Healthcare institutions are adopting traditional and complementary medicine practices in response to patient demand — without evidence integration frameworks, cultural sovereignty agreements, or practitioner credentialing standards. That is adoption without governance.
Steel et al. (2025) report from the WHO's 2024 Bangkok conference that the primary global barrier to TCIM integration is the absence of governance infrastructure to evaluate, integrate, and apply evidence that takes non-RCT forms. Traditional medicine evidence — longitudinal traditional use, case documentation, cultural transmission, outcomes in dimensions biomedical frameworks do not assess — is systematically disadvantaged by evidence frameworks designed for pharmacological interventions. Cultural sovereignty adds an additional governance dimension: Indigenous healing practices belong to the communities that developed them. Institutional incorporation without formal community agreement is cultural appropriation with governance consequences.
WHO Bangkok 2024 meeting report. Primary barrier is the absence of governance infrastructure to evaluate non-RCT evidence.
lāʻau lapaʻau as a living practice among Native Hawaiian elders. Specific governance implications for Hawaiian health systems.
RCT frameworks cannot adequately evaluate individualized, relationship-based, meaning-embedded CAM modalities.
The prototype organizes reflection across six proposed governance dimensions. It does not produce a validated institutional score, audit, accreditation, or certification.
Evidence integration framework documented with multi-epistemic criteria, reviewed annually by interdisciplinary body including TCIM practitioners and community representatives; written community agreement for each Indigenous healing practice; credential verification documented for all CAM practitioners; pre-treatment screening documented for each modality; legal guidance updated within 3 years; formal communication protocol with conventional care team.
The full tier operationalization — PIONEERING through EARLY STAGE, with specific observable criteria for all six dimensions — is documented in the Framework Foundation.
Hospitals with integrative medicine programs · FQHCs · Native Hawaiian health programs · Naturopathic and acupuncture practices · Wellness centers offering CAM services · Healthcare institutions in Hawaiʻi, Alaska, and tribal health systems
And the communities whose healing practices are being incorporated, and the patients seeking traditional or complementary care.
Review the module scope and proposed dimensions. The assessment remains an educational prototype; no email report or institutional finding is active.