Decisions on policy and spending would have to change to challenge systems that had failed Māori.
"To make a difference for whānau [you need] to think long term, just like iwi do, think intergenerationally ... you can't try to address inequities by incrementalism."
Tui Ora had spent the past year realigning to be ready to match the direction of the reformed system.
Wano's own long career path began by chance in 1975, without any real consideration of the future.
"I'd been up north with some mates surfing, we'd been up there for a few months ... Mum said I had to get a job, so of course I did."
His mother Mākere was from Taranaki, Te Ātiawa and Ngāti Tama, with strong links to Parihaka.
His father John was from the east coast's Ngāti Awa, and his own father had moved to Wellington in the 1920s after losing his wife and children in the 1918 flu pandemic.
There he married a first-generation New Zealander from Cornwall with an English father and Australian mother.
John and Mākere Wano raised their family in Hāwera and Hayden loved his upbringing as part of a close family, both immediate and extended, and with a strong Catholic faith.
"It was a stable, prosperous time, not as complicated and with very connected communities. We knew where we belonged.
"Education was a bit of a thing for my parents, particularly my Dad. He encouraged us to do the best we could – not that I was an exceptional student. I picked up my interest in education later in life."
The self-described "very average" student grew through Turuturu and St Joseph's schools, and on to Hāwera High, surfing in the summers and drifting into that first job.
The work was as a hospital orderly. Within six months, Wano's interest turned to nursing and he jumped at the chance for hospital training at Gisborne, which also offered good waves.
Nursing was an unusual choice for a young man in the mid-70s, but at Gisborne the principal nurse was male, as were a number of the charge nurses and the head of training.
"I absolutely loved the work and took to it with a passion."
"It's a very human career, it's very much connected to people. You could do something and there was an immediate feedback - you knew when you were making a difference."
A new interest in education was sparked. After training as a general and obstetrics nurse, Wano learned psychiatric nursing at Auckland's Kingseat Hospital just as the large institutions were closing down.
Despite a degree of shock at seeing the harm the old system could cause, he
trained as a group therapist, and as care shifted to whānau and communities so did he.
With three tamariki, Wano and his wife Antonia moved back to Taranaki and he became the first psychiatric district nurse, helping set up and expand the mental health service.
"The combination of working in de-institution and coming back here and setting up the service, as well as continuing front line work, gave me insight into the managerial side."
Eighteen months later, in 1989, he became the area health board's first mental health service manager.
Moving through the ranks to senior management, Wano then started 25 years of governance work including being the first chair of the new Taranaki DHB for seven years after its creation in 2001.
From its inception in 1998 Wano has led Tui Ora through four distinct phases.
Beginning with just four staff, it has grown to become the region's biggest community-based health and social services provider, with 180 kaimahi.
Covid-19 has dominated the past two years, and Wano said the response had proven the worth of iwi and kaupapa Māori providers working on a more equal standing with the government health system.
"A common purpose, high trust, a sense of urgency and collaboration. We had to work with each other to get the kind of results [we needed].
"We were able to achieve vaccination at rates we'd never been able to achieve before. We turned Taranaki around from being a basket case, as it was labelled at one stage.
"It showed what's possible when you let the reins loose, and you allow kaupapa organisations like Ngāti Ruanui and Ngāruahine to get those resources out to our whānau."
But strong local leadership would be needed to maintain that way of working.
"Since then things have stalled – we aren't getting the traction that we were back then. We can sense the system is trying to pull back from some of that way of working."
The road hasn't always been easy: along the way Wano lost his wife after 40 years together, a brother, a sister and a mokopuna.
He married again to Claire three years ago, and she also had lost her previous husband. But the whānau stands strong.
"We know grief but what we also found was healthy ways of working through that ... I embrace the way we as Māori approach grief – I think it's incredibly healthy and it certainly helped me."
Tui Ora's recent strategic overhaul has led to a reset called Toka te Manawa Ora 2040, a plan to guide it through to the 200th anniversary of Te Tiriti o Waitangi.
The long-term plan also points to some quick wins to chalk up in the short term.
"It's the perfect time to step off: a good time to tidy that up, get good foundational stuff in place for the reset, but bring in a new person with some new energy and ideas."
And the season of Puanga and Matariki seemed a good time to announce Hayden Wano would leave the organisation early in 2023.
Although open to opportunities to contribute further in the health field, Wano certainly won't be job-hunting.
He will continue to chair the Mental Health and Wellbeing Commission and, in the same field, sit on the board of the Wise Charitable Trust.
Locally, Wano volunteers on the boards of the Taranaki Arts Festival Trust and the Chamber of Commerce.
He said he's very lucky to have choices and the sense of appreciation for where he and his family find themselves.
"It's been very satisfying, I feel a sense of gratitude every day."
• Local Democracy Reporting is Public Interest Journalism funded through NZ On Air
