Episode 08: In conversation with Julia Hanigsberg

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The common elements in a career that has taken Julia from government to education administration, and now healthcare are her curiosity and desire to keep on learning new things.

Today, your host Ellen Gardner, Communications and Marketing at HIROC, speaks with Julia Hanigsberg, President and CEO of Holland Bloorview Kids Rehabilitation Hospital.

There are many reasons that Julia Hanigsberg was drawn to a position in healthcare and she admits most of them have to do with family. Throughout her daughter’s life (born at just 29 weeks and now at 22), Julia and her family have been accessing many healthcare services that her daughter needed to be successful. Her admiration for the skill and resilience that healthcare providers bring to their jobs has grown since she joined Holland Bloorview, and today, as CEO, one of her key priorities is to break down barriers that get in their way and ensure that workers are supported and cared for. The stigma around youth and children with disabilities still exists, but under Julia’s leadership the hospital has taken a deliberate approach to reducing stigma that has made leading and modelling social change a part of their corporate strategy – the most visible element being a transformative anti-stigma campaign called Dear Everybody.



Ellen Gardner: Good afternoon. I'm Ellen Gardner. I work in marketing and communications at HIROC, and today we have the good fortune of speaking with Julia Hanigsberg, who is the CEO of Holland Bloorview Kids Rehabilitation Hospital. Welcome, Julia.

Julia Hanigsberg: Thank you so much.

Ellen Gardner: Julia, maybe I can start by asking you what did you think you were going to be when you were growing up?

Julia Hanigsberg: Well, interestingly, I actually wanted to be a pediatrician when I was a little kid. I guess I took a pretty circuitous route to get into the kids’ healthcare business. My kids like to tease me that I managed to run a hospital without ever taking organic chemistry. So that's kind of a trick.

I've got to tell you in all honesty, at a certain point I really didn't have a lot of self-confidence when it came to science, math. And I developed the view that I was more of an arts person and a words person. So that's where my education went. And of course in retrospect, I really regret that. Not so much my education, because my education has served me extremely well, but that I lacked that self-confidence. And that's part of the reason that I've become really passionate about STEM education for young people, for girls in particular. There's some specific stuff I do in the community that relates to that because I think right now in our current world, we all need those skills. We all need numeracy, we all need analytical skills. And I think there are a lot of kids who very early on in those middle school years lose their self-confidence. So that was me, and because that was me, I really see that as something valuable, and I spend a lot of time thinking about it.

Ellen Gardner: Well, you've found your confidence, Julia, through a very interesting and diverse career, just looking at your background. You spent 10 years in government. You were at Ryerson in various roles, including VP of Administration and Finance. And then in 2015 you came to Holland Bloorview. Those kinds of changes shows you have a real commitment to learning and challenging yourself. Has that been a driving force for you?

Julia Hanigsberg: Yes. I always say to people that I'm really curious. I was just talking to a bunch of kids yesterday for Take Your Kids to Work Day here at the hospital. And I said to them that one of the best things about being the CEO, if you're a really nosy person, is you get to nose around in everything.

And I do think I've been motivated by learning. One of the things I've discovered that I'm good at is learning new things. And that has served me well. But that interest in discovering new things, learning new things, finding the challenge in the opportunity, has definitely been something that, at least in retrospect when I look at my career, is a constant.

Ellen Gardner: Thinking about those kinds of career transitions, those are big changes you've made, it takes courage. How do you manage those kinds of big changes?

Julia Hanigsberg: I think there's an expression about luck being a combination of excellent preparation and hard work. That's very much how I feel about it. Whenever I've made these changes, I've really made a commitment to thinking about what do I know, what's the gap, and how am I going to fill it? As I've gotten older and more senior in my career, I think I've become even more deliberate about that.

So, to give you an example, when I was at Ryerson, and I moved from a general counsel role and secretary of the board to VP, Admin and Finance, one of the big parts of that job was we had half a billion dollars under capital development. And I honestly knew very little about that; I had six months get myself ready. I really thought about, what would it take to build the confidence of the President and more importantly, the Board that I could handle that degree of risk the organization was facing.

And so I put a plan in place and I brought in someone who was an expert, and on a weekly basis we went through everything I could possibly know. Then I ended up hiring her, which is a really smart thing to do because you build a team around you of the people who know more about certain things than you do. Having that thoughtful plan about what you need to know and putting people around you who can help with that, either in terms of your team or advisors and supporters – that kind of personal board of directors of people who can help support you through the change.

Ellen Gardner: Being able to say, “I'm not an expert in this and I need help. I'm going to turn to people who know more than me. I'm not scared to do that.”

Julia Hanigsberg: Yes, absolutely. I think that's one of the things that is probably a key leadership quality that I value in others, and that I think I epitomize myself, is that ability to know what you're good at and to know what you don't know, and to find those people who can fill that gap. That can be on your board if you're a CEO. It can be on your team across the board.

And the other thing I should say when we talk about those kind of big career changes. It helps to have a family that supports you and people around you in the rest of your life because all of us weave these threads of our life together. Our careers aren't the only things going on. You need people around you who can help you make those transitions.

Ellen Gardner: So I have to ask you, I know you spent some time at the Supreme Court, which must have been a very interesting experience. Can you just share a little bit about what that was like?

Julia Hanigsberg: I was incredibly fortunate to have the opportunity after law school to clerk at the Supreme Court for a year. It was truly a dream job. I can tell you that the first day of work, when I walked from my apartment in Ottawa, when I first saw the Supreme Court building coming over the vista, I burst into tears. It was so much a dream for me. It was like being drafted into the big leagues. And it was almost like summer camp for bright, young lawyers. You had 27 young people, graduates from law school, all gathered from around Canada who came for a year to be a part of this experience. We're all away from home and so we created these really close bonds and special friendships and relationships amongst all of our peers, but also with the judges for whom we clerked. So it was truly one of the most intellectually stimulating experiences of my life. I was really fortunate to also meet my husband there, who was clerking at the same time. So it was pivotal for my life in many different ways.

Ellen Gardner: Yes. I was going to ask you what you really took away from that experience, and it was a husband!

Julia Hanigsberg: There we go. Exactly.

Ellen Gardner: So maybe you can tell me then what drew you to healthcare, and then of course what brought you to Holland Bloorview.

Julia Hanigsberg: So many of us who end up in healthcare and committing ourselves to this field have something in our personal lives that has brought us to this point. For me, there are probably a few things, all of which relate to my family. As a young woman, I tried to get pregnant and realized I was infertile. Because we needed IVF to conceive our children there was a lot of contact with the health system. In my first pregnancy, my daughter, who's now 22, was born at 29 weeks gestation. She was a tiny little thing. We spent a lot of time in NICUs here in great hospitals in Toronto where we live. But we faced a lot of hard decisions and a lot of difficult moments in her trajectory.

Then on from there, she's a lovely young woman and has done very well. But she has a developmental disability and autism, and so over the course of her life we've been accessing many services that she needed to be successful. So I think we've had that personal experience of what healthcare brings to the lives of people, into the lives of families when it's at its best, when it's at less than its best. And I think those experiences have really helped me in my role here at Holland Bloorview.

Ellen Gardner: You had had exposure to the healthcare system through your daughter. But the discovery when you're here of the kinds of demands on staff, the kinds of pressures that go with these jobs, was that a surprise to you just how difficult these jobs are?

Julia Hanigsberg: Yes. I thought I had a good handle on it, but there's nothing like being in the space to really see it. One of the things I did when I started this role and that I've tried to keep up the habit of doing is spending time with clinicians – job shadowing them, spending time in clinics, spending time in therapy gyms to really make sure I'm staying close to the work. It’s a constant reminder to me of how human the job of being a healthcare professional is. Sometimes I find it hard to believe it's actually even a job. It is such an intensely personal interaction that clinicians are in with their patients, with their clients, their families. It is quite an amazing thing for people to be able to do day in and day out. I'm so admiring of the talents and the compassion that people bring to their work every day here.

And so my job is to figure out a way to care for them and help them to be resilient, and how I can break down barriers that might get in their way. We do talk a lot in healthcare, and it's a good thing we're talking a lot about wellness, a lot about mental health for our teams. But, often it's the system itself that's the biggest barrier to their wellness. And so what can we do to actually improve that system so that our deeply committed providers are able to do the kind of care that they want to do?

Ellen Gardner: I want to talk to you a little bit about Holland Bloorview. What struck me wasn't just the breadth of the programs, but the medical complexity of the range of conditions that you treat here when it comes to children and youth with disabilities, everything from brain injury to spinal cord to dental services. And you've said that managing that complexity means having an innovative mindset. How do you and your leadership team cultivate that whole culture of innovation and collaboration?

Julia Hanigsberg: Yes, I think it's really important. We've made it a priority. About three years ago we had a board retreat and the theme was innovation. We really wanted to address what would that mean, what is the leader's role in fostering innovation? Which is different than being innovative. A lot of people think that for innovation to happen you've got to be Steve Jobs. You've got to be some really creative type. You've got to be thinking about a new X or Y every day.

What we were really trying to tackle was, what is the leaders’ role in enabling innovation amongst your teams, particularly in healthcare? The innovation is going to mostly come from the frontline. It's mostly going to be coming from the point of care. So our job as leaders is less to be driving the innovation and more freeing up room for innovation.

So part of that is, how do you get rid of the impediments to innovation? Are there things that you put in place, bureaucratic impediments? Do you make it too hard for people to do things that are different? What does that look like? Are we as leaders open to hearing about new ideas? So, we actually developed some simulation training that gives leaders the opportunity to try out, what does a dialogue sound like with a member of your team who's coming to you with a new idea ... What are some of the things you would say that might shut down that conversation versus open that conversation?

We've developed a leadership training program called Achieving Innovative Mindsets. The neat thing about that is it's always driven by a particular problem that the leader is facing in their practice within in their team, so they're using the innovation training and the techniques as ways to actually solve live issues that they and their teams are working on. Bringing in tools like innovation jams where you bring lots of people from different disciplines together, from inside the organization and outside, to come and try to co-design a solution.

We've done a lot of work on co-design with patients and families. To take an example, we were looking at our hours of service. We wanted to expand our hours or service, and we had a million reasons why not to do it. Staff didn't want to do it. It would be too complicated. It would actually cost money, it wouldn't save money, any kind of reason. Interestingly, when we brought the teams together, as well as clients and families, we discovered we all had lots of myths about each other. We had myths about when families actually wanted to come for appointments. We had myths about what providers were and weren't willing to do, including, yes, I don't want to work every Saturday, but I'd work every fourth Saturday.

So, all sorts of ways that we could break down some myths. And to me, that was a really innovative way of approaching that problem.

Ellen Gardner: You and your leadership team developed a statement around risk appetite and risk tolerance with a focus on enterprise risk management. So there does seem to be a willingness to embrace risk. What's your approach to risk, and what do you see as one or two of the bigger risks facing Holland Bloorview right now?

Julia Hanigsberg: It was really a tremendous exercise. We developed a risk appetite statement, and it was actually driven from the board. We had a trustee who was really passionate about enterprise risk management. And we said, "Okay. We're going to spend a year." We spent a year doing this work. And it ended up being a phenomenal education for our leadership, for our senior management team and our broader leadership group. Because what we realized is, we actually were taking on new risks, but we weren't talking about them that way. We weren't thinking about them in terms of the taxonomy and our enterprise risk management structure. And so the educational piece about saying, “What is our tolerance, where is it different?” and then to develop that statement and to really identify what are our top risks, and to make sure we're talking about them. That was incredibly valuable. Ultimately, we decided that there were certain areas where we actually were willing to take on moderate risk.

So in the area of patient acuity, new complex populations, we're willing to take on greater risk. We're willing to take on new populations that the system was saying to us needed service. We were never willing to increase our risk tolerance around safety and quality. We were going to maintain a low-risk tolerance. The other place we moved our tolerance to moderate was around research and expansion of research.

We got ourselves really clear on that. And then we did the exercise of identifying with our teams what are our top four risks, and not surprisingly, the number one risk is acuity and complexity of our patient populations. So, it was a great thing to nail down and to be really clear with ourselves about.

The second one was around technology, cyber security. We're all so dependent on technology in all of our work, our electronic health records, etc., so it's a great one to stay on top of. Our third one was around people, our human resources, the capabilities. As we think about more complex populations, do we have the leadership, do we have the teams that have the competency for what we're serving and who we're serving? And then the fourth one was around expansion of research.

So to be clear about that in our own minds I think really helps us and gives us that ability to think, are we talking about the right things, thinking about the right things? If we haven't spoken about one of these risks recently, then we're probably not paying attention. And I can tell you, I'm thinking about them every day. We're talking about them a lot. So it really has helped us a great deal.

To be innovative, you have to be willing to take on risk. And that was really the important learning of developing the risk appetite statement. We had always said we're really low-risk tolerance. And then we said, "No, we're willing to move our risk tolerance to moderate in some of these areas." I think that you want to of course be monitoring your risks. You want to have systems in place that give you comfort, that you understand those risks, are developing mitigation plans, and preemptively determining where you need to go.

But you also need to be confident enough that you've got a team that's nimble and flexible and can address issues when they come to you. And I think sometimes people feel like the risk process is actually an impediment to being innovative, and it can actually stop them from being creative in their role and can be quite overwhelming.

I think it’s finding that balance. That’s an important role for leadership, to help the organization overall and teams to feel that balance between of course we're going to be concerned about risk and we've very focused on patient safety, very focused on quality, but that doesn't mean we can't do something new.

Ellen Gardner: Maybe you can expand on that a little bit and tell me why research is so important for improving the lives of youth and children with disabilities?

Julia Hanigsberg: All patients should have the right to research in the areas of their healthcare. If you think about it in other areas, it may be a bit more familiar to people. If you have a difficult cancer diagnosis, a rare cancer, you want to be treated in an academic health science center where you know the most advanced research is happening. You want access to clinical trials if you need them.

I think about it exactly the same way for kids with disabilities and medical complexity. Their needs, their conditions have been under-scrutinized. There hasn't been enough research done. There's so much we don't know. And that's the fascinating thing. When I first got here one of the things that I found the most interesting is, whenever I'd be at the research symposium or a research presentation, I was always surprised by what we didn't know, what was still in the process of discovery.

To take an example: our concussion center is doing some really groundbreaking research on concussion in the developing brain because most of the research that's been done has been done on adult brains. So if you think of the NFL, you think of varsity athletes in college. That's where a lot of the research was done. So we were using treatments or expecting kids to progress based on evidence that was on developed adult brains and not on youth brains. That research is really critically important because what the teams are discovering is that the approaches we have taken to those concussions, those brain injuries, has not fully taken into consideration the nuances of that developing brain. This is really important work.

Autism is another great example. Our Autism Research Centre is a world-class centre. They are understanding everything about this important condition with its high prevalence, working across networks internationally, everything from basic science and genomics. What we're understanding is there is a lot of complexity, the genetic story behind autism, to treatments, and really trying to understand what's going on in the brain of a child who is diagnosed on the autism spectrum.

So that research is also really important. And then the other thing that's so important is the applied nature of our research. So we have scientists, researchers, engineers, who are developing solutions to enable families and to enable children to have better functional lives, more enjoyment of their lives. So whether that’s accessing technology to enable children with very severe physical disabilities to actually be able to communicate where they otherwise wouldn't be; whether it's the anxiety meter designed for young people with autism to allow them to monitor their own anxiety. These are things which have a really palpable and immediate impact on people's lives. So it's that combination of research which I find really exciting.

Gamification…to enable kids to be more compliant with therapy. We all know that therapy can be painful and not always that fun. If you can create a video game as one of our scientists has done that allows a therapist to program the therapy needs in the back end of the video game and the kid is just playing. That'll make a big difference. So there are all these kinds of things that are just so interesting and so much fun.

Ellen Gardner: In your blog, Julia, you write that children and youth with disabilities are two to three times more likely to be bullied and that 53% of youth with disability are more likely to have zero close friends or even one close friend. You call this the shadow of stigma. It's amazing in these times that that shadow still exists. And I just wonder why have we as a society not done better in dealing with the stigma around youth and disability? And then, of course, you probably get asked this all the time, but what should we be doing about it?

Julia Hanigsberg: So I think a couple things. I think that young people and people with disabilities were invisible in society for a very long time. It's only in our recent lifetimes, in our adult lifetimes that we have de-institutionalized people with disabilities and taken a community living approach, an approach of inclusion and assumption that people with disabilities will live with their families in their communities. That's all pretty recent history.

I think also that people are afraid of what they don't understand and what they don't know. And so a lot of what comes out as stigma, what comes out as prejudice is ignorance. So the approach we've taken has been one not of judgment, but of education and understanding. We’ve been quite deliberate. And in our new strategy, we actually made leading and modeling social change a part of our strategy. We take the position that we can do a tremendous amount for children and young people within the four walls of Holland Bloorview. But we can't truly make the transformative difference we want to in their lives unless the world starts to change too.

So we've created that as part of our mission, and we've launched an anti-stigma campaign called Dear Everybody. And the point of that is to give children and youth the opportunity to tell the world what they wished everybody knew about them. It really is Holland Bloorview merely being the amplifier for those voices, and the vehicle by which they get to carry out their message.

So a lot of our message is, don't define me by my disability. I'm all sorts of things that are a lot more and a lot different from my diagnosis. And it's really giving people access to the stories of young people with disability. So the website is deareverybody.ca. There's a great social media campaign that goes with it. And you get to see wonderful stories directly firsthand from kids. And the other thing that's really useful there is really concrete and practical tips.

If you're a parent who wants to have an inclusive birthday party where every child in the class is going to feel welcome, there is a sheet in there that will explain that to you, information for teachers on how to build inclusive classroom activities. Colouring sheets that are inclusive. Resources in terms of stories and books and novels that feature people with disabilities. So we're really trying to bring an educational perspective to say this is everybody's job.

Now speaking of jobs, the other thing we know about people with disabilities is they're vastly underemployed. And there are direct things that people can do about that. They can think about the accessibility of their workplaces and be a part of it, enhancing that accessibility. They can think about whether they're hiring people with disabilities, and what it would take to do that. And that's something we do very actively. We're very fortunate we have a tremendous amount of community support through our hospital foundation. And when we work with sponsors and supporters and donors, we also want to make sure they embrace our values.

We're always having a conversation with them as well about their workplaces. So it's not just about write us a cheque – we like the cheques – but it's also about are you embracing our values and how can we help you? How can we help you become a better employer of people with disabilities And we find that for many of the corporations we work with, they love that perspective. They love being part of something, and they really have taken concrete steps to make employment of people with disabilities a more pressing priority.

The latest thing we did as part of the Dear Everybody campaign that we think is quite exciting is working with our pro bono ad agency that has been so generous in its time with us. We're working with the advertising industry and with companies that buy consumer-facing advertising to include people with disabilities in their ads. So if you see the proportion of people with disabilities in Canada is around 17-18%, we want them all to take on the responsibility for having that same proportion of people with disabilities in their advertising.

Think about it in terms of visibility. So you'll see more people with disabilities around you all the time in advertising, which we consume all the time everywhere. It's also employment for people with disabilities because they've got to be in those ads. We think it's a really easy opportunity for corporate Canada to make a different in the lives of people with disabilities.

Ellen Gardner: Julia, I'm sure that a big part of the treatment of children and youth here has to do with helping them build confidence in themselves. How do you see that play out in the halls of Holland Bloorview every day?

Julia Hanigsberg: You know, a huge part of what we think is important for children is their development of their own self-advocacy. They're going to need those skills their entire lives. And so we see that growing in children. We foster that. We want kids to be independent. We're trying to think about things like making sure that they're the ones asking for services. They're the ones contributing to saying what their goals are. It's not just mom or dad speaking for them.

They have to develop that ability. They're going to be advocating for themselves in school, in the workplace, and everywhere else. So the more that we can be part of that journey for them, the better off they are. So absolutely, it's a really important part of our work.

The worst thing you can see is when a child loses that self-confidence. And it happens. And it sometimes happens because of what we do in healthcare. We're not always good at enabling children to feel confident, to feel that they're respected and their voices are truly being heard. If a child tells us they have pain and we don't respond to that, we're telling them what you say doesn't matter. We don't believe you. So we see that too, and then we have to work hard with families to rebuild that.

Sometimes we're not always the best. We try hard, but we're not always best at doing that. I love that you asked about that because it's one of the greatest things when you come through the doors at Holland Bloorview and you wander through these halls. You see kids who are smiling and happy and achieving new things, and making their dreams come true in all sorts of different ways. It's a very, very happy place. It's a really happy place.

I'll tell you one of my favorite stories of a confident child. Not long after I started here in my first couple of months, I had met a young woman, a young girl. I think she was about seven years old at time. Even younger, six. And we'd met in the course of our orientation. So one day she just comes into my office. She just wanders in and says, "I have to talk to you." "Okay. What's up?" She says, "Well, I don't know what you've done here, but I was just having lunch and the chicken fingers are terrible."

So I thought to myself, "Holy smokes. We're a children's hospital. If we can't get chicken fingers right, there is going to be trouble in this place!" So I said, "Thank you for letting me know, Gillian. I will take it up with the folks down in food services." Which I did. Of course her mother's down the hall, dying. She's probably about three different shades of purple because she's so embarrassed! But it was the most phenomenal thing. And I loved it. Once in a while I tell Gillian, who's now older, this story and she gets quite embarrassed. She knows it's one of my favorite stories that I tell about her.

But to me, it's the perfect example of how we want every child to feel. We want every young person to feel like they know what their needs, they know who to ask if their needs aren't being met. They do it in a way that's respectful, but that's also clear, and then we can do our best to do what we can to help them meet those needs. So yes, self-advocacy is a very important skill here at Holland Bloorview.

Ellen Gardner: Julia, I want to ask you a little bit about your leadership style and if you can think about a difficult moment in your career.

Julia Hanigsberg: Like all of us, there have been several of those. There are a couple of things that I could think of off the top. There was a period of my life where I had one of my great jobs, I've had many great jobs in my career. And I was chief of staff to the Attorney General of Ontario, and I had said I'd do that job for six months. And two years in, I was still there. I had twins who were four years old, and an older daughter who was eight. I was working 18 hours days pretty consistently. I knew it was not a feasible lifestyle to continue. But it was a tremendous job, and I loved it. I loved my work. I loved my family. And I had to make a choice. And the choice I made was that the job was not going to be able to continue.

So it was a tough decision to make. I was fortunate. I had people around me professionally who supported me in making that decision. Again, I had a wonderful family that allowed me to do that job for as long as I had, and was prepared to support me through the transition. It was a bit of a leap of faith because I left that job without anything to go to. But I was really fortunate I was able to be a visiting professor for six months, and that gave me a wonderful collegial atmosphere to think about my next steps. And then I spent six months talking to a huge number of people. People are so generous with their time and sharing their experiences, and their advice. It actually ended up being a really pivotal moment in my career and it led to lots of great opportunities.

Ellen Gardner: What have been your priorities as CEO, and what do you feel has changed for you in the time you've been here?

Julia Hanigsberg: When I started,my key priority was learning. You start a new job as a CEO and people say, "What's your vision for Holland Bloorview?"

And I would always say, "I don't have a vision for Holland Bloorview. Holland Bloorview has a vision for Holland Bloorview. I'm here to learn from you about what you do and understand what makes you tick and makes this organization as great as it is." So in the beginning my priority was about being open, being invested in the understanding of what every single person in this extraordinary organization does. My priority is always the people who work here and thinking about what they need to do their jobs well. My priority is the clients and families. They are at the centre of everything we do and making sure that we never lose track of that.

We've talked about the care we give in this hospital. We've talked about research. The “connect the system” part is really important. As a healthcare CEO, a lot of what you're doing is trying to knit together this thing we call a healthcare system. And I can tell you, honestly, I'm clearly a slow learner. For about the first 18 months I was in this job, I kept thinking someday I will find this healthcare system of which we all speak. I finally realized, there really is no “there, there”. The healthcare system is all of us. It's all of these organizations working hard together, passionate people, passionate leaders, devoted volunteers, incredible supporters. And we knit it together every single day, one provider at a time, one child, one patient at a time.

Recently I saw a short film, it was very impactful. It's a story about a young man in Alberta who died an entirely preventable death because of health system failure. And I came back and we happened to have a leadership forum that day. So I came back and the first thing I said when I greeted the leaders was that I think sometimes when we talk about connect the system as one of our strategic impact areas, I wonder if some people think that's what Julia does, and what vice presidents do. They're out there. That's the system, that's what they work on.

And what I really emphasize to them is that it’s them every day – whether it's following up on a test result, calling up a referring physician to understand the referral, making sure that that next step is in place for the social worker who is knitting together the home care as we're planning a discharge. That is the healthcare system. It's in every moment, it's in every interaction. It's not something outside of us. It's something that we have to do every day. And every single person who works in healthcare is responsible for it.

Ellen Gardner: So it's not a job that gets easier with time, Julia.

Julia Hanigsberg: I think it's a job that gets harder with time. I honestly think the more you know, the more you realize there is to do, but it is also a job that never stops fascinating. I pinch myself every day that I get paid for this. There's so much to learn. I am surrounded by people who are transformative in their thinking, who are literally changing lives every day, and I get to be a part of that. It's a tremendous honour. It is really and truly service. I can't imagine that anybody does this work for any reason other than service.

It gives me great confidence in our healthcare when I observe the people who work in healthcare in my organization, in other organizations with which we partner, among the leadership tables where I sit with other CEOs. And I'm always just so full of hope for what we all do collectively because we are passionate people. We're people who are trying really hard to make it better every day, and we're people who really care about doing it well.

Ellen Gardner: It's just great that you've embraced Twitter. And when you joined it, you said you wanted to be able to have an open door to more people than could cross your threshold of your office. And why? Well, to build those relationships. So has it happened that way for you?

Julia Hanigsberg: Yes, absolutely. It started before I came here. I started on Twitter when I was at Ryerson University. In fact, what I did was I brought some students together to explain to me how to do it because I figured they would know better than I would, which of course they did. So that was great. I had these reverse mentors who were helping me to understand things I needed to know to be able to serve them and their needs better. And then it was a great bridge to Holland Bloorview. It was a great bridge to colleagues in healthcare, to research. There are scientists who I met for the first time over Twitter, and then I'd be at a conference and they'd come up to me. They feel like they know you. Right away, you've accelerated the relationship. You're friends already. I get so much valuable information, and I'm able to make connections and contacts. Truly for me, it's been a wonderful vehicle for expanding the circle much more than I could do in person.

Ellen Gardner: It's been such a pleasure talking to you, Julia. It's a tough job, but you're making a big difference in the lives of children and youth with disabilities, and just in terms of the atmosphere here at Holland Bloorview. Great chatting with you.

Julia Hanigsberg: Thank you so much. It's been a pleasure.