Partnership by design: co-designing an institutional framework for engagement at a leading Canadian pediatric hospital

Healthcare institutions are increasingly recognizing the importance of implementing integrated processes for carrying out patient engagement in health systems improvement and research, however, concrete tools and guidance for doing so are needed. While frameworks for engagement exist, most are not specific to pediatric organizational settings where children, youth, families, and community members are engaged across the continuum of clinical care, research, and education. To address this gap, an organization-wide framework for engagement that would have relevance to clinical care, research, and education was co-designed with patient and family advisors and staff at a large pediatric hospital. This commentary aims to (i) describe the process of co-designing an organization-wide engagement framework; (ii) share lessons learned about the co-design process; and (iii) document the experience of the co-design process from the perspectives of family advisors and staff. The framework development process consisted of several steps over the course of a year, including: (i) interviews and focus groups to identify advisor and staff priority areas, (ii) an environmental scan, (iii) a co-design process, (iv) patient consultation, and (v) a framework validation survey. This process revealed important learnings, including the importance of flexible approaches for collaboration, rapport-building, transparency about how advisor and staff input was being used, and highlighting the practical relevance of the framework and its implementation. Developing an organization-wide framework for engagement uncovered key challenges and insights related to co-design, resulting in a ready-to-implement framework. Evaluations indicated the co-design experience was positive and impactful for members. The methods employed in this initiative can be applied to various healthcare settings. The framework development process involved collaboration with patient and family advisors to bring their crucial insights to its content and design. This article was co-authored with family advisors. Healthcare institutions understand the importance of engaging patients, families, and the community to ensure the health system meets the needs of those who rely on it. Most existing engagement frameworks are not specific to pediatric settings where children, youth, families, and community members are engaged in clinical care, research, and education. This commentary describes the process of co-designing an engagement framework for a pediatric hospital in Toronto, Canada. The process included: holding interviews and focus groups to identify patient, family, and staff priority areas; looking broadly at the healthcare engagement landscape to identify trends and gaps; committing to a co-design process to create a framework for engagement; and inviting the broader hospital community to provide their input via a survey. This process resulted in a ready-to-implement framework that provides guidance on how to effectively engage in a pediatric healthcare setting where clinical care, research, and education happen. Those who participated in its creation reported that the experience was positive and impactful and that the framework reflects the needs and priorities of those with lived experience. The methods described in this paper can be applied in various healthcare settings where maximizing engagement with patients, families, and the broader community is a priority.