Gout is a health condition that can be managed to prevent morbidity and premature mortality. Māori have a higher prevalence of gout yet are less likely to receive appropriate care than non-Māori. There is scant literature presenting the patient/whānau voice relating to the health system response to gout. The study reported in this article aimed to highlight barriers and enablers in achieving best practice management of gout as defined by patients in order to inform the development of appropriate pathways and services. Using a Kaupapa Māori approach, interviews were undertaken with 23 participants as part of a multi-layered intervention to improve the management of gout for Māori. Two domains emerged from the analysis of the interview data, the first relating to biomedical practice and the second relating to Kaupapa Māori. Both domains were overarched by the theme of te ara pai—creating interwoven solutions to shift power. Reframing the health system to enable rangatiratanga for Māori would address inequity for Māori with gout and is likely to benefit other health conditions.