Meeting the talent pipeline challenge at Niagara Health

The pandemic didn’t just reshape how Niagara Health cares for patients – it transformed what it means to lead human resources (HR) in one of Ontario's largest hospital systems. Since joining Niagara Health in the Regional Municipality of Niagara, Ont., in 2019 and assuming the role of Executive Vice President, Human Resources in 2023, Fiona Peacefull has overseen a period of extraordinary pressure and, by several key measures, a remarkable recovery. 

Job vacancies that hovered between 500 and 600 at the height of COVID-19 in 2020-2021 are now under 200, according to Peacefull. Staff turnover has stabilized at 4.88 per cent – well below what many comparable health systems experience. Across more than 7,700 team members – including approximately 6,300 staff, about 700 physicians, midwives, and dentists, and 700 volunteers – the organization serves close to half a million residents across five hospital sites, says Peacefull. That degree of workforce stability didn’t happen by accident. 

Niagara Health's workforce strategy is anchored in a human capital plan it calls People First – a framework built around several interconnected pillars, two of which Peacefull highlights as particularly transformative: wellness and diversity, equity, inclusion and belonging. 

Rapid-response employee wellness support 

On the wellness side, Peacefull says the organization has moved well beyond standard employee assistance programming. In-house social workers are available exclusively to support staff and physicians. The hospital has also adopted Code Lavender – a model developed at the Cleveland Clinic in the U.S. – which functions as a rapid-response mechanism for team members experiencing acute personal or professional distress, she says. 

"If there's a member of our team who's having a significant kind of personal or professional worry, we can immediately deploy spiritual care [professional, compassionate support that helps people find hope and comfort during illness, grief, or life changes] and our wellness team to provide support," Peacefull says. "In a hospital, it's fast-paced and often you need to go to the next patient to provide care, so Code Lavender response is really just to take a moment to do a debrief and understand what's happening." 

The approach reflects a wider recognition – backed by research – that engaged, supported employees deliver better patient outcomes. As Canadian employers continue to grapple with workplace wellness strategy and rising employee health costs, Niagara Health's model offers a practical template for high-demand healthcare environments, says Peacefull. 

Metrics are tracked monthly and span turnover, vacancy volumes, reported workplace conflicts, occupational health indicators, and staff participation in wellness and inclusion initiatives, according to Peacefull. 

"We have a very close eye on all of those metrics and we look at them on a monthly basis," she says. "We can see if we need to pivot based on the trend data we're seeing in our organization." 

Standing firm on diversity, equity, and inclusion 

While debates about the future of diversity, equity, and inclusion (DEI) programming have intensified globally – and the political climate south of the border has added pressure on Canadian organizations – Niagara Health's response has been to double down rather than retreat, says Peacefull. 

Canadian employers across sectors are largely holding firm on DEI commitments even as U.S. executive action dismantles federal programs in that country and a number of major corporations scale back their own. For Peacefull, the decision at Niagara Health wasn’t a close call. 

"When we were seeing this political view around diversity, equity, and inclusion, we had a conversation with our exec team and we also had a conversation with a diversity equity inclusion team, and it was unanimous that we need to reinforce and grow this commitment," she says. "I'm really proud that I work alongside leaders with no hesitation that our commitment to DEI remains high and will continue to grow." 

Fostering diversity from the beginning 

Peacefull points to the particular context of Niagara Health – a border community organization that draws heavily on internationally educated nurses, who she notes now represent approximately 50 per cent of new nursing registrations nationally. 

"They bring so much to our work environment," says Peacefull. "They have different experiences from patient care, clinical operations, and hospital operations, and it serves our patients and our communities well to really honour and respect the different experiences people bring to clinical care." 

DEI is embedded structurally: candidates are assessed on their commitment to inclusion during hiring, cultural sensitivity education is woven into orientation, and a network of DEI champions across all five hospital sites reinforces expectations on the ground, with swift consequences following clear breaches of workplace conduct, according to Peacefull. 

"We really have a no-tolerance culture when somebody doesn't demonstrate that level of kindness and support to a patient or a colleague," she says. 

Building the pipeline and planning for an older workforce 

With 84 per cent of Niagara Health's staff identifying as women and an average employee age of 42, according to the organization’s own data as reported by Peacefull, workforce planning demands intentionality on multiple fronts. She says the organization has committed to the federal government's 50-30 Challenge – a voluntary pledge to increase representation of women to 50 per cent and underrepresented groups to 30 per cent on corporate boards and in senior management. 

Peacefull also highlights the importance of academic partnerships in sustaining the talent pipeline as the healthcare workforce ages. She says Niagara Health works with Niagara College, Brock University, the University of Niagara Falls, McMaster University, the Michener Institute, and Western University – hosting more than 2,000 students annually in clinical placements. 

"It’s growing your pipeline of talent so that when vacancies come up, we have individuals who've already trained at Niagara Health," she says. 

A formalized mentorship program and structured succession planning complement that external pipeline, with particular focus on supporting a predominantly female workforce – including dedicated education on perimenopause and women's health – as well as flexible work arrangements such as job sharing, according to Peacefull. 

All of this leads to not just a healthy and productive workforce, but also the ultimate goal of good patient care, she says. 

“There's just been this continual focus on patient experience and recognizing that an engaged workforce really supports the best patient outcome,” she says. “And the research shows the direct correlation between employee engagement, physician engagement, and the patient experience.”