Graeme Kohler - Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
Tara Sampalli - Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
Ashley Ryer - Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
Judy Porter - Diabetes Management Centre, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
Les Wood - Diabetes Management Centre, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
Lisa Bedford - Diabetes Management Centre, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
Irene Higgins-Bowser - Diabetes Management Centre, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
Lynn Edwards - Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
Erin Christian - Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
Susan Dunn - Public Engagement, Nova Scotia Health Authority, Halifax, NS, Canada
Rick Gibson - Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
Shannon Ryan Carson - Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
Michael Vallis - Behaviour Change Institute, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
Joanna Zed - Dalhousie Family Medicine, Halifax, NS, Canada
Barna Tugwell - Endocrinology, Nova Scotia Health Authority, Halifax, NS, Canada
Colin Van Zoost - General Internal Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
Carolyn Canfield - Canadian Foundation Healthcare Improvement, Ottawa, ON, Canada
Eleanor Rivoire - Canadian Foundation Healthcare Improvement, Ottawa, ON, Canada

Background Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice.   Methods The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach.   Results The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this ۱۸-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide.   Conclusion This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability.

Patient and Family Engagement, Decision-Making, Quality Teams, Patient Experience