Wednesday, April 26, 2017

School volunteer honours his daughter's memory

By Louise Kinross

I first met Yoonus Mia in 2003. I’d bump into him in the hospital walking beside a child in a helmet, feet strapped onto the pedals of an adapted bike. He was a volunteer in the Bloorview school. He was also a retired elementary school teacher and principal. We talked about what’s kept him coming back to work with Bloorview students for 14 years.

BLOOM: You started off with kids in the integrated education and therapy classes. What did you do?

Yoonus Mia: I was with the very little kids and we did everything from helping them in the classroom to helping feed them a snack. A highlight was helping them achieve whatever they could with the bikes. They would practise while we talked to them and showed them things in the hospital. Some of the kids were very vocal. That was a big lesson. I had to pack my assumptions in a bag. These children can do all kinds of things, but you have to have the patience and the time to do it.

BLOOM: Now you’re working in a class with children with complex disabilities.


Yoonus Mia: Every day is a challenge learning how to work with different students. Some days I’ll be doing math with a student and other days I’m encouraging a child to touch things or doing hand-over-hand painting.

BLOOM: Some of the children don’t speak.

Yoonus Mia: They communicate by letting you know what they want with a look on their face or a nod or a wink.

BLOOM: You had a daughter who came to Holland Bloorview.


Yoonus Mia: That’s the real connection, but because I become a little more emotional about these things, I tend not to mention that. My daughter Anisa was disabled as well. She came to what was the Hugh MacMillan site for respite care, and she was fitted for orthotics and a special seat for her wheelchair. Anisa passed away when she was 16. We cared for her the best way we could.

Sometimes I think back and wonder, could we have done things differently now? With modern technology a lot more options are available. Knowing this place through my daughter was my motivation to volunteer. I started about six months after I retired. It was a chance for me to give back and it helps me as well.

BLOOM: Can you tell us a bit about Anisa?


Yoonus Mia: She had cerebral palsy. She also didn’t speak. But we knew exactly what she wanted. There were ways she would communicate with us that she was tired or hungry. She went to school every day. She enjoyed going out for drives and she enjoyed music. Sometimes she wasn’t well because of seizures. We have another daughter, Nadia, who was younger, and we cherish fond family memories of our time with Anisa. We did our best and it was great to have her in our life.

BLOOM: It sounds like she changed your life in many positive ways.


Yoonus Mia: Yes, we are connected to our past and connected to all sorts of things. Anisa used to receive care at a recreation program at Columbus Centre run by Barb Germon, who is a social worker who works at Holland Bloorview now.

Sometimes volunteering here makes it more difficult for me, because I think of my child. But I don’t carry it on my sleeve. I sense something about these children who are so vulnerable, and it’s rare to have a school like Bloorview. This is my small way of giving back.

BLOOM: What do you get out of your time with our students?


Yoonus Mia: It’s the little things you have to watch for, and that I’m fascinated with. When you’re with the same student for several weeks you suddenly notice growth: Oh, he can do this now. When a child looks at you and smiles to say ‘I get it, I can do this,’ that’s the real treat and benefit of being around. In this program every little thing counts.

BLOOM: It sounds like you’ve adopted this as a philosophy.


Yoonus Mia: That’s what it’s all about. One of the other benefits is I met my friend Peter Sandiford, and we have lunch together. Peter is a nice man.

BLOOM: We just had a celebration for Peter’s 80th birthday, to recognize the many years he’s volunteered here, and I learned all kinds of interesting things about him.

Yoonus Mia: He was a photographer, though he isn’t able to do that anymore. He’s another example of someone with all of these challenges, but he enjoys life the best way he can. When I come on Tuesdays I’m exposed to Peter and the children and it helps me.

Learn more about Holland Bloorview’s volunteer program.

Community keeps this volunteer coming back



By Louise Kinross

After her daughter Elizabeth was diagnosed with global developmental delay, Jean Hammond immersed herself at Holland Bloorview as a family leader.

The former advertising exec has co-chaired our family advisory, sat on hospital committees, helped hire staff and plan an annual recreation fair, educated medical students about what matters to families, and hosted coffee nights that give our inpatient parents a break and a sweet treat.

This month Jean’s efforts were recognized with a 2017 Volunteer Service Award from Ontario Premier Kathleen Wynne.

“I find being here and volunteering and spending time with other parents going through similar stuff is therapy for me,” Jean says. “The best thing of all is the community and the people I’ve met—both staff and parents. They help me feel like I'm not going through this alone. I’ve learned so much that’s affected the way I’ve been a caregiver to Elizabeth.”

Jean says one of the first things she learned at our family advisory was about fun things her daughter could do. 


“Chatting with other parents before and after our meetings gave me tons of great information about what other kids were doing, Jean recalls. I was navigating what activities there were for Elizabeth to do outside of school. None of what my son was doing seemed to work. Holland Bloorview became my hub for that. Elizabeth has done every camp the hospital has going, from Spiral Garden to Life Skills to a sleep-away camp. 

“I remember coming for an information session on the Out and About camp and being handed a stack of waivers for activities like rock climbing, dragon-boat racing and going up in a glider. I thought holy cow, this is so cool. I learned that Holland Bloorview’s philosophy is to expose kids to a huge array of activities and, as a result, Elizabeth has become more confident and is enthusiastic about trying new things.”

Now Jean shares what she’s learned about adapted activities when she helps our Life Skills team plan an annual recreation fair for families. “It’s like a mini trade show and I get to connect with so many parents who are just at the beginning of learning what’s available. I love guiding them through, and telling them what I’ve found helpful.”

Jean says one of her favourite volunteer gigs is sitting on the quality committee of the hospital’s board. “It’s a big responsibility, but I love it because it’s proof that the hospital is walking the talk by including the family voice at a very high, decision-making level. I try to speak up and channel the concerns of other parents.”

Jean says her work as a family leader gave her a focus after she left her job in advertising to coordinate Elizabeth’s care. “Volunteering was a way to keep my brain from atrophying and a way for me to feel like I still had my hand in the game.”

Jean used her marketing experience when she helped the hospital’s foundation develop its successful Capes for Kids fundraiser. “I was in the room when we brainstormed what the fundraiser would be, and then helped on aspects of its roll-out.”

She says her work at the hospital led her to recognize that when she returns to paid work, it will be in a different field. “I won’t be going back to the world of advertising. I have to work in something that I genuinely care about.”

Jean encourages other parents to consider becoming a family leader. “As a family, you have something that only you can contribute
—your voice and your lived experience. It’s so meaningful to see the difference you can make in policies and other changes in the hospital.

Jean says the parents she’s met at Holland Bloorview have become her “peeps. We share information and we go out for a glass of wine and a crazy laugh, because nobody else would find some of this stuff funny.”

Learn more about our Family Leadership Program.

Tuesday, April 25, 2017

Instead of changing her child, a mother changes herself

By Louise Kinross

Superbabies Don't Cry is a brilliant essay about how the birth of a child with a chromosome deletion upended one mother's ideas about perfection and our ability to control life.

It's written by Heather Kirn Lanier. She blogs about her daughter Fiona (centre above) at Star In Her Eye

Here are some of my favourite lines. "With my woo-woo belief that the mind could control the body, I'd pushed disability away. I'd done this by subscribing to the belief that disability always had an avoidable cause. I'd believed I could control the body because I could not stomach the truth: that the body is fragile, ephemeral."

"If you buy into a false narrative that the body is controllable, that illness can always be prevented, then my proxy you are left with a disturbing, damaging, erroneous conclusion: the belief that a person's disability is their fault."

"The world is a terrifying place. We manage it by believing we can control it. And when it hasn't been controlledwhen it doesn't bend to our willswe either look for something to blame, or we surrender."

Heather's essay is about how she's let go of trying to change her daughter Fiona's disabilities. Instead, she opens her mind to the idea that fragility and pain are essential parts of humanity. This is a must-read.

Thursday, April 20, 2017

'Care for the family shouldn't stop when the child dies'



By Louise Kinross


When Bruno Geremia’s son Matthew died two years ago, Bruno's sense of loss extended to the people he knew at Holland Bloorview during Matthew’s life.

“When you lose your child, you also lose your care team and the community at Holland Bloorview,” says Bruno (centre, with wife Marlene right and family leader Vivian Low left).

“When you walk through the door for the first time after, there's a sense that you don’t belong anymore. We live in a culture that doesn’t want to talk about death, especially if your child is really complex or fragile.”

Bruno and other parents want to change that.

They’re working with Holland Bloorview staff to create an annual celebration of life event and other supports.

The first event will take place in Spiral Garden on June 11. It’s for Holland Bloorview families whose child has died in the last two years. There will be photographs of the children, fun activities for the whole family, and the dedication of a piece of art. “We’re working with Spiral Garden staff to create a butterfly that will honour the children,” Vivian says. Her son Ethan died almost 10 years ago. “The plan going forward is that every year we will have the celebration and install a new piece of art.” The parents also hope to have a dedicated art work inside the hospital.

Vivian recalls that after her son died, “there was no support besides Bereaved Families of Ontario. But it’s in the community, and you have to retell your story to strangers.”

Families feel cut off from “the people who know the road we’ve travelled, and who knew our child,” Bruno says. “We believe it shouldn’t end like that.”

Bruno and Vivian, who are both members of Holland Bloorview’s family advisory, say the group has been an important ongoing connection for them. “I was lucky because June Chiu called and said ‘I hope you’ll come back and be part of the family advisory,’ Vivian says. “Sometimes it was hard, and I’d feel a little like a fraud, like my child isn’t going to any of the clinics, maybe I shouldn’t be here? There’s a fear of being an outsider.”

But Vivian says she was welcomed back. “When your child dies, you get the feeling that nobody else understands, and they can’t. That’s why it’s so important to talk to someone with the same experience, who knows what it feels like to live through that. I had June, and then Bruno and Marlene, to talk to.” Too often, Vivian says, Holland Bloorview families “don’t have that opportunity.”

To remedy this, the parents plan to set up coffee talks a couple of times a year where parents meet at Holland Bloorview to remember their kids and share support. “We’d also like to look at supporting siblings,” Vivian says. “For us, that was a huge gap when parents are struggling themselves.”

Bruno says his continued participation on Holland Bloorview’s family advisory “is a tribute to Matthew’s life. Before Matthew died, I didn’t think I’d be strong enough to do that. But after, I thought, everything I’ve learned, I’ve learned because of Matthew. This keeps him alive.”

Vivian agrees. “We’re a voice for our children and the needs of our families. Our children keep us connected to Holland Bloorview and we honour them by staying involved.

Bruno and Vivian shared these reflections that may be helpful to other parents whose child has died:
  • There is no road map for grief, no time line or 12 steps. It’s individual, and you have to accept that your journey is going to be that way. It will change from day to day and year to year.
  • Anniversaries, especially in the first year after your child dies, are very hard.
  • Grief can ambush you when you’re least expecting it.
  • Talking to other parents who’ve lost a child is soothing. You don’t have to explain anything, and if you fall apart, it’s okay.
  • Counselling helps.
  • Find ways to honour your child. Vivian’s family raised money for a multi-sensory room in the school her son went to, and where her daughter still attends. Bruno’s family participates in the Hike for Hospice to make people aware of the amazing care they received at Emily’s House.
Advanced care planning with a palliative care team can help families build beautiful memories with their child. “We spend so much time going to appointments, doing therapy, and for the more complex kids, just feeding them, that we don’t get to have family time,” Vivian says. “We need to be encouraged to not feel guilty about putting that aside, so we can have fun times as a family.” Bruno notes that his family cherished Thanksgiving, Christmas, birthday and Easter celebrations with Matthew while he lived at Emily’s House.

Most important, “Care for the family shouldn’t stop when the child dies,” Bruno says. “If we are family-centred, we need to continue to provide care to the family that has to go on.”

Bruno and Vivian say social workers, nurse practitioners and senior managers at Holland Bloorview are eager to participate. The other parent on the celebration of life committee is Cheryl Runstedler. You can read about Cheryl and her son Jordan here. To learn more about the June event, e-mail social worker Barb Germon at bgermon@hollandbloorview.ca.

Tuesday, April 18, 2017

Rana finds her voice in advocacy

By Rana Nasrazadani

“You’re not ready for university.”

A staff member said this to me in high school, in front of the whole class. These words, from a person whose job was to guide and support students, had a profound impact on me. Sometimes, they still linger.

It wasn’t these words alone that affected me. Staff had discouraged me from pursuing post-secondary education throughout high school. I believe they had a limit about how far I would go. When I pushed the limit, they made it more difficult. I was walking on eggshells. I felt like I had tougher expectations put on me than my peers. The pressure to live up to these standards increased each year, but without the supports I needed. It seemed like no matter what I did, it was never enough.

As a teen with a disability, my life was already quite stressful: appointments, physical therapy and surgeries were not out of the ordinary. I was also on a competitive swim team, practising multiple times each week. On top of this, I was a student with a clear plan to graduate in four years and continue my education.

When the staff member said I wasn’t ready for university, I didn’t say anything. In high school, I didn’t want to show any vulnerability. At the time, I felt I needed to manage the extra pressures related to my disability while making everything look effortless. But in reality, I was struggling.

I started to doubt myself. I had no reason to worry, as I was meeting the requirements to go on to university. But discouragement plays with your self-confidence. I worried about other people’s approval, and more so, their disapproval of my decisions. I began to question whether I should apply to university.

Then I asked myself “Why am I letting this happen?” Far too often, people with disabilities are seen as incapable, before being given a chance to participate as an equal in society. I didn’t need the approval of school staff to go to university.

I had a strong support system of family and friends and their encouragement to reach my goals outweighed those that discouraged me. Without telling school staff, I applied and got accepted to university.

I’m now a student at York University, studying towards a future in human rights law. As a former ambassador for Holland Bloorview, I always knew that I had an advocate in me. More recently, I got involved on the youth advisory committee of the Office of the Provincial Advocate for Children and Youth. I was part of­­­­ the We Have Something to Say Project, which brought together the voices of youth with disabilities from across Ontario to work towards a barrier-free future. I shared my story about some of the obstacles I faced in high school (p. 64).

Four years ago, if you’d asked me if I’d be where I am today, I would have had a hard time believing it. Opening up about these experiences has been very difficult. It took a while for me to gain enough confidence to tell my story on an open platform, but once I was ready, it was like a weight was taken off me.

Over time, I’ve learned that many students go through similar experiences. They feel the need to “cover up” their struggles because of social pressures and ideals. It can feel like no matter what you do, it will never be enough.

To those reading who are going through a similar situation, there’s nothing wrong with saying you’re struggling. Don’t bottle it up. I encourage people to talk about it. Right now it may be hard to see the positives, and it might feel like your situation isn’t getting better, but have confidence in yourself, trust your judgment and keep pushing towards your goals.

Monday, April 17, 2017

From patient to bioethicist, Dolly comes full circle

By Louise Kinross

I met Dolly Menna-Dack in 1999 when we interviewed her as a youth role model in BLOOM (then called Connections). At age three, Dolly, who has juvenile rheumatoid arthritis, began coming to Holland Bloorview three days a week for therapy. From age eight to 12 she came every day for school and therapy. At 12 she spent eight months here as an inpatient following surgery. “Greg Steffler taught me to drive a stretcher, known as a ‘banana cart,’ which is even more difficult than driving a car,” she says. At 16 she was a member of our first youth advisory council, and volunteered for many years throughout the hospital. For eight years Dolly worked as a youth facilitator in our LIFEspan clinic supporting youth who are transitioning to the adult world. Last summer Dolly graduated with a master’s in health sciences in bioethics. In February she was hired as Holland Bloorview’s clinical bioethicist.

BLOOM: How did you get into the field of ethics in children’s rehab?

Dolly Menna-Dack: I have arthritis and because of that I was personally involved with the health-care system from a very young age. I started off my university career in human biology, planning to go to medical school. But then I discovered I was really interested in how we make healthcare decisions.

I wanted to help kids and youth understand that they can participate in discussions and be empowered to make decisions about their healthcare.

I’ve always wanted to be a support system for children and youth as they think about those big health-care decisions. Most kids don’t make decisions on their own, they make them with family, friends and the health-care team. The pediatric health-care team is like a long-term member of the family, and disability isn’t something to be fixed or figured out, it’s to be explored and understood together.

BLOOM: What was it like when you came here as a three year old?

Dolly Menna-Dack: My first memories all centre around the old Pat pool and the rainbow over the pool. My first memories include Joan Ferguson, who was my first physiotherapist [and later our vice president of programs and services]. From Grade 3 to Grade 7 I came here every day for therapy and school. It was like home. It was always a part of my normal and was never strange.

BLOOM: Did you identify any ethical issues here as a child?

Dolly Menna-Dack: I could see that not all of my friends that came for regular therapy knew as much about their health care as they could have. I recognized that my mom had been making an effort to make sure I listened and was present during conversations. My friends that didn’t have disabilities knew even less about their health. They didn’t put any thought into answering ‘How are you?’ For kids with disabilities, ‘How are you?’ is an evaluation. You’re evaluating what type of answer you’ll give and how that answer may impact your day. If I say ‘I have pain’ or ‘I’m not feeling well’ or ‘my splints are hurting’ that can change what I do that day.

BLOOM: What are common ethical issues in children’s rehab?

Dolly Menna-Dack: An example of a common issue is consent and capacity. It’s really about when a clinician proposes a treatment or a plan to a family, they’re tasked with evaluating if the child understands and appreciates the consequences of the options given to them.

There can be times when the child and family may disagree about the course of action, or the child and team disagree, or the team members disagree among themselves.

BLOOM: It sounds very black and white—that either a child is capable of making decisions or not—whereas it seems like there would be a lot of grey area.

Dolly Menna-Dack:
Kids need to be a part of the discussion, whether or not they’re making the decision. The beauty of pediatrics is the dance of assent—of ensuring that a child is enrolled and empowered to say when they’re not sure about the treatment. We want to encourage children and youth to express what their concerns are so they can be better prepared. They need to participate.

BLOOM: I can’t really ask you about your typical day as bioethicist as you're only just starting. 


Dolly Menna-Dack:
A big part of my role will be providing ethics education for staff and the Holland Bloorview community, leading the bioethics forum and ensuring teams have someone who is easily available to them to talk about ethical issues. My plan is to engage staff to highlight how ethics can support them when they encounter moral distress. I want them to view ethics as something that will help them help clients and families.

The important lens I’m bringing to this role is multi-faceted and grounded in my experience being a user of the health-care system in pediatrics and adult care. I've also worked with clients and families for many years both here and at Toronto Rehab. I believe that’s going to guide my work and make me relatable to our clients and families. It’s a rare gift to understand the roles of everyone who may wish to have the support of a bioethicist.

As Dolly is just starting her bioethicist job, we'll check back in six months to learn more about what happens in a typical day.

Thursday, April 13, 2017

'We can't fix what we don't know'

Kimberley Siu-Chong (centre) is Holland Bloorview’s touchpoint for feedback from families. As client- and family-relations facilitator, she collects input from children, teens and families about what we’re doing well and where we need to improve. “The Patient Declaration of Values is my bible,” Kim says. “It was developed with families and is based on the values of quality of care, partnership, respect and information sharing. When I hear a family’s story, I map their experience through that lens.” BLOOM talked to Kim about her work as a facilitator between families and staff.

BLOOM: How did you get into children’s rehab?


Kimberley Siu-Chong: Can I tell you my meandering path? I did my undergraduate studies in bioethics and criminology. Then I went into law and specialized in social justice because my passion is human rights advocacy.


BLOOM: Why were you interested in human rights?


Kimberley Siu-Chong: Ever since I was young, I’ve had a visceral reaction to unfairness and injustice. When people aren’t treated as people—when an aspect of your social identity results in oppression—that made me really angry, and I wanted to channel that anger into something productive to help others.


I practised law briefly, but I realized it wasn’t for me. The legal system is designed to be adversarial and that isn’t my personality. I’m more conciliatory.


From there I became a legal writer and editor and worked for four years at a legal publication company that specializes in employment and labour law. That job gave me the opportunity to educate people about their rights in the workplace, but it lacked a lot of human interaction.


After that I became a family mediator and did divorce mediation. The families I worked with came to me at a very vulnerable time. I worked to help people identify their shared interests and come to an agreement, often in emotionally charged situations. It was very rewarding work, but I didn’t feel like I was doing direct child advocacy and I missed that piece. It was children that I was interested in, and working with families.


My passions are education, mediation, advocacy, writing and policy. I wanted to find a job that combined all of those. I never thought I would end up in a hospital!


Through my research, I heard about how hospitals have ombudspersons. Then I saw a posting for Holland Bloorview. My sister is a nurse and she did a rotation on our brain injury unit, so I’d always known about the hospital. The ad said Holland Bloorview was looking for people with a masters in health care. I didn’t have that, but when I looked at the description, I knew I had transferable skills and my heart and passions aligned with the work. I knew I had something to contribute and I had to throw my hat in the ring.


BLOOM: What is a typical day like for you?


Kimberley Siu-Chong: My role is to listen and collect all types of feedback. I have an open-door policy, so anyone and anything can walk through my door. It could be a consult with a staff member who says ‘I’m experiencing a relationship challenge with a family, can we talk about it?’ Or perhaps a manager says ‘We have this family meeting coming up, and we imagine there may be some contentious issues. Could you facilitate it?’ Sometimes a clinician brings a family down to see me. Or a family may knock on the door and say ‘I have a concern.’


In addition, I lead conflict-resolution training for individual staff and teams. It’s been incorporated into the core competency education program for all of our inpatient nurses.


I also manage Spotlight Awards from clients and families, so I may receive a heartfelt letter recognizing a therapist or nurse. My role is neat because I get to read every single compliment that comes through this hospital.


BLOOM: When feedback is positive, what kinds of things do you hear?


Kimberley Siu-Chong: There’s such a range. One client submitted a card saying ‘I want to recognize my primary care nurse because she’s like a mother to me.’ A Youth at Work participant wrote that their supervisor ‘made me know me more as a person and learn more about myself.’ There are comments like ‘They listen and care about what matters to me, and they give me a voice.’ Or ‘I was going through the most devastating experience, and the team was there for me.’


Sometimes people think Spotlights are just for frontline clinical staff. But one of our most nominated staff members is Berthe Nabico, who cleans the accommodation suites where many inpatient families stay. They’re often here for a long time and she builds relationships with them. One family wrote a long, heartfelt letter about Berthe and said ‘She taught us how to hope.’


BLOOM: If staff only knew the power they have to help families feel heard and valued.


Kimberley Siu-Chong: We each have that opportunity, across teams and at different levels, to change and affect people’s experience with every interaction—in both positive and negative ways.


BLOOM: I know you track and trend complaints.


Kimberley Siu-Chong: People view a complaint as a negative thing, but it’s not. I can hear from families who love this place, but they have one area of concern. We can’t fix what we don’t know, so this is an opportunity to partner and improve. We need to create an environment where feedback is welcome.


BLOOM: I guess if you weren’t getting complaints, it wouldn’t necessarily be a good thing.


Kimberley Siu-Chong: No, if complaints are low, that’s a flag to me that maybe parents are scared to come forward, or feel the process is futile, or don’t know that it exists. The families who come forward believe that their voice matters, that we care, and that their concerns are going to translate into change.


Our families and kids have a lot on their plate, so when they say ‘I want to share my story,’ I’m so honoured by that. These are very personal stories, very emotional stories.


BLOOM: Do we tend to get common complaints?


Kimberley Siu-Chong: Communication is generally number one, here and for hospitals across Ontario. 


A family may say ‘I had questions that weren’t answered,’ or ‘the information shared with me wasn’t clear,’ or ‘I didn’t hear back from someone.’ We publish our data online in an annual report because we want to be accountable and transparent.


The number one area which comes up when I meet with staff is also communication. I may hear that a parent is yelling or swearing or extremely hostile, and staff find it very hard to work together and share information. Partnership means using language and strategies that are respectful and self-respecting.


BLOOM: Do you ever get frustrated by how long it may take us to change something based on feedback?


Kimberley Siu-Chong: Sometimes change takes time. If I’m a cynical person, I don’t belong in this world, which is always about hope. Do I get impatient? Sure.


BLOOM: I guess the word ‘complaint’ isn’t the right word, because it has such a bad rap.


Kimberley Siu-Chong: How you name things does affect how you see them. Every complaint is an opportunity, and that’s not just ‘wordsmithing’ it. It’s an opportunity to partner with families and improve.


BLOOM: Based on your experience with families, what kind of things do our frontline staff need to keep top of mind?


Kimberley Siu-Chong: That every family and every child is an individual. Even though you may have worked with tons of clients with a similar condition, each family is different. Each family has their own values, experiences and journey. We need to view each person as a blank slate and not make presumptions. We need to be willing to listen to what’s important to them by asking open, neutral, exploratory questions.


BLOOM: What do you mean by open questions?


Kimberley Siu-Chong: With closed questions, you’re directing the conversation. So you might say ‘Is it really important for you that your child walks?’ That’s a value-laden, closed question. An open-ended question would be: ‘What’s really important to you?’ Open-ended questions take more time, and are not as efficient.


BLOOM: I guess time constraints make those conversations challenging.


Kimberley Siu-Chong: Yes, I hear that challenge all the time. I know staff have appointments and schedules and workloads, and I don’t want to minimize how challenging it is. But if you don’t take the time to really get to know the client and family, and their values, the care can go down a path that’s not right for the family, and then it has to be undone and you have to backtrack. If you take the time in the first place to really understand where a family is coming from, and establish open communication, in the long term it results in better care and is time-efficient.


BLOOM: Are you ever called to provide support during a disagreement between a family and staff, or is it usually after an incident that you hear about it?


Kimberley Siu-Chong: I can be asked to assist at any stage. But the family has to feel comfortable with including me. I’m a facilitator, so I’m not an advocate for the family or for staff. I picture myself as an advocate for the Patient Declaration of Values. When I hear feedback, I map it against the declaration and identify gaps.


BLOOM: It’s interesting, because I remember when the declaration of patient values was developed many years ago. At the time, people talked about it a lot, but I don’t think I’ve heard it referred to in several years.


Kimberley Siu-Chong: The behaviours we teach in our training for client- and family-centred care in new staff orientation are based on the values in the patient declaration: respect, information sharing, quality of care and partnership.


BLOOM: I guess we tend to refer more to family-centred care now, when we think about those principles.


Kimberley Siu-Chong: Client- and family-centred care at Holland Bloorview is informed by that document. It’s my bible, my analytical framework and the lens through which I see a family story.


BLOOM: What do you love about your job?


Kimberley Siu-Chong: I have an avalanche of thoughts right now. I love the partnerships with frontline staff and managers and clients and families. I love hearing about the rich journeys that families are on. I think I’m uniquely positioned to hear those stories from a 360-degree perspective. This is such a place of hope, I find. When I hear about what our kids and families have been through, it’s a testament to the resiliency of the human spirit, and I get so uplifted. And when I hear about why staff are here, and how their hearts are so much in this work, it’s so moving and soul-stirring.


When I see a complaint translate into change, I get really inspired. Often times, a family or child comes to me because they’re in a place of disappointment, hurt, anger or sadness about some aspect of their experience. 


The thing about pediatric rehab is that our kids and families are with us for a long time, so they’re invested in us improving. Advocating for themselves and others, to make this place better, is a beautiful thing. When it’s appropriate, and the family has an interest, I can channel them into our family leadership program. Quite a few of our family leaders came from our complaints process.


BLOOM: What’s most challenging about your work?


Kimberley Siu-Chong: I hear all of these stories and I’m deeply moved by them. You’re a sponge and you absorb all of these emotions, and it can be challenging in that respect. That takes a lot of energy, and you want to avoid being burned out so that you can be fresh for every single family.


BLOOM: Do you do anything to help you cope with the emotional side?


Kimberley Siu-Chong: I try my best to manage my time. I have drop-ins, and I can’t control that. But if I know there are two emotionally-charged situations I’m dealing with, I try not to put them back to back. I want to be fresh for the next family.


I do try to share my experiences and what I’m feeling with our team. I may say ‘I had a really challenging situation this morning’ and they’re very supportive in listening. I’ll take a deep breath to clear my head, or I may go for a quick Spiral Garden walk to help re-centre. More recently I’ve been exploring mindfulness meditation. You have to take care of yourself to have energy to help others.


Another thing that helps is that I don’t only deal with concerns. We get way more Spotlights than we get complaints, so that balances things. I don’t just talk to people when they’re frustrated.


BLOOM: What strategies work best when you’re meeting with a family that is upset about care?


Kimberley Siu-Chong: My approach is always the same. When they first come in, I apologize for their experience. They’re coming to me because they’re concerned, or scared, or sad, or angry. If you have reason to be in a pediatric hospital, there’s a lot going on in your life, and if you say we’ve done something to add to that stress, that’s very regrettable. Apologizing sets the tone for rebuilding the relationship.


The second thing I do is thank them for coming forward and for trusting me with their story. I thank them for having confidence that even though we’ve disappointed them, we’ll make the effort to make things right. Then I ask them to tell me what happened and I give them space to share their story.


Silence is a very helpful tool. I’m listening to understand where they’re coming from and what’s important to them and what they’ve experienced. They’re helping me to understand so that I can, in turn, help them. I listen and take notes. Once they’ve shared their story, I ask them about their goals or hopes from this process.


BLOOM: If you could change one thing about health care, what would it be?


Kimberley Siu-Chong: We’ve talked a lot about having the time to really get to know each client and family—about what’s important to them, their values, hopes and dreams.


If I had a magic wand, I wish we all had more time to have those important conversations, and that there would be no competing priorities that can create tension. I wish we had more time to build those connections so that we can see each person as an individual.


I’ve met so many young people who have experienced discrimination based on their disability, and who want to channel that anger into change. Sometimes they’ll tell me about a concern here, but then they’ll share about what it’s like in the broader context of their life.


BLOOM: Do you mean how they’ve been devalued in the community?


Kimberley Siu-Chong: Yes. They’ll say this thing happened here, but my whole life I’ve been bullied. Then I get to understand that a particular incident here that seems small—if you understand it in the context of their life—is really huge.


BLOOM: It sounds like something we discovered with our narrative nursing group. It was the idea of the back story—that every family has a unique and painful back story before they even come here, and by being aware of that, it can help us be more compassionate and flexible and non-judgmental.


Kimberley Siu-Chong: Yes, it is the back story. If we don’t understand a family’s context and journey, we just cross paths with each other. But if I have the time to dig behind the anger, often a complaint that is about one thing isn’t really about that at all. It’s about something else that’s motivating the anger.


BLOOM: I think it can be cumulative, too. So maybe a parent has felt devalued or traumatized in their care or in the community before coming here. And these feelings of disempowerment grow, but they don’t express them.


Kimberley Siu-Chong: And then an incident is the straw that broke the camel’s back.


BLOOM: Exactly. But if you’re only looking at the incident in front of you, their reaction doesn’t make sense.


Kimberley Siu-Chong: Often times if I have the time to dig and unpack, I find that a complaint about one thing is really about a number of incidents in their lives that have hurt them to their heart.


BLOOM: What have you learned from the families you work with?


Kimberley Siu-Chong: So many things. I consider myself new to health care, because I don’t have a clinical background. I rely on families to teach me about their health care experiences from their perspective. Because they provide the primary care for their child, families become medical experts, and they explain the medical jargon to me when I don’t understand it. They’re very generous and patient with me.


I think the power of empathy is what I’ve learned. That’s always been important to me, but I get reminded of it, and how it plays out in health care, every day.


Our strengths-based approach made sense to me before I came here. But now I see it in the context of how we talk about disability in common discourse, where people just talk about what you can’t do. I’ve learned to see a world of possibility and hope in action with every client and family.


Do you have concerns or kudos about your care at Holland Bloorview? Call Kim at 416-753-6084 or e-mail feedback@hollandbloorview.ca.