Photo caption: Paul Francis Jr., Executive Director of Indigenous Health at the Ontario Hospital Association.
Advancing Indigenous health in hospitals requires more than isolated programs, it demands a fundamental shift in how care is defined, delivered, and experienced. Patient and family experience is where that shift becomes visible – and measurable.
Health System News recently spoke with Paul Francis Jr., who was appointed Executive Director of Indigenous Health at the Ontario Hospital Association (OHA) in January 2026. His secondment appointment was developed in collaboration with St. Joseph’s Care Group in Thunder Bay, where he also serves as Vice President of N’doo’owe Binesi, Indigenous Health, Partnerships and Wellness.
Paul is Odawa Anishinaabe with mixed European ancestry and a proud member of Wiikwemkoong Unceded Territory, with roots on Manitoulin Island. He currently lives in Thunder Bay and is Bear Clan. Living between these cultures and traditions informs his work, enabling him to bridge Indigenous and Western knowledge systems and strengthen connections within the health care system.
The creation of this dedicated OHA role reflects a growing recognition that advancing Indigenous health in hospitals is directly tied to improving Indigenous patient experience. By embedding Indigenous leadership at a system level, the OHA is strengthening its ability to address how care is experienced by Indigenous Peoples, and how those experiences shape trust, access, and care outcomes across Ontario’s health system.
Patient and family experience is often discussed as a measure of satisfaction, but for Indigenous Peoples, it carries far deeper clinical and cultural significance.
Why is patient and family experience important to advancing Indigenous health in hospitals?
Patient and family experience is not a “soft” measure – it is a clinical and system indicator. For Indigenous Peoples, experience is where the impacts of history and ongoing colonialism are most visible. Policies, environments, and interactions can either reinforce mistrust or begin to repair it.
If Indigenous patients and families do not feel safe, respected, or understood, they will delay care, leave early, or disengage altogether. That directly affects outcomes.
Advancing Indigenous health requires more than improving access – it requires transforming how care is experienced. That means embedding Indigenous worldviews and perspectives of health and wellness into the health care system – not as an add-on, but as foundational and a core part to how care is defined and delivered. It also means recognizing Indigenous Peoples as Rights Holders; Indigenous health is grounded in rights and not representation – it must be advanced as a distinct priority grounded in rights rather than being absorbed within equity, diversity, and inclusion frameworks.
Your time at St. Joseph’s Care Group (SJCG) provided a more direct view of the Indigenous patient journey. How does that experience shape the strategic vision you’re bringing to this new system-level role?
My time at SJCG gave me a front row view of the Indigenous patient journey – not just the challenges, but the possibilities when Indigenous knowledge, culture, and leadership are genuinely honoured and fully integrated into care. At SJCG, the growth of the Indigenous Health Division, N’doo’owe Binesi (Healing Thunderbird), shows what’s possible when an organization commits to Indigenous led care and cultural safety in both vision and practice. Over recent years, N’doo’owe Binesi has defined “Who We Are” in Anishinaabemowin, anchored its work in the Seven Sacred Teachings, and expanded into community-based models that restore balance and promote wellness wholistically.
The Walking With Humility: Embracing the Teachings of the West progress report reflects that this work isn’t symbolic – it’s structural and relational. It highlights plans to embed Indigenous voices in governance through the first Indigenous Client and Family Partner Committee, ensuring planning and evaluation are shaped by lived experience. It also advances TwoEyed Seeing within the organization’s quality and safety framework – bringing together Indigenous and Western knowledges to support wholistic care across physical, emotional, mental, and spiritual domains.
There are concrete carelevel examples that speak to this vision in action. Indigenous Health Associates at the bedside, for instance, aren’t just translators or advocates in a clinical sense – they help bridge Western interventions with cultural practices such as smudging, drumming, and connection to Elders. They support families through deeply human moments like attending ceremonies and funerals, which profoundly shape what “safe care” looks like in Indigenous worlds.
Efforts like voluntary self-identification across programs and forthcoming Indigenous Client Journey Mapping show that we’re moving beyond isolated initiatives to embedding Indigenous understanding at every step of care – from admission through discharge and beyond.
What this has taught me – and what I’m bringing forward into this systemlevel role – is a shift in how we define success: not as the number of programs we build, but as the consistency with which Indigenous patients experience care that respects their culture, strengths, and whole selves.
Paul Francis Jr., Executive Director of Indigenous Health at the Ontario Hospital Association
The work at SJCG demonstrates that when Indigenous knowledge and Western systems walk together with humility, we create pathways toward genuinely culturally safe and equitable care across the system.Building on those insights, are there any recurring themes from the bedside that you are particularly eager to influence on a larger scale?
Indigenous cultural safety remains inconsistent. There are strong examples, but they are often driven by individuals rather than embedded as standard practice. There is also a clear need for Indigenous presence – staff, Elders, and traditional supports. When they are present, trust improves immediately.
There is also a gap between intention and execution. Many organizations are committed to reconciliation, but those commitments are not always operationalized in day-to-day care. Addressing these themes requires moving from individual effort to system design – ensuring culturally safe care is the default, not the exception. At the OHA, this translates into supporting hospitals as they transition from commitment to implementation. We achieve this by advancing shared expectations, embedding Indigenous leadership within governance and quality frameworks, and scaling leading practices to ensure Indigenous health is delivered consistently across all organizations.
From your perspective, what does a ‘gold standard’ for Indigenous patient experience look like?
A gold standard is not defined by the organization – it is defined by Indigenous patients and communities. It means patients feel safe being who they are, without having to explain or defend their identity. Cultural practices – ceremony, medicines, language, and the presence of family and Elders – are respected and supported as part of care.
Paul Francis Jr., Executive Director of Indigenous Health at the Ontario Hospital Association
It also means that care is relational, not transactional – and that there is time to listen, understand context, and build trust. In practice, this means Indigenous voices are present at every level – governance, leadership, and care delivery – and experience is measured using Indigenous-defined indicators.
It reflects a system that understands its responsibilities within Treaty relationships and upholds them in practice. And importantly, it is consistent. Every Indigenous patient can expect the same level of respect and care, wherever they enter the system.
For hospital members, what is the most impactful first step they can take toward achieving a system-level change?
Start with meaningful listening and be prepared to act on it.
Indigenous Peoples must be present in decision-making roles, shaping how quality, safety, and patient experience are defined and measured. This is not advisory work; it is governance.
Too often, patient experience work reflects what the system values, rather than what matters to Indigenous patients. Indigenous leadership is essential to ensure information is gathered appropriately and translated into meaningful change.
Organizations also need to address structural barriers. Indigenous people remain underrepresented in decision-making spaces and are often excluded through ongoing colonial processes. Shifting that requires intentional changes in governance, leadership, and accountability.