levels of staff engagement are linked with lower-quality patient care, including safety, and burnout limits providers’ empathy — a crucial component of effective and person-centered care.

The IHI has developed a framework for improving joy in work emphasizing that systems change is what is needed not only to reduce burnout but to actually ensure high quality care.

Team wellness is a top priority for me and I’m excited that work has begun on our new No Boundaries people and culture plan – a plan that will be about “doing” rather than more “talking” (stay tuned on how members of the Holland Bloorview team will be engaged in this important work).

 

Conclusion

Whether it is a healthcare system or the team in any individual organization, hospital or community-based, wellness is mission critical. Let’s make 2019 the year we take our system and our organizational wellness to the next level.

Want to provide feedback on how we can take it to the next level? Email me at jhanigsberg@hollandbloorview.ca or tweet at me @hanigsberg. (For members of the Holland Bloorview team, come to my next CEO Coffee Chat. See HBConnect or stay tuned to your email inbox for HBConnect Weekly for timing and location details.)

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Julia
@Hanigsberg

CEO blog: Busting myths about Holland Bloorview (part two of a two-part series)

As mentioned in my last post, this one will focus on some myths and truths about Holland Bloorview (spoiler alert: there will be numbers!).

How do we share information?

Every summer we issue our annual Impact Report where we share some of the stories we are most proud of from the previous year from care, research and teaching and learning that demonstrate how we are making progress on our No Boundaries strategic plan and how community and donor support is advancing our work.

Our Impact Report also shares some of the key numbers that help describe who we are. I’m using this post to focus on these numbers and to do some gentle myth busting!

By dollars, Holland Bloorview is a $94M hospital. This makes us the smallest by funding (but certainly one of the mightiest by impact!) of Ontario’s academic health science centres, but there are many community hospitals that are smaller than us across the province.

 

Myth #1: “There are more management at Holland Bloorview than any other hospital!”

Myth-buster: We have only 16 people who are Directors or Senior Directors! We have 6 Vice Presidents who along with our Chief Financial Officer, our Chief Nursing Executive and the President and CEO of the Holland Bloorview Foundation, make up our Senior Management Team. Our overall management (managers and above) is only 5% of our total staff. 72% of our funds are spent on care and only 13% on administration.

That would make us among the leanest management teams out there especially when you take into consideration the complexity of our client population, that we serve the province (2/3 of our clients come from outside our Local Health Integration Network) and the fact that we are a teaching and research hospital with responsibilities to our trainees, learners and clinical supervisors!

We have just over 1000 staff with virtually a 50/50 split of full and part-time. Of this staff, a majority are physicians, nurses, members of health disciplines and family and caregiver support.

 

Myth #2: “When clinicians leave or retire they are never replaced!”

Myth-buster: Also not true! But I can understand where the misunderstanding comes from. Sometimes when a person leaves (happily we have incredibly low turnover) we consolidate their responsibilities with another position and even sometimes in a different area or clinic. Here’s an example of how this works:  clinician A who works part-time leaves and clinician B who also works part-time moves into a full-time role by the combination of two part-time positions. While in that scenario we have gone from two to one staff, we have maintained the amount of clinical resource (what is referred to as “full-time equivalent” or “FTE”).

So to be fair, a particular individual or team may feel like “their” person hasn’t been replaced, and the loss in expertise, knowledge, experience and camaraderie is real for them.

Fact: We work hard to fill vacancies in clinical positions even if that means we have to keep vacancies in administrative positions in order to ensure we have the money we need to fill clinical jobs. Retaining clinical capacity is always (and will always be) our top priority.

 

What IS absolutely true: 

Your work is getting harder and more complex. Even with the same amount of clinical resource available, there is more work and it is harder.

We are seeing more children and youth every year because the need just continues to expand and we doing everything we can not to turn families away.

The children we are seeing are more complex. 71% have two or more diagnoses. The number of rare conditions continues to expand as science progresses and diagnostic processes become increasingly specific. There were children with more than 2000 different diagnoses served at Holland Bloorview last year.

Children are also more complex because we are seeing them at a younger age. When I started at Holland Bloorview (just under four years ago) we rarely saw infants. We now routinely admit infants and very young children.

In addition, with the length of stay at acute care hospitals becoming shorter than it used to be, children arrive at Holland Bloorview with greater medical acuity than they ever have. That fact changes our required knowledge and capacity and we have worked hard to build that through professional development, training and new equipment.

The psychosocial needs of families are greater than they have ever been. What does this mean? For example:

• Half of our clients have a family income less than $50,000.
• Many of our clients are food-insecure.
• Sources of funding for equipment families need are dwindling.
• Waitlists for services (including those in the community or at other hospitals/service providers e.g. mental health) are long.
• Children and families are living with trauma.
• Parents (and other caregivers) are under relentless stress and sometimes appointments with Holland Bloorview care teams are where that frustration gets aired.

We are proud to extend Holland Bloorview’s care to some of Ontario’s most complex children and children and families across Ontario who need us most. But, that makes the work hard and it means fewer and fewer client visits are straight-forward and routine. It also means, that physicians and clinicians also live the pressure of never feeling like they are doing enough. I hear directly from clinicians that they frequently go home demoralized because they know that they haven’t been able to meet all the hopes and needs of the children and families they have seen that day. Fewer days end on an optimistic high note.

 

Myth #3: Children who come to Holland Bloorview receive extraordinary care and benefit from programs and services and work done by all of our teams that changes lives every day.

Oops, sorry, that one is true. And I could not be more grateful to every single person who has chosen to make Holland Bloorview the place to spend a career. These are not jobs they are callings and I am humbled to work alongside the Holland Bloorview team every day.

Best of the holiday season, and a safe, healthy and joyful 2019 to all.

_____

Julia
@Hanigsberg

CEO blog: Decision-making at Holland Bloorview (part one of a two-part series)

As the 2018-year comes to a close, I’m planning a two-part year-end set of posts to the blog (do you see how I am cleverly distracting you from the fact I didn’t post in November?).

This first one will focus on decision-making at Holland Bloorview especially regarding budgeting (it is, after all, that time of year). The second one will focus on some myths and truths about Holland Bloorview (spoiler alert: there will be numbers!).  And to start off the New Year in January, I will focus on a subject particularly near and dear to my heart, the wellness of our team. Stay tuned.

All three of these of these posts are likely to be of greatest interest to our Holland Bloorview team and in the spirit of transparency – more information is always better than less – and I’m eager for your comments and questions!

As promised, this post will focus on decision-making at Holland Bloorview especially, but not only, regarding budgeting. This is what I sometimes hear:

“It’s impossible to understand how decisions get made in this place!”

This post is an attempt to help to clear some of that up.

There are other ways to better understand decision-making: ask your manager if there’s something happening on your team or in your department that you want to know more about; check out HBConnect (the Holland Bloorview intranet) where information on major initiatives can be found (e.g. Meditech EXPANSE, our health care information system); come to a CEO Coffee Chat and ask me directly!

But here are a few FAQs to help make it (hopefully) clearer:

 

How are money decisions made?

By now all departments will have completed their financial optimization and budget process and submitted the results to the Finance Department. Our Chief Financial Officer has brought preliminary numbers to the Senior Management Team to show us that all departments have met their savings targets (thank you – we know it wasn’t easy!).

[Why savings? Because the increases in funding we have gotten each year in the past few years while terrific, don’t keep up with inflation (the amount our costs go up). Stay with me!]

These departmental budgets also include new operating budget “asks.” Later, capital (e.g. equipment) requests will be brought to the Senior Management Team. Where operating and capital need exceed our funding (always), Senior Management Team is responsible for prioritizing.

This priority setting gets reflected in the annual Operating Plan, which is prepared to demonstrate alignment with our No Boundaries strategy. In other words, our activities in the coming year are shown organized around how they will advance the impact areas of our strategic plan: Personalize Pathways, Discover for Action, Connect the System (as well as our four enablers).

The Operating Plan pulls together financial requirements with priorities. In other words, are there things we want to stop doing, consolidate, start doing, or do differently? For example last year, a key priority was to develop a plan to transition medically complex and younger clients from specialist acute care (primarily SickKids) to Holland Bloorview for rehabilitation. This change (and the funding required to make it happen which we ultimately received from the Toronto Central Local Health Integration Network (LHIN)) had been developed by our Rehabilitation and Complex Continuing Care team with support of lots of other resources across the hospital before it made its way into the Programs and Services priorities and finally into the Operating Plan.

The Operating Plan is reviewed by the Quality Committee of the Board of Trustees  – to ensure focus on services, programs, safety and quality – and the Business and Audit Committee of the Board of Trustees – to ensure that it demonstrates financial responsibility and adherence to our Hospital Services Accountability Agreement (HSAA), which is our contract with the government for our funding. Then the whole thing goes to the full Board of Trustees

Aren’t you glad you asked?

 

What about equipment and IT?

Similar process for capital requests but Information Systems/Information Technology (IS/IT) equipment is reviewed by the Digital Health Strategy and IS Committee. This committee has been newly constituted this year and includes physician and health discipline representation as well as two family leaders.

The Senior Management Team also decides on equipment needs in line with the No Boundaries strategy and quality and safety (as well as lifecycle of current equipment). For example, last year some big approvals were for capital required for Meditech EXPANSE and new X-Ray equipment to replace an aging existing machine.

 

Where does the Foundation come in?

Great question! Much of what we do as the bread and butter of Holland Bloorview couldn’t happen without the generous support of our donors. Roughly $9M annually of donor dollars are spent on equipment (e.g. new inpatient sleeper beds – finally!), programs (e.g. therapeutic recreation, therapeutic clowns, parent education), the family support fund, and research (e.g. the new research MRI which will come to Holland Bloorview next year as part of the Bloorview Research Institute Growth Strategy) and innovation (e.g. No Boundaries Fund projects such as KneuroKnits anxiety reduction through knitting for kids with ASD). In addition there are generous endowments (donor funds which are invested to create an income stream), which fund particular research areas (e.g. named chairs/positions supported by targeted funding like the Holland Family Chair held by Dr. Nick Reed, the Bloorview Children’s Hospital Chair held by Dr. Melanie Penner, and the Chang Family Chair held by Dr. Tom Chau).

Decisions on how the annual donor support is spent are made by the Senior Management Team (SMT) through the annual grants process. Grant fund requests are made on a template, VPs review all the grants coming through their areas to make sure they represent the most important priorities, the whole bundle gets reviewed by me, and then the full “ask” comes to SMT. Once we have decided which among the grant requests the hospital will ask be funded, I sign off on the package and it goes to the Board of Directors of the Foundation for approval. The Foundation will only fund something that has been identified by the hospital as a priority.

The Foundation President and CEO also looks at the Senior Management Team approved equipment needs and will fundraise for a significant proportion so we can purchase more through donor support then our capital budget each year would make possible (thank you donors!).

More questions on donor funding, how you can help generate more of it, or anything else about community support? Stop Sandra Hawken our terrific Foundation President and CEO in the halls, chat with any of her great team or join the staff philanthropy champions group.

 

I have a great new idea, how do I get it funded?

If it is something that will help to personalize pathways, give us an edge in discovering for action or connecting the system and you can do it for less than $5000 it is perfect for the No Boundaries Fund. This is a fund that members of the Holland Bloorview team can apply to. Check out HBConnect (Holland Bloorview’s intranet) for more information.

Not every new idea requires new money. Doing things differently to make our organization better and to enhance the care and services we provide is always top of the agenda. But it isn’t always clear where to go with those ideas. If your idea doesn’t fit the No Boundaries Fund requirements talk to the relevant manager or if you aren’t sure talk to a VP or come chat with me and I’ll help to steer you in the right direction.

 

Okay, those are decisions about money, but what about other decisions? How do they get made?

The answer is … it depends. Lots of decisions are made locally. Of course clinical care decisions are made by physicians, nurses and clinicians as part of their everyday responsibilities. Managers and Directors make decisions for their areas and the VPs make decisions in the portfolios for which they are responsible (most often in consultation with colleagues across the hospital). “Final” decision-making typically (but not always) resides with the Senior Management Team, and ultimately, on matters of governance, with our Board of Trustees.

There are committees such as the Medical Advisory Committee that have a number of sub-committees that ensure safety and quality. These committees for example review incidents and determine whether and how they could be prevented and take steps to do so working with practice councils and our Quality, Safety and Performance team. Policies regarding care, quality and safety are approved through this mechanism. The Medical Advisory Committee reports into the Quality Committee of the Board of Trustees every month.

The Family Advisory Committee sets goals every year and then works with Programs and Services leadership to coordinate how to achieve them. For example last year one of the Family Advisory Committee goals promoted by our Chief Nurse Executive was the creation of Family Communication Whiteboards for inpatients.

The Digital Health Strategy and Information Systems Committee make recommendations to the Senior Management Team on how to enhance the use of technology at Holland Bloorview.

Academic and research priorities are set by the Teaching and Learning Institute and the Bloorview Research Institute in annual plans and budgets that go to the Research, Teaching and Learning Committee of the Board of Trustees.

Sometimes important and strategically aligned (i.e. supporting No Boundaries) ideas come directly to me. For example this year we launched Canada’s first Autism ECHO, a very important initiative to build healthcare provider capacity where there is huge client need across the province. This was “pitched” to me, we decided as a Senior Management Team that it was a very important, impactful and strategically aligned idea and put our support behind the team creating a proposal that was ultimately funded by the Government.

 

Is that it?

No! There are lots of committees and groups that promote change and new actions at Holland Bloorview. There’s the Equity, Diversity and Inclusion Committee, the Social Committee, the Evidence to Care Committee and the Human Resources Council, to name just a few. There is BRITE (the Bloorview Research Institute Trainee Executive) and an emerging council looking at integrating learning opportunities across the hospital building on work in the Teaching and Learning Institute, strength-based nursing and Organizational Development and Learning. There is a brand new (and our first!) affinity group that is a grass-roots initiative of staff interested in LGBTQI2S issues.

Have ideas about this (or anything else?) then come to one of my quarterly CEO Coffee Chats to share your thoughts!

_____

Julia
@Hanigsberg