Coproduction and macrosystems of healthcare

April and Doug bring their long familiarity to describe the transformative change when the indigenous community became the “customer-owners,” as they now call the members of the Native American community. They explore the way commonly occurring meetings happen and some of the implications for their work as executive-persons in the setting. April describes what it’s like getting a professional-person’s help for a problem. Doug describes some of the data that is used to measure the changes that have occurred since the change.


April Kyle

President and CEO for Southcentral Foundation’s Nuka System of Care

Doug Eby

Vice President of Medical Services for Southcentral Foundation’s Nuka System of Care

Supplementary materials


A website dedicated to exporting the best practices from Nuka system of care:

This article provides really great context:

Gottlieb K. The Nuka System of Care: Improving health through ownership and relationships. Int J Circumpolar Health (2013) 72:21118-

Self-study is a website with several materials and self-study activities