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This commentary examines the inequitable access to healthcare services that Indigenous peoples in Canada face on a daily basis. It considers not only geographical or physical access but also culturally safe access to healthcare. Racism is cited as a major deterrent in not accessing mainstream health services. Three recent studies are cited that reveal that racism, discrimination, stigma, sexism and bias prevent Indigenous peoples from accessing mainstream health services. Cultural safety training is recommended, as well as recruitment and retention of Indigenous health professionals. Several recommendations to address physical and geographical access are also recommended, including self-governance and capacity building; enhanced partnerships and collaboration to address jurisdictional issues, particularly for First Nations communities, and a national strategy for access to healthy and affordable food in northern, remote and rural communities.

In this article, we share words spoken by Aboriginal elders from Saskatchewan, Canada, in response to the research question, “What would you like non-Aboriginal health care providers to know when providing end-of-life care for Aboriginal families?” Our purpose in publishing these results in a written format is to place information shared by oral tradition in an academic context and to make the information accessible to other researchers. Recent theoretical work in the areas of death and dying suggests that cultural beliefs and practices are particularly influential at the end of life; however, little work describing the traditional beliefs and practices of Aboriginal peoples in Canada exists to guide culturally appropriate end-of-life care delivery. Purposive sampling procedures were used to recruit five elders from culturally diverse First Nations in southern Saskatchewan. Key informant Aboriginal elder participants were videotaped by two Aboriginal research assistants, who approached the elders at powwows. Narrative analysis of the key informant interview transcripts was conducted to identify key concepts and emerging narrative themes describing culturally appropriate end-of-life health care for Aboriginal families. Six themes were identified to organize the data into a coherent narrative: realization; gathering of community; care and comfort/transition; moments after death; grief, wake, funeral; and messages to health care providers. These themes told the story of the dying person's journey and highlighted important messages from elders to non-Aboriginal health care providers.

The Southern Saskatchewan/Urban Aboriginal Health Coalition is an interdisciplinary, intersectoral team of researchers and communities dedicated to exploring what 'culturally respectful' care means in Aboriginal communities. Although the purpose of the research project was to examine this concept in an effort to improve health care service delivery and education for health professions, the members of the Coalition realized early in the process that one of the primary factors related to the success of the project would be the building and sustaining of relationships. This paper describes a relational process that was used to initiate, facilitate, and support a research partnership with the Aboriginal communities. Through a community-based process, two communities and the Coalition used sharing circles and workshops as a method to create relationships and begin a discussion about what constitutes key elements of culturally respectful health care and education. These elements have not yet been determined as the Coalition and community members have focused on fostering relationships which have been critical to building the partnership with the Aboriginal communities.

For community engagement to be successful, the interests of the community must be taken into account and researchers must become facilitators. Patience is required. Meaningful and sustainable relationships that have been developed over time promote mutual learning and capacity building among the partners (Elders, community members, health care providers, and researchers). In addition, community engagement leads to the sharing of available resources (eg, human, time, and financial) and to a sustained commitment by the partners. This mutual commitment makes future projects easier to develop and complete. Thus, authentic transformative health development, informed by participatory health research, becomes an ongoing process.

The Southern Saskatchewan/Urban Aboriginal Health Coalition is an interdisciplinary, intersectoral team of researchers and communities dedicated to exploring culturally respectful care in Aboriginal communities. Through a community-based research approach, the communities and the Coalition used sharing circles to determine the key elements that 2 Saskatchewan Aboriginal communities see as requisite for culturally competent care. Through triangulation and thematic analysis, 9 initial themes and 4 broad thematic groupings were derived. The lessons from this study could inform further research with these communities and other culturally diverse groups with respect to cultural competency in terms of both health-care providers and health services.

The Saskatchewan Ministry of Health has committed to a multi-million dollar investment toward the implementation of Lean methodology across the province's healthcare system. Originating as a production line discipline (the Toyota Production System), Lean has evolved to encompass process improvements including inventory management, waste reduction and quality improvement techniques. With an initial focus on leadership, strategic alignment, training and the creation of a supportive infrastructure (Lean promotion offices), the goal in Saskatchewan is a whole health system transformation that produces "better health, better value, better care, and better teams." Given the scope and scale of the initiative and the commitment of resources, it is vital that a comprehensive, longitudinal evaluation plan be implemented to support ongoing decision-making and program design. The nature of the initiative also offers a unique opportunity to contribute to health quality improvement science by advancing our understanding of the implementation and evaluation of complex, large-scale healthcare interventions. The purpose of this article is to summarize the background to Lean in Saskatchewan and the proposed evaluation methods.