Abstract
Background: The Noojmawing Sookatagaing Ontario Health Team (OHT) covering the District and City of Thunder Bay in northwestern Ontario, spans approximately 103,000 square kilometers, 11% of Ontario Canada’s land mass. The area includes rural, fly-in, First Nation, and urban communities. Recognizing the need for a culturally informed, partnership-driven healthcare that is cross-sector Noojmawing Sookatagaing has adopted a collaborative decision-making model rooted in Indigenous values. This approach responds to the limitations of conventional governance models and prioritizes equitable and inclusive decision-making with Indigenous communities, where small First Nation communities of 300 people have the same power as CEOs of urban hospitals.
Approach: The OHT’s collaborative decision-making process, guided by the philosophy of “we move as fast as we can, and as slow as we need to,” emphasizes consensus and respect for all voices. The process begins with introducing a topic or proposal, followed by structured discussion and Q&A to clarify and address any concerns. Consensus is tested, allowing participants to either agree or raise issues. If concerns arise, the proposal is modified iteratively, with the goal of reaching a consensus where participants can at least express “I can live with it.” This iterative approach ensures that each person within our circle holds equal power, with respect given to each participant's comfort and understanding. It allows everyone the freedom to pause or stop the process, supported by Indigenous representatives, sacred circles, and the guidance of Elders. This creates a culturally respectful environment where collaboration is prioritized over hierarchy, honoring the voices and contributions of all participants equally.
Results: Using this decision-making model has strengthened trust-based relationships, especially with Indigenous communities and led to improved healthcare outcomes and better integrated care pathways. The model has enhanced transparency, inclusivity, and accountability, empowering all partners to actively shape healthcare policies and services. The result is a sustainable partnership framework that honors diverse perspectives and allows decisions to emerge at a natural pace, ensuring genuine consensus.
Implications: This collaborative decision-making model highlights the effectiveness of consensus-based governance in healthcare, especially when working with Indigenous communities. This process level sets power, enabling any member to request a pause, slow down, more information or revision. The approach provides a valuable example for other health organizations seeking equitable, culturally relevant partnerships. Moving forward, the OHT will continue to expand these practices, deepen community engagement, and set a precedent for inclusive governance that honors Indigenous wisdom, collective decision-making, and the principle of moving at a pace that respects all voices involved.