Centering Indigenous perspectives and priorities in a Learning Health System: a case study of the new Frontenac, Lennox & Addington Ontario Health Team

A "Results in Brief" for this report can be found here. 

# Abstract

# Background

Community engagement to address inequities faced by Indigenous peoples is a stated aim of the new Ontario Health Teams. This research seeks to examine collaboration processes with Indigenous community partners in the governance and activities of the Frontenac, Lennox & Addington Ontario Health Team (FLA OHT).

# Methods

We used a case study method involving community-based participatory research and using principles of Ownership, Control, Access, Possession (OCAP) in ethical Indigenous health research. Data sources included: 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.

# Results

Focus groups and interviews with Indigenous members pointed 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 included: feeling dismissed and ignored; perceptions of tokenism; slow-moving work with unclear goals; burdening the Indigenous community; and alack of accountability and transparency. Enablers included: 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. Interviews with FLA OHT leadership pointed to five major themes on how to move forward in improving and enhancing meaningful collaboration: growing Indigenous knowledge and relationships; catalyzing action; creating Indigenous spaces; increasing Indigenous representation; and obtaining additional funding, supports and resources. Leadership proposed action items such as dedicating time for relationship building; advocating to Ontario Health for long-term funding; and building an Indigenous lens into current programs. These were identified as just some of the ways forward to improve meaningful collaboration between the Indigenous community and the FLA OHT.

# Conclusion

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. It is recommended that some ways forward for the FLA OHT to improve meaningful collaboration with the Indigenous community be done through actions such as: patience while relationship-building; advocating for additional funding and supports; improving organizational cultural competency; and incorporating an Indigenous lens into already-funded programs. This research generates a framework to operationalize meaningful collaboration between Indigenous partners and mainstream health systems. In addition to offering insight for use within the FLA OHT region, the framework may be broadly useful to guide partnership processes between other mainstream institutions and Indigenous groups in health and public health systems and policy.