Emergency Department External Assessment

Our work to implement the Emergency Department Assessment Panel recommendations

Niagara Health accepted all recommendations from the Emergency Department Assessment Panel. Implementing them is a Niagara Health responsibility.

Our Indigenous Health Services and Reconciliation (IHSR) team provides guidance and support across this work. Accountability for action sits with the organization as a whole.

Cultural safety is not a checklist or a one‑time initiative. This is long‑term, system‑wide work that requires sustained leadership, education, accountability and partnership with Indigenous communities.

Heather Winterstein’s death was a tragedy. We acknowledge the broader and ongoing concerns about racism and bias in healthcare, including within hospital settings. Niagara Health remains committed to confronting these realities and making meaningful and lasting improvements.

Actions completed and underway

Education and culture change

Mandatory and recommended cultural safety education has expanded for staff, physicians and learners. This includes San’yas Indigenous Cultural Safety training, 4 Seasons of Reconciliation and cultural humility learning modules and anti-Indigenous racism and discrimination education aimed at leaders who work in and support our Emergency Departments. This education is being embedded into orientation and ongoing professional development.

Indigenous spaces

The Gathering of Good Minds space has opened at the Marotta Family Hospital. Planning is underway for dedicated Indigenous spaces at the South Niagara Hospital to support ceremony, reflection and culturally grounded care.

Patient and family support

Niagara Health supported the development of the Indigenous Health Services and Reconciliation team. The Indigenous Health Services and Reconciliation team supports Indigenous patients and families by providing patient advocacy, support for informed healthcare decisions, access to traditional ceremonies and medicines, help navigating communication with care teams, discharge planning and connection to community supports and advocacy for rights of passage. Read more about their work on the team’s webpage.

Welcoming environments

Indigenous artwork and visual displays are now present in Emergency Departments, urgent care centres and outpatient mental health areas across all five Niagara Health sites. This work continues as spaces are renovated or refreshed.

Partnerships and care pathways

Niagara Health was the first hospital in Ontario to sign a relationship agreement with the Indigenous Primary Health Care Council. The IHSR team works closely with partners including De dwa da dehs nye Aboriginal Health Centre and NPAAMB Indigenous Youth and Employment Training to strengthen access to primary care, support transitions out of hospital, create career pathways and host Indigenous student placements.

Representation and workforce

Work is underway to increase Indigenous representation on advisory and decision‑making bodies, including through an Indigenous patient partner program. Niagara Health is also developing strategies to recruit and retain Indigenous employees, physicians and volunteers.

Policy and accountability

Niagara Health has developed smudging guidelines and continues work on culturally grounded reporting processes. Data initiatives are being developed in alignment with Indigenous data sovereignty principles to ensure information is collected and used respectfully and appropriately.

Community engagement and accountability

Niagara Health leaders attended a healing ceremony hosted by Heather Winterstein’s family. The IHSR team sponsored a jingle dress dance in Heather’s honour at Brock University’s first annual powwow, recognizing the cultural and healing significance of the jingle dress for her and her family.

Ongoing work and next steps

Implementation of the Panel’s recommendations is ongoing. Current priorities include:

• Continuing to embed cultural safety expectations into leadership practice and accountability structures
• Introducing a draft anti‑Indigenous racism policy, aligned with Niagara Health’s mutually respectful workplace and diversity policy, to strengthen accountability and improve how racism and discrimination are identified, reported and addressed across the organization
• Advancing work to support Indigenous self‑identification and data collection, including staff training, transparent communication and governance structures to guide implementation
• Expanding Indigenous patient partnership and feedback mechanisms
• Strengthening data and reporting processes to better identify barriers and measure change
• Advancing Indigenous workforce recruitment and retention strategies
• Sustaining long‑term partnerships with Indigenous organizations and communities

This work will continue to evolve as we learn from Indigenous partners, patients and families.

Our commitment

Niagara Health is committed to steady and transparent progress. With guidance from Indigenous partners and the Indigenous Health Services and Reconciliation team, we will continue working to build a healthcare environment that is safe, respectful and culturally grounded for Indigenous patients and families.

A statement from Lynn Guerriero, President and CEO of Niagara Health

Monday, Aug. 28, 2023

“Following the tragic death of Heather Winterstein at our St. Catharines Emergency Department (ED), an independent Emergency Department Assessment Panel was convened to understand the circumstances surrounding her death, and the experiences of Indigenous Peoples when they visit our emergency departments.

Today, the Panel released its report. We thank members of the Indigenous community who courageously shared their ED experiences with the Panel, as well as the staff and physicians who took part in the review in an effort to assist us on the path to meaningful change. Niagara Health is grateful for the Panel’s work and accepts all of the recommendations. These recommendations will be critical in furthering our ongoing work to advance reconciliation in healthcare in Niagara Region.

As an organization, Niagara Health has a deep commitment to promote a culturally safe environment to better support Indigenous patients and their families. This includes the creation of the Indigenous Health Services and Reconciliation team, whose mandate is to implement practices and services that are not only culturally safe, but also deliver the highest quality of care for Indigenous patients.

The death of Heather in our care was an absolute tragedy that is at odds with our high standards of care at Niagara Health.

As CEO, I am personally committed to ensuring every person who visits us – regardless of age, race, or background – receives the compassionate, high-quality care that our patients expect and deserve.

While we continue to mourn the tragic death of Heather, her legacy will live on for decades to come.”

ED Assessment Panel

The independent ED Assessment Panel was composed of six external leaders with a unique blend of expertise in emergency department and clinical operations, governance and management, employee engagement and patient care, and knowledge and practise of Indigenous culture and traditional healing.

The ED Assessment Panel members include:

• Panel Chair: Dr. Eric Letovsky, Chief of Emergency Medicine, Trillium Health Partners
• Elder Renee Thomas-Hill, Cayuga Nation, Bear Clan, Educator
• Pat Mandy, Registered Nurse, Member of the Mississaugas of the Credit First Nation
• Carolyn Farquharson, Director Urgent and Critical Care, Sinai Health
• Dr. David Price, McMaster University Professor and Family Physician
• Debra Jonathan, Registered Nurse, Turtle Clan, Cayuga Nation

Click here to read the ED Assessment Panel biographies.

What was done and why?

Niagara Health’s goal is to learn, offer healing, and mobilize change to improve the quality and safety of care for Indigenous patients.

The independent ED Assessment follows an internal Quality of Care Reflective Review that Niagara Health completed in March 2022 following the tragic death of Heather Winterstein, an Indigenous patient in our care in December 2021. This ED Assessment was done in Heather’s memory.

As part of the assessment, the Panel sought input from Indigenous patients and families, organizations, community services, and healthcare partners to understand experiences and assess opportunities for improvement. Feedback, suggestions and experiences were shared with the Panel, Niagara Health Executive Team members, Director of Engagement and Jill Shimizu-Wilson, former Indigenous Advisor to Niagara Health. Our ED physicians and staff also had the opportunity to share their perspectives. The Panel listened and examined all information collected and provided recommendations to Niagara Health to improve the care and experiences of Indigenous patients, families and communities.

Niagara Health thanks the Panel members for their participation on the Panel, recognizing the tremendous responsibility that comes with this important work.

We thank members of the Indigenous community who courageously shared their ED experiences with the Panel, as well as the staff and physicians who took part in the review in an effort to assist us on the path to meaningful change. These recommendations will be critical in furthering our ongoing work to advance reconciliation in healthcare in Niagara Region.

Actions we have already taken to enhance care and assist with our reconciliation work include:

• The creation, development and implementation of the Indigenous Health Services and Reconciliation Team, which includes five staff members who participate in patient navigation, advise Niagara Health on relevant governance and decision-making issues and participate in recruitment; 
• Introduced a smudging policy to ensure Indigenous patients and families are able to participate in this important spiritual ceremony in the hospitals; 
• Provided healing gardens and spiritual spaces for Indigenous Peoples, including in the plans for the new South Niagara Hospital; 
• Provided cultural sensitivity training to frontline staff and leaders; 
• Continue building and strengthening partnerships with Indigenous health, social and community organizations across Ontario;
• Created a dedicated webpage for Indigenous Health Services & Reconciliation.
• Commissioned Indigenous artwork to signal to Indigenous patients that our EDs are safe spaces. 

Niagara Health also completed an extensive internal quality review following Heather’s death that resulted in 16 recommendations. All of those recommendations were accepted and completed.