"Standing on the right side of history": Place, structure, and Indigenous patient navigation in Ontario

Despite global and national commitments to Indigenous self-determination in healthcare, including the United Nations Declaration on the Rights of Indigenous Peoples and the Truth and Reconciliation Commission's Calls to Action, Indigenous Peoples in Canada continue to face systemic discrimination within health systems. Indigenous Patient Navigation (IPN) has emerged as a critical response, yet the voices and experiences of IPNs remain largely absent from the literature. This study explores how IPNs in Ontario understand and practice Indigenous health, cultural safety, and patient care, and how the institutional environments in which they work shape their capacity to do so. Drawing on an Indigenous Research Paradigm grounded in relational accountability; we conducted semi-structured interviews with 13 IPNs working across 7 hospitals and 4 Indigenous healthcare centres. Thematic analysis produced three core themes: understandings of health, care, and cultural safety; responsibilities of the IPN role; and challenges and supports that shape their work. Findings reveal that IPNs understand health holistically through medicine wheel teachings and define cultural safety as the ability to offer traditional healing practices within healthcare settings, with Indigenous patients' own sense of safety as the ultimate measure. While IPNs perform multidimensional roles spanning relationship-building, advocacy, education, and traditional healing, their capacity to practice culturally safe care is profoundly shaped by institutional context. Indigenous healthcare centres, governed by Indigenous values and knowledge, enable this work; hospitals often require IPNs to build this infrastructure alone. This study demonstrates that place-based and structural conditions shape IPNs' capacity to provide culturally safe care, and that permanent Indigenous-led infrastructure within healthcare institutions is necessary.