Working Together for the Health of Ontario

2010-11 Annual Report

Our Values

Contents1 Our Values

2 Messages from the Chair and the Executive Director

4 Leadership

6 Committee Members

8 Collaboration

10 Discovery

20 Quality

22 Financials

24 2011+

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VisionImproving lives for a stronger Ontario through the integration of health research, education, and specialized care.

MissionAs key partners in the health care system, the CAHO community will harness our collective research and innovation strengths to advance world-leading patient care and a sustainable health care system.

The Council of Academic Hospitals of Ontario is the non-profit association of Ontario’s 25 academic hospitals and their research institutes. CAHO provides a focal point for strategic initiatives on behalf of our member hospitals.

As research intensive hospitals, CAHO members are fully affiliated with a university medical or health sciences faculty. Our hospitals provide the most complex and urgent care, teach the next generation of health care providers and foster health care innovation derived from discovery research.

LeadershipOur member hospitals employ world-class researchers and innovative leaders. Working together in new and innovative ways, CAHO takes a leadership role in finding solutions to the pressures facing health care in Ontario.

CollaborationCAHO believes in working collectively as a community and in partnership with others to affect transformational change and build a strong health research enterprise in Ontario.

Quality In all that it strives to do, CAHO believes that all activities should lead to positive outcomes and driving quality improvement.

InnovationAs the creators and early adopters of health research and innovation, the contribution of Ontario’s research hospitals is profound. Whether it’s the research and discovery of novel therapies, the education of the next generation of health care leaders, or caring for the most complex patients, Ontarians depend on CAHO hospitals to provide hope in health care.

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Over the past year, CAHO has seized the opportunity to answer the question of what we can do as leaders in the health care community to contribute to the future of health care in Ontario and beyond. 2010-11 marks the first year of our five-year strategic plan and has put in place the strong foundation needed to realize the strategic foci for CAHO. The success CAHO has achieved is a result of the commitment our members have demonstrated to working together and collaborating with others to improve lives for a stronger Ontario through the integration of health research, education, and specialized care.

With a new governance structure, we have witnessed more fruitful collaboration within our committees and with our partners. We have refined our focus to ensure that our perspectives and advice are borne out of the unique research hospital mandate of integrating research with the specialized care that we provide and ensuring we translate that knowledge to continually improve health care.

Over the past year, we have joined forces with others to advise government on how best to streamline the ethics review process for multi-site clinical trials. We have also supported the implementation of Ontario’s Excellent Care for All Strategy, providing expertise and support to the government and others to drive quality improvement through evidence-based research. In fact, with the launch of the CAHO Adopting Research to Improve Care (ARTIC) Program, CAHO is a leader in implementing Ontario’s policy of continuously driving evidence-based quality improvement into the health care we provide. Our community’s commitment to finding a more effective way of moving evidence to the bedside is unprecedented.

And we are stepping up in our roles as leaders within the health care system to provide real ideas for improving the sustainability and quality of health care. Anticipating the 2011

provincial election, we have launched our election platform document, Building a Stronger Ontario Through Health Research.

On a personal note, I want to express my sincere gratitude for the opportunity to serve as CAHO’s Chair for the past two years. It has been a privilege to represent such an exceptional and respected group of leaders. I am most grateful for the spirit of collaboration that has grown in our Council in recent years. With a renewed focus, the CAHO community has demonstrated how we can effectively partner with each other and with the broader health care community to drive real change in Ontario. I am also extremely grateful to Karen Michell and her team for the tremendous support they provide to me and to Council as we move forward with our objectives and priorities.

While there is still more work ahead, I would be remiss if I didn’t pause and reflect on the tremendous accomplishments we have achieved together. Building on the success of this past year, I look forward to CAHO’s continued collaboration to ensure Ontario continues to be a world-leading jurisdiction in health care and health research.

Mary Jo Haddad Chair, CAHO Council President and CEO, The Hospital for Sick Children

from the Chair

Messages

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2010-11 has been a tremendous year for CAHO. With the successful launch of the CAHO ARTIC Program and the implementation of our new governance structure over the past year, we have really started to bring our new strategic plan to life.

I continue to be inspired by the level of commitment and engagement I witness from our members. Our success over the past year is in large part due to the level of collaboration and partnership that is demonstrated by our members. Whether it is participating in one of CAHO’s committees or volunteering to be the CAHO representative to government in a particular area, the unwavering commitment to support our sector is impressive.

I am also encouraged by the openness and willingness of the government to work with our sector. Our collaboration with the Excellent Care for All Strategy, as well as our efforts to support the streamlining of the ethics review process for multi-site clinical trials are met with both optimism and confidence that collectively we can resolve the challenges facing our sector.

To more aptly reflect our renewed aspirations, over the past year we have updated our visual identity and built a new website that showcases the amazing research that takes place at our member hospitals. We have also launched a new e-newsletter, the CAHO Catalyst, as a tool to better inform our members and our partners on the work we are doing at CAHO.

We continue to make great strides with the CAHO Adopting Research to Improve Care (ARTIC) Program to help build a pathway to move research evidence into practice across the health care system. We have learned a great deal with the launch of the Program over the past year and the implementation of the first two CAHO ARTIC Projects.

We look forward to building on what we’ve learned as we enter into the next phase of the ARTIC Program in the year ahead.

I would like to recognize Mary Jo Haddad for her incredible vision and support of CAHO during her two years as Chair. Under her leadership, CAHO has become a revitalized organization, building upon the strengths of our members and working to ensure that we can realize our full potential as an association by challenging all of us to realize the benefits of collaborating as a community.

I continue to look forward to working with our members and our partners to leverage the great health research enterprise we have in Ontario.

Karen Michell Executive Director Council of Academic Hospitals of Ontario

and from the Executive Director

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Aligned with the Strategic Plan 2010-2015, CAHO launched a new governance model over the past year that facilitates a multidisciplinary approach to leadership. Our new governance model allows for greater collaboration across our communities of experts within CAHO hospitals. It is specifically designed to facilitate the identification, assessment, and rollout of health research evidence and innovations across our member institutions.

In addition to the CAHO Council, the association is supported by three committees: the Practice and Education Committee, the Research Committee, and the Resources Committee.

Leadership

Practice and Education CommitteeThe CAHO Practice and Education Committee provides strategic advice to CAHO Council on patient care, clinical practice and education matters stemming from and impacting CAHO’s mission. The Committee is responsible for operationalizing and implementing CAHO’s strategic focus of enabling the rapid and responsible movement of research evidence into practice to improve quality, in collaboration with other partners. In 2010-11, the Practice and Education Committee provided the leadership and oversight to launch and implement the CAHO Adopting Research to Improve Care (ARTIC) Program. In addition, the Practice and Education Committee is undertaking efforts to examine long-term strategies to build capacity within the health care system to systematically move research evidence into practice to drive quality and sustainability. The Committee also worked together to assess developments related to the Excellent Care for All Act, 2010 from the perspective of research hospitals; and held meetings with the leadership of the Health Quality Ontario, the Ontario Health Technology Assessment Committee and the Registered Nurses Association of Ontario to foster collaboration with key system partners that are also committed to evidence adoption and knowledge translation.

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Research CommitteeThe CAHO Research Committee provides strategic advice to CAHO Council on health research matters stemming from and impacting CAHO’s mission, with a representative view of the full spectrum of health research that takes place at CAHO hospitals. This includes strategizing on how to advance the stability of and investment in the health research and innovation enterprise in CAHO hospitals. In 2010-11, the Research Committee provided guidance regarding CAHO’s involvement in the Clinical Trials Stakeholder Committee and helped shape the recommendation to government on streamlining research ethics reviews for multi-site industry clinical trials. The Committee has also advised on and supported the advancement of a number of provincial government initiatives such as the design of an “Ontario First” approach to provincial matching of Canada Foundation for Innovation awards, and an Ontario-China research funding program.

Resources CommitteeThe CAHO Resources Committee provides strategic advice to CAHO Council on resourcing issues stemming from and impacting CAHO’s mission. “Resources” are defined as operations, finances, people, facilities, technology and other appropriate areas. The Committee considers and advises on financial or other resource enablers to advance the stability of and investment in the health research and innovation enterprise of CAHO members. In 2010-11, the Resources Committee worked collaboratively to understand the implications and provide guidance to the Ontario government on Patient-based Payment (PbP) policy and Health-Based Allocation Model (HBAM) as it relates to the mandate of a research hospital. The Resources Committee is also working with the Research Committee to develop the vision for how to ideally resource the research and innovation enterprise at a CAHO hospital, using that as a starting point to identify operational, financial and other structural areas where the

CAHO community can collaboratively bring greater stability to the health research enterprise.

In addition to the Committee work, CAHO initiated several task forces over the past year. The ARTIC Task Force was formed to provide the ongoing leadership for the Adopting Research to Improve Care (ARTIC) Program. This task force provided the recommendations for the inaugural ARTIC Projects and is providing guidance to CAHO as we further develop and evolve the Program.

CAHO also established a Strategy Task Force to help with the development of ideas for CAHO’s first-ever Election Platform document released in April 2011. In addition, the work of the Physician Performance Review Steering Committee continues to finds ways to strengthen the quality of care that is provided in CAHO hospitals. Finally, the Research Hospital Resourcing Task Force was created to examine critical factors required to ensure the success of a strong research hospital enterprise. The collaborative work of this Task Force provides a forum for members to learn from each other and design joint strategies for how best to enhance a strong health research enterprise in Ontario.

The governance structure has strengthened CAHO’s ability to collaborate and approach challenges and opportunities in the research hospital in a more collective manner. The results have contributed to reducing the silos that exist within our sector and leveraging our research and innovation strengths to better support advancing world-leading patient care and a sustainable health care system.

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Committee Members

Research CommitteeDr. Ian Rodger (Co-Chair) VP Research and Academic & Director Father Sean O’Sullivan Research Centre, St. Joseph’s Healthcare Hamilton

Dr. Arthur Slutsky (Co-Chair) VP Research, St. Michael’s

Dr. Heather Arthur Chief Scientific Officer Hamilton Health Sciences

Dr. Larry Chambers President & Chief Scientist, Élisabeth-Bruyère RI Bruyère Continuing Care

Dr. Roger Deeley VP Health Sciences Research Kingston General Hospital

Dr. Francisco Diaz-Mitoma VP Research Hôpital régional de Sudbury Regional Hospital

Dr. Andrée Durieux-Smith Scientific Director Hôpital Montfort

Pat Elliott-Miller (Clinical Practice Rep) VP Patient Services & CNE Children’s Hospital of Eastern Ontario

Dr. Darcy Fehlings Senior Scientist Holland Bloorview Kids Rehabilitation Hospital

Dr. Geoff Fernie VP Research Toronto Rehabilitation Institute

Dr. David Hill Integrated VP Research & Chief Scientific Director London Health Sciences Centre

Dr. Michael Julius VP Research Sunnybrook Health Sciences Centre

Lisa Malbrecht Coordinator, Complex Care and Ambulatory Care St. Joseph’s Health Care, London

Dr. Randy McIntosh Director, Rotman Research Institute & VP Research Baycrest Centre for Geriatric Care

Dr. Zul Merali President & CEO, University of Ottawa IMHR Royal Ottawa Health Care Group

Dr. Benoit Mulsant (Clinical Practice Rep) Physician-in-Chief Centre for Addiction and Mental Health

Dr. Martin Osmond VP Research & Chief Scientist, CHEO RI Children’s Hospital of Eastern Ontario

Dr. Christopher Paige VP Research University Health Network

Dr. David Pichora President & CEO Hotel Dieu Hospital Kingston

Dr. Bruce Pollock VP Research Centre for Addiction and Mental Health

Dr. John Puxty Chief of Staff Providence Care

Dr. Paula Rochon VP Research Women’s College Hospital

Dr. Janet Rossant Chief of Research The Hospital for Sick Children

Dr. Tim Rutledge President & CEO North York General Hospital

Dr. Duncan Stewart CEO, Ottawa Hospital RI & VP Research The Ottawa Hospital

Dr. Jim Woodgett Director, Samuel Lunenfeld RI Mount Sinai Hospital

Dr. Michael Wood VP Research Thunder Bay Regional Health Sciences Centre

Practice and Education CommitteeDr. Karima Velji (Co-Chair) VP Clinical and Residential Programs & CNE Baycrest Centre for Geriatric Care

Dr. Carrol Pitters (Co-Chair) Chief Medical Officer & Chief of Staff Children’s Hospital of Eastern Ontario

Dr. Rajiv Bhatla Chief of Staff & Chief of Psychiatry Royal Ottawa Health Care Group

Dr. Chris Bourdon VP Medical and Academic Affairs Hôpital régional de Sudbury Regional Hospital

Dr. Charles Chan VP Medical Affairs and Quality University Health Network

Dr. Rhonda Crocker Ellacott VP & CNE Thunder Bay Regional Health Sciences Centre

Winnie Doyle VP Clinical Programs & CNE St. Joseph’s Healthcare Hamilton

Ella Ferris EVP Programs & CNE St. Michael’s

Susan Jewell VP Patient Care & Chief Nursing Executive Toronto Rehabilitation Institute

Dr. Richard McLean VP Medical Affairs and Quality Hamilton Health Sciences

Heather McPherson VP Patient Care and Ambulatory Innovation Women’s College Hospital

Dr. Dale Mercer Chief of Staff Hotel Dieu Hospital Kingston

Dr. Golda Milo-Manson VP Medicine and Academic Affairs Holland Bloorview Kids Rehabilitation Hospital

Dr. Guy Moreau Chief of Staff Hôpital Montfort

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Dr. Nigel Paterson Interim VP Medical Education and Medical Affairs London Health Sciences Centre

Dr. Louise Patrick VP Academic Affairs, Decision Support & Chief of Health Professionals Bruyère Continuing Care

Karen Perkin VP Professional Practice & CNE St. Joseph’s Health Care, London

Dr. Peeter Poldre VP Medical Education and Professional Practice Sunnybrook Health Sciences Centre

Karyn Popovich VP & CNE North York General Hospital

Eleanor Rivoire VP Clinical Administration and Professional Practice & CNE Kingston General Hospital

Dr. Ginette Rodger Senior VP Professional Practice & CNE The Ottawa Hospital

Maurio Ruffolo VP Patient and Client Care & CNE Providence Care

Dr. Maureen Shandling Senior VP Medical Mount Sinai Hospital

Dr. Rani Srivastava Chief of Nursing and Professional Practice Centre for Addiction and Mental Health

Dr. Susan Tallett Chief of Education The Hospital for Sick Children

Resources CommitteeJim Flett (Co-Chair) COO, Kingston General Hospital

Justine Jackson (Co-Chair) Senior VP & CFO University Health Network

Gerald Bisson Senior VP Corporate Services & CFO Children’s Hospital of Eastern Ontario

Dev Chopra EVP Corporate Services and Redevelopment Centre for Addiction and Mental Health

Dan Coghlan VP Finance and Information Management & CFO Providence Care

Cal Crocker Senior VP & CFO Royal Ottawa Health Care Group

Stephen D’Arcy VP Finance and Planning Toronto Rehabilitation Institute

Jim Garner EVP Corporate Services The Hospital for Sick Children

Shawn Gilhuly Acting CFO London Health Sciences Centre

Murray Glendining EVP Corporate Affairs Hamilton Health Sciences

Laurie Harrison VP Corporate Services & CFO Baycrest Centre for Geriatric Care

Lori Higgs Acting CFO St. Joseph’s Health Care, London

Dan Hill CFO Women’s College Hospital

Susan Hollis VP Business and Therapeutic Services & CFO St. Joseph’s Healthcare Hamilton

John King EVP & Chief Administrative Officer St. Michael’s

Daniel Levac Senior VP Corporate Services & CFO Bruyère Continuing Care

Dean Martin VP Finance and Information Technology & CFO North York General Hospital

Steve Miller CFO Hotel Dieu Hospital Kingston

Gino Picciano Senior VP & COO The Ottawa Hospital

Joe Pilon COO Hôpital régional de Sudbury Regional Hospital

Scott Potts Senior VP Corporate Services and Operations Thunder Bay Regional Health Sciences Centre

Danny Purcell VP & CFO Hôpital Montfort

Joan Sproul Senior VP Finance Mount Sinai Hospital

Ben Sybring VP Corporate Services Holland Bloorview Kids Rehabilitation Hospital

Michael Young EVP & Chief Administrative Officer Sunnybrook Health Sciences Centre

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CAHO recognizes that to truly affect change and to claim Ontario as a world leader for health research, we need to work collaboratively within our community and with our partners. Over the past year, CAHO has embarked on many new initiatives to continue to shape the health research enterprise in Ontario.

Collaboration

Ontario’s Clinical Trials Enterprise: Building a Streamlined Ethics Review ProcessIn late 2010, the Ministry of Research and Innovation (MRI) tasked a group of key stakeholders, including CAHO, to make recommendations on how best to streamline the ethics review process for industry-driven multi-site clinical trials. Alongside CAHO, the Council of Ontario Faculties of Medicine (COFM), the Ontario Council on University Research (OCUR), Canada’s Research-based Pharmaceutical Companies (Rx&D), BIOTECanada, and Canada’s Medical Technologies Companies (MEDEC) formed the Clinical Trials Stakeholder Committee which provided recommendations for a streamlined ethics review process for clinical trials. These recommendations were designed to maintain the current high standards of protection of the rights, safety and well-being of human subjects involved in the trials while contributing to shorter trial start-up times, thereby helping maximize Ontario’s share of global clinical trials activity. The recommendations are under consideration by the Ontario Ministry of Research and Innovation and are expected to be implemented in 2011.

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Medical Technology Sector StrategyThrough Ontario’s Business Sector Strategy, the Ontario government has established an open and collaborative relationship with business stakeholders in the medical technology sector through its industry association, MEDEC. Under this strategy, the Ontario government and MEDEC identified five key priorities to help strengthen the medical technology sector in Ontario. CAHO has been identified as a collaborative partner to help with the successful implementation of these priorities given the unique role as both the creators and early adopters of medical technology, and as a key partner in building an economic strategy that leverages the health research enterprise in this province as a key contributor to a growing knowledge-based economy. CAHO will play an important role in indentifying high priority health issues facing the Ontario health care system and working with the medical technology sector to identify potential solutions; and creating a pre-market assessment process for medical technologies. CAHO is actively engaged with MEDEC and other key partners to support these initiatives that will serve to further strengthen Ontario’s place as a world leader in medical technology and innovation.

Ontario Health Technology Assessment CommitteeOver the past year, CAHO has played an increasingly collaborative role with the Ontario Health Technology Assessment Committee (OHTAC). CAHO member hospitals are often the early adopters of new technology and therefore are considered the test bed for many of the new technologies that are eventually adopted in our health system. CAHO and many of its members are active members of OHTAC. We are currently in discussions with OHTAC about how to do an even better job of leveraging the CAHO community to provide OHTAC with additional support and expertise in their health technology assessments.

Excellent Care for All StrategyIn 2010, with the passage of the Excellent Care for All Act, 2010, the Ontario government set out to improve the quality and value of the patient experience through the application of evidence-based health care. CAHO welcomed and supported this strategy and legislation since many of the initiatives that were being proposed had been established in CAHO hospitals for some time. CAHO offered its collective leadership through representation on the government’s Implementation Working Group, and the committee looking at Patient-based Payment (PbP) policy. CAHO continues to work with the government and the newly created Health Quality Ontario to support moving research evidence into practice to improve the quality of health care our health system provides.

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Baycrest This past year, the best minds at Baycrest’s Rotman Research Institute (RRI) and the Kunin-Lunenfeld Applied and Evaluative Research Unit (KLAERU) have been extending the foundation of excellence in cognitive neuroscience and aging research to build a knowledge translation pipeline that will transform the way scientific discovery impacts care. The Centre for Integrative Brain Dynamics is a multi-million dollar international collaboration seeking to create the world’s first virtual, functional brain — a groundbreaking technological advancement in the quest to effectively guide cognitive rehabilitation. The Toronto Trans-generational Brain and Body Centre is systematically studying how combinations of genes and environments influence our health over time — with the aim of identifying the best predictors of healthy and unhealthy aging. Cogniciti, a joint venture between Baycrest’s Centre for Brain Fitness and MaRS, unveiled a unique cognitive training program for the workplace, grounded in sound neuroscience-based methodology.

DiscoveryThe unique mandate of a research hospital – the integration of research, teaching, and specialized care – provides an exceptional environment for innovation. Providing care to some of the most complex patients provides the motivation for CAHO hospitals to search for innovative ways to deliver health care. From bench to bedside, our hospitals provide the hope in our health care system – being both the creators and early adopters of innovations that improve the lives of our patients and the care that our system can provide.

Eighty percent of the publicly-funded health research in Ontario takes place in CAHO research hospitals. CAHO hospitals are the living laboratories in which some amazing medical breakthroughs have happened; breakthroughs that have revolutionized the way health care is delivered in Ontario, and around the world.

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Centre for Addiction and Mental Health A Research Renaissance is underway at the Centre for Addiction and Mental Health (CAMH). This renaissance, spurred by a major investment into new research facilities, enables greater collaboration among our internationally renowned scientists to study mental health and addiction issues from the Neuron to Neighbourhood level. Among last year’s major findings was a study that used a combination of brain imaging and genetics to identify healthy individuals at high risk of late-onset Alzheimer’s disease. In the area of depression, CAMH researchers discovered a new target in the brain to develop depression treatments with potentially minimal side effects, while another study showed the effectiveness of mindfulness-based cognitive therapy, using meditation, to prevent depression relapse. CAMH has also launched the first known mobile research laboratory focused on mental health and addictions issues. This lab, operational in 2011, will undertake community-based research across Ontario in rural, First Nations and other underserved communities.

Bruyère Continuing Care Bruyère Continuing Care is recognized nationally as the source of relevant, practical and leading-edge knowledge for those seeking answers to applied health research questions in primary care, continuing care, care of the elderly and rehabilitation, long-term care and palliative care. Through our Élisabeth Bruyère Research Institute, we continue to solidify our reputation as a leading academic health centre by conducting world-class research that advances the health and well-being of aging Canadians. In 2010, the Primary Care Research Group worked to enhance the patient’s first contact with health system services by implementing e-consult technology to create an electronic consultation framework between primary care practitioners and endocrinologists. Scientists within the Care of the Elderly Research Group were responsible for investigating ground-breaking technological innovations including smart monitoring tools and services, hands-free computer assistive devices and virtual reality applications – all of which support older adults suffering from a broad range of health issues including mobility and cognitive impairments.

Children’s Hospital of Eastern Ontario Established in 1984, the CHEO Research Institute coordinates the research activities of the Children’s Hospital of Eastern Ontario (CHEO) and is one of the institutes associated with the University of Ottawa’s teaching hospitals. In 2010 the institute completed a comprehensive 5-year strategic planning exercise. Foci of research excellence are in both basic biomolecular research and clinical research. Scientists in the basic science lab are uncovering the process of apoptosis (programmed cell death) and using this information to develop anti-cancer therapies. They are also developing oncolytic viruses to target and eradicate difficult to treat pediatric cancers. In clinical research they are testing new treatments for pediatric respiratory disease in the emergency department, tackling the issue of osteoporosis in children with chronic disease on glucocorticoid treatments, and testing interventions in children with severe obesity.

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Hamilton Health Sciences Research at Hamilton Health Sciences is diverse, innovative and comprehensive. Joint efforts between Hamilton Health Sciences and McMaster University have led to cutting-edge research in cancer, cardiovascular diseases, thrombosis and atherosclerosis, mothers and children. Our coordinated efforts have placed us amongst the top 25 most influential research communities in the world, based on an analysis of the impact of our research. Through our partnerships between clinical and basic researchers, we are: exploring the prevention of influenza by immunizing small groups of children to protect entire communities; discovering new drugs as viable alternatives to stroke prevention for patients with atrial fibrillation; exploring the prevention of heart disease and stroke by determining the individual risk factors that are most strongly associated with different geographic areas and ethnic groups around the world; and working towards bridging the gap between discoveries and quicker translation into enhance patient care, for example, implementing the gentle persuasive approach to prevent or reduce agitation in patients with dementia or delirium. Through this and other innovative inter-professional research, Hamilton Health Sciences will continue to grow as a world leader in advancing and creating new knowledge that informs patient care by bringing evidence into practice through translation and application.

Holland Bloorview Kids Rehabilitation Hospital Creating a world of possibilities for kids with disabilities starts with enhancing their health and well being. At Holland Bloorview Kids Rehabilitation Hospital we pioneer treatments and real-world programs so children with disabilities have the tools to participate fully in life. In 2010, a team of researchers were awarded the 2010 da Vinci Award for the Virtual Music Instrument, a computer-based instrument that allows people of all abilities to make music by using motion sensing technology. We are playing an important role in NeuroDevNet, the first trans-Canadian initiative seeking to understand the early brain development of children with cerebral palsy, autism and fetal alcohol syndrome. Through a new partnership with the Toronto District School Board, non-verbal children with the most complex disabilities will have access to cutting-edge communications technology during a two-year research project at Sunny View Public School.

The Hospital for Sick Children At The Hospital for Sick Children, our cross-disciplinary teams are conducting innovative world-class scientific research and transforming discovery into effective clinical practice to improve children’s health. In 2010, SickKids in partnership with McMaster University led the most ambitious autism study of its kind. Involving 1,500 families and more than 120 scientists and clinicians from across North America and Europe, it uncovered key changes in DNA in individuals with autism – offering new hope and answers for families. Furthermore, research into pain reduction, skin regeneration, diabetes, asthma and cancer continue to directly impact the lives of children here and around the world. This year, construction on our state-of-the-art building for discovery and sharing, the new Research & Learning Tower, reached ground level and is on track to open in 2013. Through the dedication, curiosity and innovations of our researchers, SickKids is fulfilling our vision of Healthier Children. A Better World.

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Hotel Dieu Hospital, Kingston At Hotel Dieu Hospital, Kingston, planning began this year for a new Research Institute that will support the hospital’s recently launched five-year strategic plan. The Research Institute will focus on innovation, collaboration, knowledge-translation and scholarly activities across disciplines and professions in the field of ambulatory care. Also helping Hotel Dieu to lead the way in transforming ambulatory care is the creation of the Human Motion Performance Laboratory, set to open in May 2011. Built in partnership with Queen’s University, this world-class research facility will develop new treatments for musculoskeletal disorders such as arthritis and osteoporosis. In 2010, research partnerships with Queen’s also included studies related to the treatment of macular degeneration, a common but serious eye disorder now affecting increasing numbers of individuals; outcome predictors in colon cancer screening; and integrated models of care for the early identification and treatment of schoolchildren with mental health problems.

Kingston General Hospital Research at Kingston General Hospital is advancing in a strategic way, building on our unique strengths. The KGH Research Institute was created this past year to focus on patient-oriented research and guide the hospital’s delivery of outstanding patient care. Research highlights from 2010 include providing global leadership by creating an international forum for clinicians who treat the sickest patients in intensive care units, collaborating between our computer specialists and surgeons to test a new way to repair damaged knee cartilage (mosaicplasty), licensing a new technology to detect aggressive prostate cancer, and completing our operating theatre, OR2010; one of the world’s first fully integrated facilities for interdisciplinary research into computer-assisted surgery.

London Health Sciences Centre At London Health Sciences Centre our physicians and researchers work closely together to improve our understanding of disease, its prevention and care. In 2010, in collaboration with our research partner, the Lawson Health Research Institute and our educational partner, The University of Western Ontario we opened two state-of-art research buildings that will provide our staff with the resources needed to make significant advances in several areas of healthcare. Located adjacent to the clinical areas at University Hospital, the Lindros Legacy Research building and its five distinct centres will make strides in surgical technologies, tissue and organ transplantation, novel therapeutics and personalized drug therapy. The Gerald C. Baines Centre for Translational Cancer Research, situated at Victoria Hospital at the interface of the London Regional Cancer Program and the Victoria Research Laboratories will help bridge novel research findings to lead the way for improvements in the diagnosis, treatment and prevention of cancer. In addition to the launch of these innovative research centres, LHSC surgeons were the first in the world to successfully perform an aortic valve bypass using a specialized Aortic Valve Bypass (AVB) device.

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North York General Hospital North York General Hospital has been working intensively over the past year, and has received Board approval, to develop its unique role as a “Community Academic Hospital”. Leveraging its high clinical volumes, diverse patient population, recognized accomplishments in improving access and timeliness of patient care, and close ties with its associated community providers, NYGH will answer questions that are vital to system sustainability and excellence in patient care across all life stages and the continuum of care. NYGH continues to grow the number of research protocols, trials undertaken and grants administered. The distinct value proposition NYGH offers allows critical questions to be answered in a community hospital setting where a significant percentage of hospital care in the province of Ontario is delivered. In 2010-2011, the Gordon F. Cheesbrough Research Chair in Family and Community Medicine was established. This Chair, the first of its kind in Ontario, will facilitate globally-relevant research by capitalizing on the unique integration of NYGH’s acute care service delivery with community-based primary care networks, focusing on transitions of care, access, and interprofessional models of care.

Mount Sinai At Mount Sinai Hospital, research continues to drive discovery and healthcare innovation. In 2010, Samuel Lunenfeld Research Institute scientists published 37 primary papers in the 30 highest impact research journals including ground-breaking studies defining a new DNA repair pathway (which also earned Dr. Dan Durocher a Top 40 Under 40 award), new genetic contributors to inflammatory bowel disease, ulcerative colitis, rheumatoid arthritis and ovarian cancer and new methodologies for re-programming of somatic cells to pluripotent stem cells. This past year we also boosted our strengths in stem cell research and regenerative medicine by building a Centre for Regenerative Medicine and Musculoskeletal Research. Within this new space, scientists and clinicians will apply the rapid advances in stem cell research to develop novel strategies for bone and tissue regeneration, including biologic joint replacements.

Hôpital Montfort The “Institut de recherche de l’Hôpital Montfort “ (IRHM) is a relatively new research institute. One of its research focuses is the health of francophones in a minority environment. Researchers from the University of Ottawa and the IRHM have received funding from the Ontario Ministry of Health and Long-Term Care to establish an applied research network on the health of francophones in Ontario called the Réseau de recherche appliquée sur la santé des francophones de l`Ontario (RRASFO). Data is being collected on the physical, mental and social health needs of this population to help identify research priority areas. Another focus to be explored by the institute is the area of nutrition and metabolism. A multidisciplinary research team is looking at metabolism in relation to chronic health conditions such as diabetes and obesity as well as severe environmental conditions such as extreme cold.

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The Ottawa Hospital Research at The Ottawa Hospital is focused on making tomorrow’s health care possible today; bringing new hope to our patients, while advancing health research at a global level. Priority research areas include vascular health, practice-changing clinical research, and the development of regenerative and biological therapeutics. This year we developed a novel stem cell therapy to prevent lung injury in life-threatening systemic infection (sepsis) and are about to launch the world’s first clinical trial to repair the heart after a heart attack using gene-enhanced progenitor cells. Our researchers also deciphered the function of a key Parkinson’s gene, opening the door to future clinical trials of novel treatments. Cancer-fighting viruses is one of our flagship translational programs, and this year we showed how their replication can be enhanced by certain drugs. We also advanced regional and in some cases global implementation of home-grown, evidence-based models to improve care for blood clots, traumatic neck injuries and stroke, as well as patient safety.

Providence Care Leading the way in Compassion and Discovery. Providence Care is committed to creating, sharing and applying knowledge, and training the next generation of health care professionals. Providence Care’s Centre for Studies on Aging and Health provides leadership in building capacity for eldercare and dementia studies. In 2011, Providence Care partnered with six Ontario long-term care homes and developed and implemented new best practices to keep elderly residents healthy and safe. Providence Care’s hospital clinicians conducted research to enhance the quality of life for stroke survivors and for those who have suffered a serious injury, and expanded understanding in areas such as mood disorders, sleep disorders and schizophrenia.

Royal Ottawa Health Care Group The Royal has begun to lay the groundwork for the development of a new multidisciplinary Depression Research Centre which will encompass several leading-edge scientific research platforms that specialize in basic and clinical mental illness research. It will comprise some of the world’s most accomplished and promising minds in mental health research – several of whom hold prestigious Government of Canada Research Chairs (CRCs). This centre will systematically tackle depression which is one of the leading causes of social and economic burden locally and globally. The Depression Research Centre will also include an important knowledge transfer and uptake component which will take research findings from the laboratory (bench) to the clinic (bedside and neighbourhood) where this new knowledge can be used to improve the quality of life for patients and their families.

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St. Michael’s Hospital A major focus of research at St. Michael’s is generating knowledge that can impact health policy, and can be applied to improve the health of disadvantaged populations, both locally and globally. In 2010, our Centre for Research on Inner City Health quantified important inequalities in healthcare such as low rates of cervical cancer screening among urban immigrants and higher rates of obesity, injury and infant mortality among indigenous children in Canada. For the first time, we have data to prove that homeless and marginally-housed people nationwide are dying earlier than even the poorest Canadians. Research studies have identified health risks resulting from osteoporosis drugs, deaths related to opioids and unnecessary (expensive) use of diabetes test strips. These findings have impacted health policy; for example the development of new Canadian guidelines related to opioid prescriptions, and an ongoing re-evaluation of funding policies for diabetes test strips in Ontario. A high profile study published by our Centre for Global Health Research demonstrated that the number of people dying from malaria in India has been hugely underestimated, with 13 times more malaria deaths than the WHO estimates.

St. Joseph’s Health Care London Research through St. Joseph’s Health Care London at Lawson Health Research Institute – a joint venture of St. Joseph’s and London Health Sciences Centre - has achieved major advances in hospital-based research including diagnostic imaging and chronic disease management. Building on investments from the Canada Foundation for Innovation, St. Joseph’s has created a state-of-the-art Molecular Imaging Program to formulate and test new biomarkers that add specificity to PET and SPECT imaging. Empowered by a cyclotron and radio-pharmacy facility, and in partnership with industry, radiolabeled biomarkers are evaluated by hybrid PET-CT and SPECT-CT platforms in pre-clinical and clinical studies, while preparing for Canada’s first PET-MRI. Additionally, St Joseph’s has been chosen by the Juvenile Diabetes Research Foundation to house one of three clinical trials centres for the evaluation of new therapies for type 1 diabetes in Ontario.

St. Joseph’s Healthcare Hamilton St. Joseph’s Healthcare Hamilton (SJHH) is transforming the future of health care through its innovative research and care. SJHH had a banner year in 2010 as it became the first Canadian hospital to launch a CCSVI-Multiple Sclerosis research study in our Imaging Research Centre to critically examine Dr. Paolo Zamboni’s hypothesis. SJHH’s Brain-Body Institute published a landmark study that clearly identified an interactive relationship between a person’s gut, brain and skin, through stress-induced skin responses like hair loss and skin inflammation. A global four-year study, led by a physician in the hospital’s Intensive Care Unit, determined a way of improving the survival rates of some of the sickest patients. Set to open in fall 2011, the newly constructed Peri-Operative Surgical Centre will operate 12 surgical rooms, 14 post-anesthesia care beds, a 22 bed day surgery centre and a new sterile processing department. The new operating rooms, some of the most technologically-advanced in North America, will be designed to suit the needs of St. Joseph’s varied surgical specialties, with the two largest suites designed and constructed to accommodate image-guided surgery.

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Hôpital régional de Sudbury Regional Hospital Significant milestones were achieved in research at the Hôpital régional de Sudbury Regional Hospital. The hospital recruited its first-ever Vice-President of Research and is moving ahead with its plans to create a Research Institute. A pilot project between the HRSRH and the Hospital for Sick Children involving retinal screening for premature babies received an award in the category of “Improving Access” at a major health care expo in Toronto. A new research company co-founded by hospital researchers and university professors was named best new business venture, best venture in health care, and co-winner of best intellectual property at the TieQuest 2011 Awards. An HRSRH research paper entitled “Chloroquine and its analogs: A new promise of an old drug for effective and safe cancer therapies” was ranked as one of the top 25 papers in the area of Pharmacology, Toxicology and Pharmaceutical Sciences.

Sunnybrook Health Sciences Centre We are inventing the future of health care. In 2010 we founded a dual-site centre for focused ultrasound therapy in partnership with Thunder Bay Regional Health Sciences Centre. Here, clinical research teams will lead trials evaluating “incisionless surgery”— using magnetic resonance-guided focused ultrasound to destroy tumors and other lesions in the brain and body. We teamed with MaRS Innovation to commercialize four discoveries. One of these is a compound that shows potential to heal chronic wounds like those that afflict people with diabetes. We continued building the world’s first Centre for Research in Image-Guided Therapeutics, set to open in 2011. The 150,000-square-foot space will house top medical science minds, among them physicists who are building diagnostic and therapeutic devices, and biologists who are designing cell-based therapies—all toward preventing and treating conditions such as cancer, heart disease, stroke, bone and joint disorders, and dementia.

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Toronto Rehab Toronto Rehab is driven by a bold vision to revolutionize rehabilitation and maximize life. Bringing together bright research minds and state-of-the-art technology, Toronto Rehab is fast becoming a world leader in practical research aimed at helping overcome the challenges of disabling injury or illness, chronic disease or age-related conditions. Among many breakthroughs, this research has led to the development of new technologies such as a device that will allow people to be tested for sleep apnea at home, a unique handheld unit that enables hospitals to accurately audit hand hygiene compliance and the use of functional electrical stimulation to help people with spinal cord injuries regain use of their hands. Scientists and clinicians have also worked together to improve the understanding of risk factors and more effective treatments for people living with stroke, heart disease and brain injury. In the fall of 2011, Toronto Rehab will unveil the world’s most advanced research facilities dedicated to rehabilitation science.

Thunder Bay Regional Health Sciences Centre Research has taken root at the Thunder Bay Health Science Centre with the creation of the Thunder Bay Regional Research Institute a few short years ago in 2008. In 2010, in partnership with Sunnybrook Health Sciences Centre, we became the world’s first, dual-site centre for High Intensity Focused Ultrasound. We launched our Translational Research Program, formalizing our research mandate in clinical trials conducted in cancer, cardiology, molecular imaging. For the first time in our corporate history, patients in Northwestern Ontario are gaining access to early-stage trials in molecular imaging and advanced diagnostics. We continue to foster close relationships with our partners Sunnybrook Health Sciences Centre, Northern Ontario School of Medicine, Lakehead University, Cancer Care Ontario, and Confederation College. And as part of a robust research and innovation healthcare cluster in Northwestern Ontario, we are recognized by all levels of government as a major player in medical research, and have become the first member of MaRS Innovation located outside of the Greater Toronto Area.

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Women’s College Hospital At the Women’s College Hospital (WCH), our scientists are reinventing care. Researchers are developing and implementing innovative programs that will be both sustainable and responsive to the needs of women and their families. Dr. Sophie Jamal has made an exciting innovation in osteoporosis prevention as her research has found that the use of nitrates can prevent bone loss in those with the disease. This research identifies a widely available, inexpensive treatment for osteoporosis. Dr. John Semple and his team have developed an innovative patient care path for patients undergoing breast reconstruction after a mastectomy for breast cancer using the TRAM flap procedure. This unique and innovative ambulatory model of care has reduced the patient’s post operative length of stay from 6.2 days (CIHI) to 18 hours. It focuses on improving quality of care at home and decreasing patients’ loss of productivity as well as reducing health care costs. Dr. Steven Narod is leading global collaborations, studying the prevalence and impact of BRCA1 and BRCA2 mutations. Dr. Narod’s international research is focusing on a new challenge: the continuing epidemic of breast cancer in the developing world, where most women develop the disease before the age of 40.

University Health Network University Health Network is committed to driving health innovation. In 2010-11, we took major steps to becoming the “Research Hospital of the Future”, one that integrates research with patient care to achieve optimal health outcomes. We created and successfully used the Toronto XVIVO Lung Perfusion System to safely and effectively treat, reassess and improve the function of high-risk donor lungs for successful transplant into patients. We broke ground for the Krembil Discovery Centre, which, when open in 2013, will house world-class research programs in neurological and autoimmune disorders. We established the cross-Ontario OCAIRO consortium to adapt radiation therapy to individual patients and their response to treatment. We forged partnerships with the California Institute for Regenerative Medicine to develop stem cell-based treatments for cancer and we brought a gene expression-based prognostic test for lung cancer closer to the marketplace.

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Adopting Research to Improve Care (ARTIC) ProgramIn 2010, CAHO resolved to address this challenge. Committed to fostering better collaboration and trying to establish a systematic approach to moving research evidence from the bench to the bedside, CAHO launched the Adopting Research to Improve Care (ARTIC) Program. The aim of the program is to move research evidence into practice from one hospital across the CAHO hospitals in order to drive quality improvement and benefit the health care system as a whole. Our aspiration is to learn from this experience in order to help build a systematic and sustainable implementation pathway for evidence across the province.

Collectively, CAHO decided to implement two ARTIC projects in 2010 – the first addressing wait times in the ER by making better use of our inter-professional resources, and the second meeting the challenge of infection control and hand washing compliance.

Through the ARTIC Program, CAHO is working to systematically understand the impediments and opportunities that underpin the realization of efforts to move evidence into practice simultaneously across a large number of institutions. We also recognize the tremendous impact this can have not only in providing better care to Ontarians, but also in managing the finite health resources we have available to us.

Applying the lessons learned through the initial launch of the Program, in early 2011 CAHO issued a call for Letters of Intent (LOI) to initiate the next round of projects for implementation. Through additional rigour, the revised process requires potential applicants to consider the following criteria:

- Present a novel innovation to address a significant health system issue

- Be evidence-based (i.e. supported by robust, peer-reviewed research evidence)

- Demonstrate a strong value proposition (e.g. have a positive impact on patient outcomes, be cost-effective, improve delivery of care, etc)

- Implementable within a 1-2 year timeframe

CAHO plans to launch additional CAHO ARTIC Projects by the end of 2011.

CAHO is committed to continuing our journey of learning through the ARTIC Program. We believe that the richness of this knowledge should not be experienced by our community alone. Working with the Ontario Ministry of Health and Long-Term Care, Health Quality Ontario and world-renowned experts in knowledge translation and evidence assessment, we aspire to build a sustainable pathway for implementing evidence that can improve care and Ontario’s health care system.

Quality

Many in the health care sector have successfully shared best practices within their own organizations, professions and sometimes across communities of care such as paediatrics or mental health. However, as a health care system, Ontario has yet to realize the full potential of sharing best practices and systematizing efforts to move research evidence into practice. Too often, we have found pathways to improve care and drive quality improvement in the health care system, but that knowledge often never leaves the organization that created it.

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Canadian C-Spine Rule to Improve ER Wait Times

Canadian emergency departments (EDs) annually treat 1.3 million patients who have suffered blunt trauma from falls or motor vehicle collisions and who are at risk for cervical spine (c-spine) injury. Most such cases are alert and stable adults and less than 1% has a c-spine fracture. A majority of trauma victims transported in ambulances are protected by a backboard, collar, and sandbags and, on arrival at the ED, are sent to high acuity resuscitation rooms, where they remain fully immobilized for hours until physician assessment and x-rays are complete.

This prolonged immobilization is often unnecessary and adds considerably to patient discomfort and to the burden on our overcrowded Canadian EDs in an era when they are under unprecedented pressures. These patients use valuable ED resuscitation room space and endure long wait times, which contribute to lower patient satisfaction.

Researchers at The Ottawa Hospital have developed a clinical decision rule, the Canadian C-Spine Rule (CCR), to allow clinicians to “clear” the cervical spine

without the need for an x-ray and to decrease immobilization times. This rule has been widely adopted by Emergency Department (ED) physicians and has recently completed testing for accuracy, reliability and safety amongst ED triage nurses.

This project will optimize resources through the use of interprofessional teams, allowing for specially trained nurses to assess patients using the Canadian C-Spine Rule, and potentially decrease ER wait times and increase patient satisfaction by quickly and effectively identifying patients who do not require immobilization.

HandyAudit™ to Measure and Improve Hand Hygiene Compliance

In 2008, the Ontario Ministry of Health and Long-Term Care (MOHLTC) introduced mandatory reporting of hand hygiene compliance as a patient safety indicator. The standard practice for mandatory reporting of hand hygiene compliance rates in Ontario is direct observation using a paper reporting form. Early experience with collecting and reporting compliance data using the Ministry’s paper-based form is proving to be cumbersome and costly.

The HandyAudit™, developed by researchers at the Toronto Rehabilitation Institute, is an innovative PDA device that records the real time of relevant caregiver actions and produces data that can be analyzed at any time using any rule set (e.g. guidelines used by the World Health Organization and Ontario Ministry of Health and Long-Term Care).

By using the PDA for data capture, hospitals can eliminate the need for transcription thereby reducing errors and costs associated with this activity. The HandyAudit™ eliminates the need for auditors to assess whether hand hygiene compliance has occurred, removes the need for manual transcription of compliance results, and simplifies report generation and other data management operations.

This project is expected to facilitate a reduction in cost and an increase in the reliability of mandatory hand hygiene auditing.

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Report of the Independent Auditor on the Summary Financial Statements

To the Members of Council of Academic Hospitals of Ontario

The accompanying summary financial statements, which comprise the summary statement of financial position as at March 31, 2011, and the summary statement of revenue and expenses for the year then ended, and related note are derived from the audited financial statements of the Council of Academic Hospitals of Ontario (“CAHO”) for the year ended March 31, 2011. We expressed an unmodified audit opinion on those financial statements in our report dated May 11, 2011.

The summary financial statements do not contain all the disclosures required by Canadian generally accepted accounting principles. Reading the summary of financial statements, therefore, is not a substitute for reading the financial statements of CAHO.

Management’s Responsibility for the Summary of Financial Statements

Management is responsible for the preparation of the summary of the audited financial statements on the basis described in the Note to the summary financial statements.

Auditor’s Responsibility

Our responsibility is to express an opinion on this summary of financial statements based on our procedures, which were conducted in accordance with Canadian Auditing Standard (CAS) 810, “Engagements to Report on Summary Financial Statements”.

Opinion

In our opinion, the summary financial statements derived from the audited financial statements of CAHO for the year ended March 31, 2011 are a fair summary of those financial statements, on the basis described in the Note to the summary financial statements.

Chartered Accountants Licensed Public Accountants May 11, 2011

Financials

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2011 2010

Special Group Projects Operating Purchasing Fund Fund InitiativeFund Total Total

$ $ $ $ $Revenue Bank interest - 2,069 - 2,069 - Membership revenue - 1,064,281 - 1,064,281 1,042,983 Investment revenue 184,538 - - 184,538 - Funding revenue - - 142,328 142,328 494,495 Other revenue - 101,348 - 101,348 29,685

184,538 1,167,698 142,328 1,494,564 1,567,163

Expenses Salaries and benefits 16,362 800,960 45,292 862,614 660,554 Business travel - 16,025 - 16,025 33,300 Committee 4,371 25,816 20,349 50,536 182,973 Office 359 28,683 1,418 30,460 22,990 Rent - 44,000 - 44,000 8,308 Fees - legal, financial, professional and insurance 61,234 60,556 67,197 188,987 264,420 Management fees - 56,000 7,000 63,000 50,000 Other sundry - 15,104 1,072 16,176 34,464

82,326 1,047,144 142,328 1,271,798 1,257,009

Excessofrevenueoverexpenses 102,212 120,554 - 222,766 310,154

2011 2010

$ $Assets Cash and cash equivalents Special Projects Fund 252,500 322,053 Operating Fund 204,650 2,065,809 Short-term investments 1,809,860 1,384,193 Accounts receivable 69,140 2,520

2,336,150 3,774,575

Liabilities Accounts payable and accrued liabilities 206,956 286,363 Deferred revenue 9,220 1,585,412

216,176 1,871,775

Netassets Special Projects Fund 1,402,840 1,306,220 Operating Fund 717,134 596,580

2,119,974 1,902,800

2,336,150 3,774,575

CAHO Summary statement of revenue and expenses

CAHO Summary statement of financial position

year ended March 31, 2011

as at March 31, 2011

Note:Basis of the summary financial statementsThe Council of Academic Hospitals of Ontario (“CAHO”) has prepared the summary financial statements to be included as part of its annual report. CAHO has determined that the level of aggregation presented is adequate for the readers of their annual report. The audit financial statements may be obtained from CAHO, on request.

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2011+2011+

Importance and impact of health research in Ontario

Ontario’s research hospitals are inventing the future of health care. Every day, the people who work in our community make great strides in improving the health of all Ontarians, often being the first in Canada, or the world, to try a new therapy, an innovative technology or a new way of delivering care to improve the lives of patients.

Together, we leverage our collective research and innovation strengths to enable the rapid movement of evidence into practice to improve the quality of our health care system and to advance the stability of, and investment in, the health research enterprise in Ontario.

Over the past year, CAHO had embraced this bold new direction and set off on a journey to lead, collaborate, and innovate to drive quality improvement and sustainability in our health care system, and to build a world leading health research enterprise.

And we will continue to build on the foundations we have put in place. In 2011-12 we plan to take this vision to the next level, building on the success we have achieved together. We will continue to champion a strong health research enterprise and a health care system that Ontarians continue to cherish.

OBC

caho-hospitals.com

Council of Academic Hospitals of Ontario200 Front Street W, Suite 2501 Toronto, ON M5V 3L1T 416 205 1336E info@caho-hospitals.com