Review of Niagara Health’s Physician Group

Our work to implement the recommendations identified in the Review of Niagara Health’s Physician Group.
In response to concerns raised by the Medical Staff Association, Niagara Health commissioned an independent review by Rubin Thomlinson LLP. While the report did not make factual findings on the allegations of systemic discrimination, it identified important opportunities to strengthen our clinical governance, policies and practices.

Building on this foundational work, Niagara Health physicians and administrators came together through the Physician Review Working Group to review and prioritize the recommendations from the report. These were then integrated with additional recommendations from a separate review of our Clinical Governance structure to form a consolidated set of priorities for the Joint Implementation Working Group (JIWG). The JIWG — made up of Niagara Health physicians and staff — made meaningful progress in promoting fairness, transparency and equity in how we work together.

Actions completed

Hiring, Promotion and Advancement
We have modernized our professional staff recruitment practices, made by-law amendments and began aligning succession planning with a proposed education strategy to support career growth of our professional staff.

Supportive Workplace Environment
A new Statement of Fairness has been introduced to help protect career progression during pregnancy leaves, parental leaves and other leaves of absence for professional staff. We’ve also updated relevant policies, introduced dedicated breastfeeding spaces and launched educational initiatives to help foster a safe, inclusive and supportive environment for all professional staff.

Enhancing Interpersonal Reporting and Support
We refreshed our education and support for navigating interpersonal conflict between professional staff members and their peers. We streamlined how physicians report interpersonal conflicts that could not be self-resolved and provided training sessions to professional staff for these processes. We also created a helpful guidebook for professional staff to refer back to when needed.

Strengthening Leadership
Role descriptions for chiefs and heads of service have been refreshed. We’ve also updated our leadership development processes including updating our leadership onboarding process and have provided ongoing training and education to our current leaders to support their success in their roles. Recruitment for a Deputy Chief of Staff is underway.

Ongoing work and next steps
These initiatives reflect our shared belief that supporting a culture of continuous improvement is not a one-time project but a sustained commitment. Niagara Health is committed to continuing to refine and evolve this work based on ongoing feedback and changing needs. We continue to focus on:

• Developing scorecards for Department Chiefs with the eventual application to every member of our professional staff to support continual growth and improvement.
• Ongoing education and training to our Professional Staff to support awareness of guidelines, policies and procedures that guide our work and interpersonal interactions.
• Engaging our professional staff to support two-way communication and highlight awareness of our ongoing efforts that support our clinical governance, policies and practices.
• Demonstrating our commitment to living in line with our values. This includes our commitment to supporting our teams to have difficult conversations and holding our teams accountable for demonstrating our values and commitments.

Our commitment
Niagara Health is committed to continuous improvement and fostering a more inclusive and supportive environment for all professional staff. We remain dedicated to transparency, collaboration and open dialogue as we continue to evolve together.

Updated: June 2025

In response to concerns raised by the Medical Staff Association, Niagara Health commissioned an independent review by Rubin Thomlinson LLP. While the report did not make factual findings on the allegations of systemic discrimination, it identified important opportunities to strengthen our clinical governance, policies and practices.

Building on this foundational work, Niagara Health physicians and administrators came together through the Physician Review Working Group to review and prioritize the recommendations from the report. These were then integrated with additional recommendations from a separate review of our Clinical Governance structure to form a consolidated set of priorities for the Joint Implementation Working Group (JIWG). Over the past year, the JIWG — made up of Niagara Health physicians and staff — has made meaningful progress in promoting fairness, transparency and equity in how we work together.

Key advancements include modernizing recruitment and succession planning processes, introducing a Statement of Fairness to support parental leave, piloting a revised incident reporting system for professional staff, enhancing peer-led supports, and strengthening leadership roles and development.

This work reflects our ongoing commitment to continuous improvement and fostering a more inclusive and supportive environment for all professional staff. We remain dedicated to transparency, collaboration and open dialogue as we continue to evolve this work together.

August 2023

Niagara Health commissioned a third-party independent review after the Medical Staff Association brought forward allegations of systemic discrimination within our physician group. While the report – conducted by Rubin Thomlinson LLP – didn’t make any factual findings on the allegations, it did identify opportunities for improvement within our clinical governance, policies and processes. A working group is being set up to review the recommendations and develop a plan for implementation.

View the report here.