From Co-Design to Systems Change: How ToP Methods Helped CTN Achieve Platinum-Level Impact

In January 2025, I registered for ICA’s Advanced Facilitator Program (AFP) with the aim of becoming an ICA Certified ToP^™ Facilitator (CTF). I took this plunge even though I had been a facilitation consultant for over 15 years and an IAF Certified^™ Professional Facilitator (CPF) for almost 10. I knew that ToP^™ certification would be demanding, labour intensive, and a significant financial investment, and I did it anyway. I had taken the Group Facilitation Methods and Transformational Strategy courses with ICA Associates, and was impressed by how practical and widely applicable the ToP^™ tools are.

What I didn’t realize until many months later is that they are also astonishingly impactful. This is the story of how I made that discovery.

The call that started it all

In March 2025 I received an unexpected call. I never would have imagined that it would lead to a Platinum-level Facilitation Impact Award from the International Association of Facilitators (IAF).

On the other end of the line was Clinical Trials Navigator (CTN), a Canadian not-for-profit. They help cancer patients across Canada find and participate in clinical trials, and they wanted to develop a culturally tailored response to the specific needs of Métis patients.

The CTN team had been working on developing this Indigenous-specific pathway for about two years already, but engaging Indigenous experts in the process had been quite challenging. There had been cultural missteps leading to hurt and disengagement. Their attempts to engage Indigenous organizations had also not borne fruit.

Understandably then, the CTN team was nervous and uncertain about how to work with Indigenous people. That’s why they decided to hire a professional facilitator for a first in-person gathering a few weeks later that would bring together five members of their team and seven Indigenous Advisors.

Putting ToP methods to work

Now, it is easy to gloss over this next part of the story—and in telling it over the past few months, I admit that I’ve done just that. But let me underscore it here: because I was registered in ICA’s Advanced Facilitator Program, ICA Associates had matched me with a mentor, an expert in ToP^™ methods, veteran facilitator and CPF Emeritus, Jo Nelson. This meant I had the benefit of first-class support for applying the ToP^™ methods. And because, to get the CTF certification, I needed a robust portfolio demonstrating successful application of the ToP^™ tools, I had every incentive to use them with the CTN.

And use them I did! The ToP^™ Consensus Workshop Method was the lynchpin of the whole process, enabling the group to work across cultural divides to co-develop the Indigenous-specific Clinical Trials Navigation program based on everyone’s ideas, ensuring that lived experience, Indigenous knowledge, clinical expertise and research perspectives all shaped the resulting model. I came back to the ToP^™ Focused Conversation Method over and over again. A focused conversation was especially critical at one point in the middle of the process, when the group’s energy and focus were flagging. It helped them fully absorb the import and possibilities of the program model they had just co-designed together. ToP^™ Frameworking allowed the group to identify and map stakeholders together. That was essential for planning how to roll out the new program in cancer centres across the country. Finally, ToP^™ Action Planning enabled the group to identify their most important goals and next steps toward implementing the program. That meant that they had the focus, direction and momentum to continue on their own once I was no longer there to support them.

And yes, I did use other methods and tools as well: Indigenous talking circles, empathy maps, graphic facilitation, World Café, Mural, and Zoom. The process design was totally bespoke and responded to what I heard from participants during the needs analysis meetings and interviews. ToP^™ methods certainly can be mixed and matched with other approaches, and that, I learned, is part of what makes them so easy to apply.

The result was a methodology that was:

• anchored in the reality of the CTN program and the cancer patient’s journey through clinical trials navigation;
• rooted in empathy;
• based on a co-constructed analysis of access barriers and solutions to overcome them;
• founded on consensus on a program model that held everyone’s ideas;
• geared toward extending relationships with stakeholders needed to implement the solutions; and
• action-oriented.

While the methodology was based on the particular needs of the CTN, I am convinced it could be used to co-design other programs aimed at overcoming barriers to access to a program or service. That’s why I created this handout, to share the sequence of tools and methods I used, for others to adopt and adapt to their contexts. Please let yourself be inspired by it and let me know how it goes!

An unexpected resonance: ToP methods and Indigenous ways of working

During one of the needs analysis meetings with the CTN team, CTN Director Dr. Caroline Hamm shared with me a scholarly paper from Pawaatamihk: Journal of Métis Thinkers, by Robline Davey, entitled “Searching for Métis Research Methodologies: natoonikew poor ayshitotamun michif.” Reading Davey’s article led to a major insight for me: that certain principles underlying the facilitation methods I use resonate strongly with features of Métis research that Davey identifies. I speak about that in this one-minute video. These features include (and here I am quoting phrases directly from the article):

• “A process of fostering relationships;”
• “Co-constructed analysis;”
• “Mutual thinking and reflection;”
• “Empowerment;” and
• “Inspiring action.”

It’s worth mentioning that while the facilitation methods I used are already based on the respect that is so essential to working with Indigenous people, it was also important to integrate practices to build trust and relationship for collaboration among Indigenous and non-Indigenous participants. For example:

• a relational needs analysis, with individual interviews with Indigenous participants;
• relational introductions, including sharing about our community and cultural backgrounds;
• honouring of Indigenous protocols, such as the land acknowledgement, ceremonial opening by an Indigenous knowledge keeper, tobacco offering for the knowledge keeper, talking circles, and storytelling; and
• group agreements to make it clear that everyone’s ideas would be included, regardless of culture, position, or education.

You can find more details about these practices in the above-mentioned handout.

ToP^™ methods provided much of the process architecture, while Indigenous protocols, relational practices and several complementary methods helped make that architecture suitable for this particular group and context.

Nine months later: measurable change

The facilitated process generated significant results in a remarkably short time.

By the end of the process, in September, the CTN had a strong, engaged program leadership group co-led by an Indigenous person, and a genuinely co-created program model of the new Métis-specific CTN program.

Just nine months after the first gathering, when I conducted semi-structured interviews with several participants to prepare the Facilitation Impact Award nomination, tangible impacts of the process already included:

In the words of one of the participants, Chantal Wahteeshkin, an Indigenous Nurse Navigator with CancerCare Manitoba: “Our work is having real, tangible impacts on the system already.”

The IAF Facilitation Impact Awardee gallery gives more details of the impacts—both in numbers and through stakeholder testimonials.

A new standard for my practice

Completing the Award nomination was almost as labour-intensive as writing my masters’ thesis! Perhaps it was at least as inspiring and thought-provoking too. It left me with this question: What if every process I facilitated were worthy of a Facilitation Impact Award? With ICA Associates’ Jo Nelson by my side and the ToP^™ tools in my toolbelt, that is no longer hard to imagine!

Bridging Indigenous & Western Worldviews – Natalie Zend – handout

Watch the Facilitation Impact Award Video on LinkedIn