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

A graphic showing some of the factors that go into decision-making: research, design, style, and inspiration.

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!



CEO Blog: What is an occupational therapist? Guest bloggers answer questions and bust myths about their work

Pictured here is  Jennifer Crouchman, occupational therapist and guest blogger, with Gabriel, a Holland Bloorview client.

Guest bloggers: Christie Welch, Carling Robertson, Jennifer Crouchman and Susan Fisher

For part of our celebration for occupational therapy (OT) month this October, Julia is sharing the blogosphere to shine a spotlight on OT and the many roles occupational therapists play at Holland Bloorview.

What are occupational therapists?

Occupational therapists are regulated health professionals. They help people do the things that are important to them. For children and parents, these are everyday things that children engage in at home and at school, like writing, eating, learning to walk, playing with friends, or going to the washroom.

Occupational therapists look for the fit between a person’s skills and the demands of their environments. They work with children to increase skills and to reduce barriers in the environment, so that children can participate at maximum levels. An OT may recommend equipment to help with positioning and mobility, exercises to help strengthen muscles, games or toys to help with social skills and visual motor co-ordination, or calming activities to help with sensory regulation. OTs also support teens and young adults to get involved with early work experience opportunities such as volunteering, high school co-ops and paid summer jobs.

Occupational therapists at Holland Bloorview

At Holland Bloorview, occupational therapists are just about everywhere! You can find OTs at all of our locations, doing a variety of things from direct therapy, prescribing equipment, running education groups, doing research and acting in leadership roles. We also have OTs working out in the community – in kids’ and youths’ homes, schools and childcare centres.

Who are occupational therapist assistants?

Occupational therapist assistants (OTA) work under the supervision of OT to enhance treatment goals. This may be through 1:1 therapy or group therapy with or without the presence of OTs.

Occupational therapy myth busting

Because occupational therapists have such a wide scope of practice and because they work in so many different settings, it can be hard for people to understand what occupational therapy is.  Occupational therapists often have to bust myths about occupational therapy.

Myth #1: Occupational therapy is all about helping people find jobs

Actually, occupational therapists help people reach goals in any area of their lives. This sometimes includes work-related goals. Also, OTs believe that various forms of work are health promoting and so, might use work-based activities as therapy!

Myth #2: Occupational therapists work just in pediatrics

Occupational therapists work with people across the lifespan.

Myth #3: Occupational therapy is all about minimizing disability

Occupational therapists work with people to reach a variety of goals within and outside the context of disability (some OTs work exclusively in ergonomic design for instance). Just because someone has a disability does not mean they need OT, and when people do have a disability, they can work with an OT to achieve goals in many ways – sometimes by changing the environment, daily schedules or accessing new technology or equipment.

Myth #4: Occupational therapists work just on “arms and hands”

Occupational therapists are holistic in their views of people. They consider physical, mental and spiritual well-being and are trained to support people in a wide variety of ways.

About the guest bloggers

Christie Welch has been an OT at Holland Bloorview since 2003. She recently took on the role as lead for the early learning and development programs. Christie’s favourite part of being an OT is the versatility it affords her in terms of practice contexts, intervention approaches and job roles. Christie hopes to become more involved in leadership and research. She is set to complete a PhD in Rehabilitation Science in December 2018.

Carling Robertson has been an OTA within the youth employment programs at Holland Bloorview since 2015 and part of the brain injury rehabilitation team (BIRT) inpatient team since 2016. Carling’s favourite part of being an OTA is how every day is different which allows her to constantly learn new things while building therapeutic relationships with many different clients.

Jennifer Crouchman has been an OT in various roles at Holland Bloorview since 2012. She has held positions on the transitions, recreation and life skills and specialized orthopedic and developmental rehab (SODR) inpatient teams; and is currently part of the writing aids service. Jennifer’s favourite part of being an OT is the opportunities to be creative in developing individualized solutions and strategies with clients and families to increase their participation in everyday activities.

Susan Fisher has been an OTA at Holland Bloorview since 1997. She has held positions in integration education therapy (IET), specialized orthopedic and developmental rehab (SODR) inpatient teams, brain injury rehabilitation and currently inpatient seating services. She is also using her skills to develop the new position within Holland Bloorview of preventative maintenance technologist. Susan’s favourite part of being an OTA is the opportunity to work with many different populations across the hospital.

CEO Blog: Dear Everybody campaign challenges perceptions about disability

Nobody wants to see their child, sibling or friend left out or picked on for being themselves.

Yet kids with disabilities often face whispers, staring, exclusion, name-calling and bullying.

Young people with disabilities are two to three times more likely to be bullied than kids without disabilities and one study found that 53 per cent of kids with a disability have zero or only one close friend.

The shadow of disability stigma doesn’t disappear as young people with disabilities get older.

Median incomes for Canadians with disabilities are 34 per cent (almost $10,000) less than the incomes of Canadians without disabilities.

Many individuals with a disability who want to work face barriers to employment: one-third say they have been denied a job because of their disability, and 24 per cent say they have been denied a job interview.

This data, as well as the stories we hear first-hand from the thousands of children, youth and families served by Holland Bloorview Kids Rehabilitation Hospital, are the reason that we have recently launched the second year of our Dear Everybody campaign.

Dear Everybody is a national movement created in partnership with kids and youth to raise awareness about disability stigma.

Disability stigma is the negative and unfair beliefs or assumptions we make about people who have disabilities. And stigma has an impact on almost every facet of life: friendships, school, employment, law, policy and more.

So the time for change is now.

Read my full column on



CEO Blog: Harnessing creativity and risk-taking for impact

The stereotype we are all familiar with is that hospitals are risk-averse and rigid. Indeed, when entrusted with individuals’ health and safety, our appetite for risk is low. Further, healthcare is one of the most complex systems in existence, more complex than banking, manufacturing, or education. Why? At least in part because the various combinations of care, activities, events, interactions and outcomes are virtually infinite (Braithwaite, J., BMJ (2018;361:k2014)).

So how do we get past our risk-averse tendencies and bring about change amid this complexity? A big part of the answer is embracing an innovative mindset. The challenge is how do we, as health care leaders, create an environment where the amazing ideas our staff, physicians, clients, and families have are harnessed into actions that make a positive impact and help us more effectively deploy our resources?

Read my full column in the August issue of Hospital News.



CEO Blog: Danforth Strong, Toronto Strong

This week has been a tough one with the unthinkable shooting on the Danforth, compounded by equally heartbreaking gun violence across so many of our neighbourhoods and the van attack only a couple of months ago. Learning that one of the victims, 18-year-old Reese Fallon, was going to study nursing at university in the fall hits many of us at Holland Bloorview particularly hard, as did the news that victim Julianna Kozis was only 10 years old. We will be flying our flag at half-mast over the next week.

This week, and every week, I encourage all of our Holland Bloorview staff members to check in with colleagues and teams to offer support and remind each other that immediate mental health resources are always available through our Employee and Family Assistance Program. Our program provider, Morneau Shepell, has also set up a crisis support line for anyone in the community in need of emotional support in relation to this event. The number is 1-844-751-2133 and is open 24/7.

Empathy and kindness are top-of-mind as we think about all of the many families, neighbours and friends touched by this tragedy. We are so fortunate in our city to have such incredible first responders and colleagues in trauma centres and communities that rally in times of deep need. We continue to prove over and over again how resilient and compassionate we are in this city.

We will always be Danforth Strong, Toronto Strong.



CEO Blog: New Strategy. New Challenges. New Leadership.

It’s the time of year when people tend to start asking each other what their summer vacation plans are. Whenever I’m asked that these days my answer is the same “I’m searching for 3 new people to join my leadership team – that’s what I’m up to this summer!” I say it with excitement in my voice and a skip in my step because I see change as opportunity and I’m eager to welcome extraordinary new people to Holland Bloorview Kids Rehabilitation Hospital as vice president people and culture, vice president corporate innovation and services and executive lead equity, diversity and inclusion. How lucky will those ultimately successful candidates be to join this superb organization.

However, recently I was challenged. More or less what was put to me is this: we have waitlists; we could use additional clinicians and other frontline staff; why are we spending scarce resources on these roles? I’ve got to admit my first response was defensive. But then I stopped and thought, good questions… and ones I too had considered before moving forward.

I fundamentally believe that we have important and urgent work to do investing in people and culture, in innovating in our corporate services and operations, and in equity, diversity and inclusion in order to achieve the goals of our No Boundaries strategy of which we are so proud. We are poised for new accomplishments on a foundation of excellence including meeting 100% of the standards on our Accreditation Canada quality survey this year and being awarded Exemplary Standing; being a leading patient-centred care organization with our recent Merck Patients First Award; 8 years as a GTA Best Employer; a Corman Award for compassionate care; I could go on and on.

We don’t get to this terrific place without intention and investment in people leadership. Today more than ever before we need to invest in bold new leadership, precisely because of the challenges to access to services, the new more complex clients we service and the diversity of challenges clients and families face.

We need leadership that will give each individual confidence that she or he can provide reliable, consistent high quality care; leadership to ensure we are a learning organization; leadership enabling and supporting every member of our team to bring their whole selves to work and to do their best work every day safely and with joy; leadership to reduce disparities in access through targeted equity and inclusion work grounded in evidence including responding to the healthcare recommendations of the Truth and Reconciliation Commission; leadership for effectiveness and innovation to all that we do including in technology and resources.

With the individuals that are members of our search committees, front line clinicians, nurses, doctors, managers, educators and administrative leaders, I promise that we will find amazing people for these roles that will help each of us to do the work that matters most to us, for the most meaningful and healthy futures for all children, youth and families.



CEO Blog: Finding Our Voices

The other evening I heard Mark Sakamoto give a reading from his beautiful book Forgiveness, this year’s Canada Reads winner. Mark was Holland Bloorview Kids Rehabilitation Hospital’s guest at an event where we were showcasing the work of the researchers in the Bloorview Research Institute and sharing our plans for the largest growth in our research history.

Mark drew a parallel between his grandmother’s lost voice because of Canada’s Japanese internment during the Second World War, to the missing voices of children with disabilities. Most literally, this parallel relates to children whose physical disabilities prevent them from speaking — the lifetime passion of our VP Research Dr Tom Chau (see a recent interview on the occasion of his winning a Governor General’s Innovation Award here).

Speech and having a voice is also what drives Dr Deryk Beal whose research in neuromodulation is leading the way in the development of new treatments administering very small electric or magnetic energy pulses to specific parts of the brain, triggering pathways that can potentially accelerate learning in areas such as language.

The voices of young people with disabilities are missing in less literal ways too: frequently from election priorities, from social policy, from the priorities of schools and school boards, from the ranks of employers and corporate boardrooms. This is changing, and Holland Bloorview is part of that change through policy impacts, awareness raising and cutting edge research relating to barriers to employment among many other activities. With a vision of the most meaningful and healthy futures for all children, youth and families,  and a mission that includes social justice for people with disabilities, change in the world is as important to us as is extraordinary care, educating the next generation of doctors and clinicians, and transformational research.

I also want every member of the Holland Bloorview team to have a voice. Our No Boundaries strategy requires that courage and opportunity and we need to do what it takes to ensure everybody feels safe to have their own unique and diverse voice. That’s why Pride celebrations are important to Holland Bloorview and why I am proud of the many things that Holland Bloorview will be doing to recognize Pride in our walls and beyond them this June and why I’m equally excited to launch a search for an executive leader for equity, diversity and inclusion in the coming weeks.

May is speech and hearing month. Be a part of ensuring that all voices are heard.