A retrospective on reconciliation by design.

It is well-established that Indigenous peoples continue to experience a lower level of health than non-Indigenous peoples in Canada. For many health leaders, finding practical strategies to close the gap in health disparities remains elusive. In this retrospective study, we will illustrate our own experience of transformational change using design and systems thinking tools toward a primary outcome of multi-stakeholder alignment. Using this approach enabled three Indigenous Provincial/Territorial Organizations (IPTOs) representing more than 150 First Nations communities from Saskatchewan, Manitoba, and Ontario to establish the largest community-led, collaborative approach to health transformation in Canada at the time. These IPTOs have gone on to pursue some of the most ambitious health transformation initiatives in Canada and in September 2018, were granted $68 million in funding support by the Government of Canada. If health leaders are looking at an alternative approach to closing the gap in Indigenous health, alignment thinking has shown promising results.