Abstract
Background: The healthcare system in Ontario, Canada is being reorganized into Ontario Health Teams, which are learning health systems based on the principles of integrated care and guided by the Quintuple Aims. Community engagement to address inequities faced by Indigenous peoples is a stated objective of the new Ontario Health Teams. This research aims to examine the collaboration processes with Indigenous community partners in the governance and activities of the Frontenac, Lennox & Addington Ontario Health Team (FLA OHT), located in southeastern Ontario.
Methods: Case study method involving community-based participatory research and using principles of Ownership, Control, Access, Possession (OCAP) in ethical Indigenous health research. The research team includes academic researchers from Queen’s University, FLA OHT leaders and administrators, and Indigenous community members from partner organizations. Data sources include: focus groups and interviews with previous and current Indigenous members of FLA OHT working groups, tables and support structures; focus groups with FLA OHT leadership and administration; and, organizational documents. The final product is a framework to operationalize meaningful collaboration between Indigenous partners and mainstream health systems.
Results: Preliminary results from focus groups and interviews with Indigenous members point to four major themes: the importance of relationship-building, drawing and building on previous work, creating and enhancing Indigenous spaces, and increasing Indigenous representation. Barriers to meaningful collaboration include: feeling dismissed and ignored, tokenism, slow-moving work with unclear goals, burdening the Indigenous community, and a lack of accountability and transparency. Enablers include: moving from continual consultation to concrete action, honouring Indigenous peoples’ time with honorariums, having open minds, and ensuring Indigenous peoples feel heard, respected and supported.
Conclusions: The importance of action-oriented engagement, adequate funding and resources, and responding actively to Indigenous voices are key steps to ensure that collaboration feels meaningful to Indigenous partners. The framework from this case study may be broadly useful to guide partnership processes between mainstream institutions and Indigenous groups in health systems and policy.