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Measuring the quality of client and family engagement

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Woven into the fabric of Holland Bloorview Kids Rehabilitation Hospital is the client and family voice. To ensure client and family voices are integrated in meaningful ways, the hospital has developed an innovative process to measure the quality of our partnerships.

In collaboration with families, the hospital developed a survey tool to measure the effectiveness of the family leadership program, through which the client and family voice is embedded in hospital planning and decision making.

Holland Bloorview asks family leaders to rate the authenticity of their partnerships with the hospital. The hospital collects both quantitative and qualitative data though the survey, which includes questions that aim to understand if family leaders feel their input at the hospital is meaningful and respected.


“Holland Bloorview has a culture of shared decision making with our clients and families,” said Laura Williams, director of client and family integrated care. “Together we are creating effective ways to achieve that.”

The hospital set targets for the ratings and first included the survey process in its 2012/2013 Quality Improvement Plan (QIP). The QIP outlines the hospital’s quality and safety priorities and is reported publicly. Setting targets for the survey process in the QIP represented a shift from reporting the number of families who are engaged at the hospital, to the quality of the engagement. The hospital’s 2014/2015 QIP raised the bar by setting even higher targets for the ratings.

“By embedding this process into our QIP, Holland Bloorview is stating very clearly that this is a priority and we are accountable to it and, more importantly, to our clients and families,” says Williams.

The implementation of the survey process was the logical next step following the creation of the hospital’s family leadership program a few years earlier. Heather Evans was one of the family leaders who was instrumental in the development of the program.


Evans explained that after participating on the hospital’s family advisory committee for a number of years and becoming its co-chair, she wanted to explore more ways to integrate families at the hospital. At the time, Holland Bloorview was keen to do the same. “The timing was right,” she says.

Family leaders and the hospital’s client and family integrated care team worked together to create the family leadership program, that among other things provides a formal framework to integrate family members in hospital committees and research, facilitates peer mentorship and offers the support and training necessary for success.

Holland Bloorview also has a youth advisory council and children’s advisory council, which provides opportunities for clients and their sibling who are as young as three years old to share their ideas about how to make improvements at the hospital.

“The family leadership program has really become the heart of client and family centred care at Holland Bloorview,” says Amir Karmali, family-centred care specialist who oversees the program. “It ensures that no major initiative or strategic process at the hospital moves forward without meaningful family input.”

“Seeing it today, it is better than I had hoped,” says Evans, whose daughter has been a client at Holland Bloorview for over 10 years.

Positive changes are happening as a result of the measurement tool, which will continue to be enhanced. Survey feedback from family leaders has led to concrete improvements that include training for chairs of committees at Holland Bloorview to ensure family leaders have the assistance they need to participate fully.

Accreditation Canada, which leads a voluntary peer review process of health care organizations, has recognized Holland Bloorview’s family leadership program as a leading practice in the field.

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