This commentary calls for a broader conceptualization of the healthcare system and proposes a health systems performance framework that will guide reconciliation and health system improvements in northern, Indigenous and rural communities. Reconciliation provides an opportunity to develop more reciprocal approaches to performance framework and indicator development in Indigenous and northern regions. An enhanced performance framework will inform management that is underpinned by policies and actionable strategies that build on evidence and Indigenous knowledge to inform health systems improvements. Performance measurement systems rooted in reconciliation and based on Indigenous values enable us to have a deeper understanding of system drivers and the legislation and policy levers that perpetuate health inequities.
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