le 2021


The research team surveyed primary care leaders across Ontario using validated survey instruments and looked at the below factors, and we found that the Processes directly and positively impacted Outcomes, and the Structures indirectly and favorably impacted Outcomes through - or as mediated by - their direct impact on Processes.




Patient engagement is a priority for health care quality improvement and health system design, but many organizations struggle to engage patients meaningfully. We describe patient engagement activities and success factors that influence organizational decision-making in Ontario’s patient medical homes.


From March to May 2018, we conducted an online survey focused on practice-level patient engagement that targeted primary care organization leaders at all Ontario family health teams, community health centres, nurse practitioner–led clinics and Aboriginal Health Access Centres. We asked questions from the Measuring Organizational Readiness for Engagement (MORE) and Public and Patient Engagement Evaluation Tool (PPEET) questionnaires. We used factor and mediation analysis to identify organizational conditions and activities that are associated with the outcomes of patient engagement, affecting board decisions, program-level decisions and the formation of collaborative partnerships.


We achieved a 53% response rate (n = 149/283); after removing missing data, our final sample size was 141 respondents. Most respondents perceived that their organization’s patient engagement activities and resources were insufficient. Processes that had a direct effect on outcomes (β = 0.7, p < 0.0001) included planning, training and supporting employees; identifying, recruiting and supporting relevant patients; and using leaders. Structures — including an organizational mission and vision for patient engagement, and policies, procedures, job positions, training programs and organizational culture that reflect that mission — indirectly affected outcomes, mediated by the aforementioned processes (β = 0.7, p < 0.0001).


Based on the perceptions of primary care leaders, organizational structures and processes are related to successful patient engagement. Organizations that seek to improve patient engagement should assess their commitment and follow-through with associated resources and activities.

Patient engagement is a process of working “together to promote and support active patient and public involvement in health and health care” to strengthen the influence of patients on health care decisions at the individual and collective levels. A growing body of evidence suggests that people who are involved in their health care experience improved satisfaction and better health outcomes; patient involvement may also contribute to lower health care costs, highlighting the potential “triple aim” effect of engagement. Furthermore, patient engagement in priority settings for health care improvement has the potential to heighten focus on community health needs.

Several initiatives across Canada have demonstrated not only the feasibility of including patient engagement in quality improvement and health system redesign, but also the contribution of patient engagement to successful program implementation and sustainability. However, despite a growing body of research and health policy, the uptake of patient engagement activities by health care providers has been slow.8 Engagement at the collective level (in organizational design, governance and policy-making) remains a challenge in health care. The reasons for this include difficulties in redesigning decision-making processes; recognizing and mitigating differentials in power and privilege; and reallocating time and other resources that may not have been built into the existing infrastructure and culture of health care. Moreover, the field is only beginning to share lessons learned about the process of patient engagement.

Patient engagement and person-centred care are critical tenets of the patient medical home, a model of primary care practice that is being increasingly adopted. Patient medical homes aim to offer accessible, comprehensive, continuous, coordinated care, where the patient’s values and preferences guide care practices. More specifically, in the patient medical home context, the pillar of patient- and family-partnered care focuses on achieving the patient’s own goals and responding to their preferences through shared decision-making; support for self-care; patient access to their own health information; convenient care options beyond the traditional office visit; including family caregivers as desired by the patient; and soliciting and using patient feedback to improve care at the practice level.

Despite substantial investments in primary care reform in Ontario over the past several decades, little is known about the extent to which patient engagement has been realized. Moreover, little has been published about how to enable patient engagement at the practice and organizational levels.22 In this study (as part of a broader program of work amplifying patient perspectives on quality improvement opportunities in primary mental health care and collaborative mental health care), we sought to understand the current extent of patient engagement in Ontario’s primary care organizations. We also sought to describe factors that may be associated with successful patient engagement in these organizations. We defined these factors as patient engagement activities that influenced decisions at the program or board level, or that influenced the organizational development of partnerships.