The Quintessential Game Changer
How Dr. Geoff Fernie helped turn a small rehabilitation institute into a world-leading research centre
In 2003, Dr. Geoff Fernie had what he admits was a wild idea: convert a smallish hole, destined to be a parking garage, underneath University Avenue in Toronto into a massive opening that could house four large research labs. At the time, Dr. Fernie was the Director for the Centre for Studies in Aging at Sunnybrook, while KITE, which was then called the Toronto Rehab Research Institute, was just in its infancy.
When he proposed the concept to the leadership team at Toronto Rehab – the hole would contain four large cylindrical structures where KITE's growing stable of scientists could conduct their research – they were skeptical. "They said, 'Well, if you dig a big hole under this hospital, it will sink because it's on a raft floating over Taddle Creek,'" Dr. Fernie jokes, referring to the underground river that runs beneath University Avenue. Then, he deadpans, "You could actually fish in Taddle Creek from the lab today, if you wanted. But I wouldn't eat the fish you caught."
Fortunately for Dr. Fernie, who spent 15 years as Research Director at KITE and is currently the Creaghan Family Chair in Prevention and Healthcare Technologies, it didn't take much to convince Mark Rochon, then CEO of Toronto Rehab, that having these labs – simulators that would mimic everything from weather and driving to conditions to help researchers study accidents accurately – was a good idea. "Sure, there was an issue that had to be dealt with," recalls Rochon, "but it wasn't anywhere near a showstopper."
It was then that the Toronto Rehab Research Institute, renamed KITE in 2019, started becoming the world-leading rehabilitation research institute that it is today. The centre's evolution is also a result of strong leadership, generous funding and smart scientists and clinicians, but the institute wouldn't be what it is today without Dr. Geoff Fernie.
We spoke with Dr. Fernie, Mark Rochon, research associate Pam Holliday and postdoctoral student-turned-scientist Dr. Alison Novak to find out how KITE – which is an acronym for Knowledge, Innovation, Talent, Everywhere – came to be.
In the beginning: Toronto Rehab is born
Mark Rochon: I started in late 1998 as CEO of Toronto Rehab, and our research efforts were quite small. There were a number of academic enterprises in post-acute care and rehabilitation, but none of them had sufficient critical mass to really push education and research alongside a clinical mandate. We needed an organization with significant clinical heft to be able to create a world-class research institute.
Before merging, Toronto Rehab was four different organizations: Hillcrest Hospital, the Queen Elizabeth Hospital, Lyndhurst Hospital and the Toronto Rehabilitation Centre. We were all post-acute organizations, none of which were large enough to offer much funding for scientists. One of the major reasons behind the amalgamation was the desire to create an organization with sufficient scale to support the development of a major academic enterprise with a focus on post-acute care.
Essentially, we started the Toronto Rehab Institute in 1998, while our leap into research began when we hired Dr. Jack Williams as our first research director. He retired two years later, so we engaged in an international search for his successor and Geoff Fernie was one of many candidates.
One of the things that impressed me about Geoff was his understanding of what we were trying to accomplish – the long-range goal for Toronto Rehab to become a crucial hub for rehabilitation innovation – and the importance of research in furthering our mission.
Dr. Fernie's path to Toronto Rehab
Geoff: I always loved making things; I loved engineering. When I was in the final summer for my first degree, my advisor sent me to a special school in the south of England in the countryside, Chailey Heritage, that provided a living environment for kids with disabilities and also was a hospital.
I was assigned to look after kids whose moms had taken the drug thalidomide (a drug pregnant women were prescribed to combat morning sickness, which was later found to impact neonatal development). They had lost typically two or four limbs, with a lot of other complications as well. They were about seven years old, and had a lot of courage – I absolutely loved being with them.
A wealthy woman had financed a workshop at the school, hiring an engineer and a technician to attempt to create powered prosthetic limbs for these children, and I was their first undergraduate student. They gave me a converted office as a bedroom, and it was an incredible experience. I would get up in the middle of the night to help the nurses change beds and really lived in the thick of it. I tried to work with prostheses for these children and saw some of the operations on them, and thought, “Wow, this is what I want to do.”
I was really taken by the fact that engineering was the only way that these kids were going to get a more reasonable life, so I applied to the PhD in bioengineering program at Strathclyde University, in Scotland.
At that time in the U.K., it was necessary, once you got your doctorate, to spend some time in North America, and get what was a BTA, a “Been To America” qualification. Of course, when I came to North America I never went back. I originally chose a job in Toronto at the Ontario Crippled Children's Centre because it looked intriguing.
But a week before I came here, the scientist who was in charge lost his grant, leaving me without a job. Thankfully he connected me with an orthopedic surgeon from Toronto Western Hospital, Dr. John Kostuik, who wanted to establish an amputee centre, and he hired me literally four days before I left England and came here.
Pam Holliday: Geoff was looking for a research assistant not too long after he arrived in Toronto. He was working at Toronto Western Hospital and they had money to do some projects related to amputee management and care at West Park Hospital, nearby. I actually don't think I ever had an interview! He was doing rounds when I met him and he kind of tested my balance by, you know, pushing me to see whether I recovered. Then he said, “Yeah that's good. You'll do,” and away we went. So that's how I started working with him on balance in the amputee program, in 1975, and we've worked together ever since.
Geoff: The long-term patients at West Park weren't getting much activity, and there was a lot of incontinence and a lot of falls. I thought these were under-researched areas, and we should do something about them. That's how we ended up focusing on balance and aging. Then in 1986, I got a visit from the CEO of Sunnybrook, who asked me to help start a Centre for Studies in Aging. So, I went there along with my team.
At Sunnybrook, I realized that you aren't going to solve these problems by treating people after they've fallen over. It's too late. We had to prevent problems. I needed to build a laboratory that would allow me to study things like falling over in winter, pedestrians having problems on the street with traffic, elderly drivers getting into trouble, people falling down stairs or falling in bathrooms. That's when I got the invitation to meet with Mark.
Mark: What Geoff brought to Toronto Rehab was a deep history with, and experience in, research and development work that made a real difference to patients and caregivers. He also had a vision for evolving the research enterprise at Toronto Rehab into the organization that you see today. It was great. It was one of the parts of my job that I enjoyed a lot – working with him and helping to create this extraordinary facility.
Pam: When we joined Toronto Rehab in 2003, we were the technology team. We supported all the other teams because we had the expertise to make prototypes to conduct research and test solutions. Our staff had expertise in machining, electronics, industrial design, plastics, cardboard and wood.
Geoff's hands-on experience is really quite broad – much more than any one member of the team. He's quite incredible in terms of his knowledge of surgery, biochemistry, the basic sciences as well as engineering, math, biomechanics, his area of formal study.
Building a state-of-the-art research facility
Mark: In 2001, I negotiated an annual $3-million grant for research purposes with the province of Ontario, and the Toronto Rehab Foundation added to that. We used that money to attract researchers to come to Toronto Rehab and investigate new treatments and technologies that might help people living with life-altering disease or injury.
Geoff: Mark was CEO of Toronto Rehab when I came on – a lovely, incredibly bright and very kind-hearted, enthusiastic guy – and without his support, none of the expansion would have been possible. His leadership was essential for modernizing TRI.
Mark: Together, we created a different focus for the research side of Toronto Rehab that not only looked at the efficacy of various treatment approaches but really asked the question of how we can make lives better for people experiencing life-altering disease, through the application of technology.
We had this idea to create a simulation laboratory as an anchor of the research efforts at TRI that would attract scientists, grad students and researchers to the facility.
Geoff: I wanted to create a motion base for a very sophisticated simulator and various environments that we could swap onto it – no one had done this before. We needed to be underground and we needed quite a high ceiling for cranes to move equipment around.
I think it started off with the Toronto Rehab team teasing me – they unrolled a piece of paper and said, “Well we could lose this broom closet here and we could move that broom closet to make a bit of space there,” and my heart sank. Then they swept those papers off the table and said, “Or we could build a new hospital.” That was fantastic, but we needed to raise the money to build this great big bloody hole in the ground, which was huge.
Mark: This coincided with the redevelopment of the University Avenue site of Toronto Rehab. And so, we were able to use that construction project to create a space that was purpose-built for the simulation laboratory Geoff wanted, with research spaces on the upper floors of TRI.
Funding a new facility
Geoff: We wrote a number of grants in order to get the funding to build the new Toronto Rehab Institute. No one had ever asked for this kind of money in rehabilitation before.
Mark Rochon: Part of the challenge of securing funding is that rehabilitation, in some people's eyes, doesn't have the same kind of allure as other elements of the healthcare system. We were successful in attracting funding from the Canada Foundation for Innovation, and the province of Ontario had a matching program. Then the Toronto Rehab Foundation raised the rest.
Pam: It was really quite amazing to be part of the development of this new research facility because, truly, you don't find that kind of equipment in a rehab facility. In the hierarchy of medical research, you look at kids research, you look at cancer research and you look at transplants – all those things are glitzy. But credit to Geoff's vision, we have the most sophisticated labs, and, certainly in rehab, there's nowhere in the world that could do what we do.
Mark: One of the important markers of success is the extent to which what you learn and what you discover is shared and taken up elsewhere. It's not good enough just to do it in-house. So, we went from, essentially, not much happening in the research sphere to this extraordinary facility as a consequence of those key ingredients: money, great people, space, equipment and relationships.
The importance of research
Pam: Once we opened up those labs, part of the process was building the science base, the network to use the facilities. So, setting the groundwork for people to come in and collaborate on research projects, collect data and even manage their data elsewhere.
Alison: I started at KITE as a postdoctoral research fellow, working with Geoff. I had done all my doctoral work on understanding stair ambulation and people who have had a stroke, and Geoff had a big vision for understanding and preventing stair falls. So it was really good timing that a PhD who had expertise in stair gait analysis was interested in Toronto Rehab, because they had this big lab called Stair Lab that they needed someone to conduct research in. So that's how I came to be recruited there.
KITE by the numbers
- 128 Principal Investigators
- 175 Trainees
- 175 staff
- $28 million in annual funding
- 687 peer-reviewed papers (2021)
Geoff: I really feel strongly that the best way to address falls is to make sure that people are wearing footwear that won't slip in certain conditions and won't encourage tripping. Also, the environment has the right handrails, stair railings and things to minimize the chance of falls.
Mark: Geoff's fingerprints are all over what you see today at KITE. What we were able to do with him was create a different focus for the research enterprise that not only looked at the efficacy of various treatment approaches, and so forth, but really asked questions about how we can make lives better through the application of technology for people experiencing life-altering disease.
Mentoring the next generation
Alison: He started off as my postdoctoral research supervisor. And then, as I transitioned into a scientist role at KITE, Geoff was the Institute Director at the time. He informally served as my mentor, as I started out in my research career.
The biggest thing that Geoff did for me specifically was set me up for success in terms of developing my research program and aligning me with his contacts
A lot of my work is to redefine or to provide evidence to support building codes and building development, and as a mentor Geoff was exceptional at identifying where my expertise would be critical to their processes and just supporting me, as a new scientist, to get involved in those circles and in that industry.
He was the best academic businessman I've ever met. It's rare, because we as academics are not trained to sell ourselves. So that was one thing Geoff really excelled at and instilled in all of us as trainees, master's students, PhD postdocs and then scientists.
A success story
Mark: In order to be successful in the research game, you need three or four key ingredients, or you'll be wasting your time. You need money, you need people, you need space and you need equipment. Absent any of those, you will not succeed.
Pam: Our research has always been not just understanding what's going on – the biomechanics of what happens to balance, for instance – but simultaneously looking at what we can do about it. What are we going to get out of this? Are we going to change the way we do therapies? Do we have a new product? An improved way to make an artificial limb? Or can we change policies, regulations, codes, those kinds of things?
That's what it's really all about: we can make a difference, we know we can. And there's more to do. We're examining how to improve the big picture in health care, where the focus should be, and of course our responsibility to ensure the work we do gets out there, makes a difference and is implemented in some way.
Geoff: We get feedback all the time about the results of research we've been conducting. We've changed building codes in Canada and we're about to change more of them. We produce more publications at KITE than anywhere in the world. And not only do we write more, we actually have more impact than any other rehab research facility – the research that we do actually changes things. So I don't think there's a week that goes by without me feeling good about something we've accomplished.
I'm finally starting to decrease some of my workload, but I'm still involved in a lot of interesting things. I've handed over some of my projects – Alison Novak is running the StairLab extremely well. I've been guiding the formation of a national network, headquartered out of Toronto Rehab, called the PATH, an assistive technology meant to diagnose older people and provide care for them at home.
I've also been a passionate advocate of hand hygiene for 20 years, working on ways to increase the rates of handwashing in hospitals. I worry about the future challenges of infection – over 100,000 patients in North America die annually of infections they catch in hospital, even when there isn't a pandemic happening. It's even higher in long-term care homes.
Lastly, I'm involved in starting some new methods of caring for people in Ontario that are quite exciting but too early to talk about.
Mark: Toronto Rehab is about knitting together research, education and care in a way that will improve not only what happens to individuals who come through here but the extent to which we can transfer what we've learned and our knowledge to other providers. Geoff's legacy is one that's really related to the positive outcomes people experience in their lives: helping people live their lives to the fullest following life-altering disease or illness.
This story is part of The Game Changers, a storytelling campaign featuring some of the groundbreaking research, innovative ideas and incredible people we have working behind the scenes to redefine the future of rehab at UHN. The series will run monthly through the rest of 2022 putting a spotlight on every corner of KITE, from our trainees, staff and scientists, to our labs, clinics and even the operating room.