Despite increased attention in the health care field to the disparate health outcomes of Indigenous peoples, inequities persist. Analytical frameworks with the capacity to account for integrated systems analysis of power and domination are underrepresented yet vital to affecting change. Narratives represent Indigenous approaches to systems thinking, yet are often excluded from the literature on theorizing health systems. Recent theorizing in systems thinking provides a conceptual toolkit to interrogate health systems in a way that emphasizes ongoing histories of settler colonialism that underpin determinants of vulnerability, risks and poor health outcomes. Walby's (2007) approach to complexity theory provides an opportunity to re-orient the way health system researchers and practitioneers approach systems of domination in the context of Indigenous peoples' health, including viewing settler colonialism as a shapeshifter who abounds within the possibility of their environment and is a master of time and space. We explore the concepts of attunement and restraint in complexity theory and complex adaptive systems to better understand the movements of shapeshifters. Further, we demonstrate an application of Walby's framework to a narrative, using the highly publicized story of Brian Sinclair, an Indigenous man who died in a Winnipeg Emergency department. Noting how this approach accounts for settler colonial logics in health care system performance, we establish linkages between Walby's articulation of complexity and the fields of Indigenous and Settler Colonial Studies, anchoring this discussion in Indigenous ontology through the metaphor of shapeshifting. By focusing on the systems level, we elucidate the plethora of individual experiences as outcomes of settler colonialism played out within highly complex, adaptive social systems.

尽管医疗保健领域越来越关注土著人民不同的健康结果，但不平等现象仍然存在。能够对权力和统治进行综合系统分析的分析框架的代表性不足，但对于影响变革至关重要。叙事代表了系统思考的本土方法，但往往被排除在关于卫生系统理论化的文献之外。最近的系统思考理论化提供了一个概念工具包，以一种强调定居者殖民主义的持续历史的方式审视卫生系统，这些历史是脆弱性、风险和不良健康结果的决定因素。沃尔比 s (2007) 的复杂性理论方法提供了一个机会，可以重新定位卫生系统研究人员和从业者在土著人民健康背景下处理统治系统的方式，包括将定居者殖民主义视为一个变形者，在他们的环境中充满了可能性并且是时间和空间的主人。我们探索复杂性理论和复杂自适应系统中协调和约束的概念，以更好地理解变形者的运动。此外，我们展示了 Walby 框架在叙事中的应用，使用 Brian Sinclair 的广为人知的故事，他是一名在温尼伯急诊室死亡的土著男子。注意到这种方法如何解释医疗保健系统绩效中的定居者殖民逻辑，我们建立了 Walby' 他对复杂性的阐述以及土著和定居者殖民研究领域，通过变形的隐喻将这一讨论锚定在土著本体论中。通过关注系统层面，我们阐明了作为定居者殖民主义在高度复杂、适应性强的社会系统中发挥作用的结果的过多个人经历。