Table 2.

Elements of hospital capacity for PE perceived as essential

		Exemplar quotes
Category	Theme	Enablers	Barriers
Resources	Operational funding dedicated to PE activities	It definitely takes resources to recruit and orient and nurture the patient and family advisory group (004 PE manager teaching)	There’s no funding. So that’s an important piece I think that’s missing (027 PE manager <100) I would say if we could have more resources to help the patient partners’ work, that would enhance what they could do (040 clinician 100+)
	Compensation for patients and release time for staff	They [patient/family advisors] get paid to work here because they are just so enmeshed in all of the things that we do (008 clinician teaching) There was funding to provide the release time for the staff so we could actually have a good 2-hour meeting with patients…so they got paid to be at the meeting (033 patient/family 100+)	Some type of financial resources for them [PFA’s] because they spend a lot of time at the hospital… it would be nice if we could give them some type of stipend for the time and commitment that they have within the organization (040 clinician 100+)
	Staff who are responsible for and enable PE (dedicated manager and staff/staff champions)	I have many staff that join me in running our Patient and Family Advisory Council (010 PE manager 100+) When we were rolling it out and doing all the initiatives, we were lucky to have the 70 staff champions to help us do all those different things because otherwise it would just be exhausting (006 clinician <100)	Well I think in an ideal world we would have more people involved. If more people are facilitating patient engagement in an organization beyond my role then we can facilitate more patient engagement because people need support (011 PE manager 100+) Well the biggest challenge is trying to create buy-in with staff with regards to time constraints because we’re too busy for this stuff (006 clinician <100)
	Technology to support PE	We use a lot of different types of technologies to help to promote people participating and having an opportunity to share (010 PE manager 100+) You know there’s a lot we can do virtually and we figured this out early on (031 clinician 100+)	I’m trying to engage our PFAC and I’m having to do it on my own. The hospital hasn’t found a virtual system across the board that can work, and even the ones that we have, have limitations in terms of how many people can join…So just really supporting more technological kind of advances to grow our connections and communication with our PFAC members (034 clinician 100+) We do it [Patient Family Advisory Committee work] mostly by paper unless we bring in our own tablets. The Board has secure emails, we are using our personal ones. The hospital does not have a Zoom account and we were using one of the member’s Zoom accounts (036 patient/family <100)
	Organization size	Small/rural Because we are a small hospital and it’s in a rural setting, it’s a totally different environment from, say, a big city. I regard myself as a liaison between my community and my hospital. So if someone has been in the hospital setting and said to me, I had a bad experience, I’ll go back to my committee, I keep it confidential, we look into it (035 patient/family <100)	Small/rural In more rural areas, you have to deal with the internet bouncing in and out, and not always being the most secure (036 patient/family <100) Being a rural hospital, all we have is a local radio station and newspaper, which is filled with adverts for patient representatives now (035 patient/family <100) Large Part of the challenge with <hospital name> is simply its size. It’s just a huge organization. I think a big challenge is coordination of different activities involving patients (014 patient/family teaching)
Training for patients and staff	Background information for patients	They sent us lots of things to read for background or samples of things and then we would be able to go ahead and do what was required (014 patient/family teaching) We usually have an education session for about a half an hour before we get into the meeting (036 patient/family <100)	–
	Establish roles and responsibilities for all involved	Something that we do upfront is define everybody’s, including the PFA, roles, responsibilities and comfort level in executing the activity as outlined because otherwise we’re not going to be successful (032 corporate executive 100+)	–
	Orientation for existing and new staff	We just held a big orientation event in October…we invited leaders to come and learn about being effective leaders in patient engagement (011 PE manager 100+) The staff and leaders received training on how to effectively engage with patient partners (029 patient/family 100+)	–
Organizational commitment to PE	Endorsed by CEO and Board	I do think having the PFA program owned by the CEO and VP Clinical really helped it. So it wasn’t something off to the side it was literally at the core of operational activity (020 PE manager 100+) Having a Board member sit on the PFAC, and bring those minutes to the Board [Quality] Committee and to the full Board ensures that if they need different equipment or whatever, that it’s not just being minuted in a meeting and then never done (001 PE manager <100)	–
	Staff commitment	I was struck by the level of commitment; that staff showed to this [PE activity]. They truly were committed to having the patient voice embedded in it… They’re really genuine; this is embedded in their thinking that the patient is the most important person (015 patient/family teaching) The most important thing is the support that the PFA program gets from the staff at the hospital… It is a very strongly supported program from the doctors and all the administration. They really see the value of bringing the patient to the centre of the activity (016 patient/family 100+)	I would try to build the culture that says that patient partners really can bring a lot of added value to any decision and any new program (014 patient/family teaching) Acceptance of the patient having a much more enhanced role is a barrier for sure. So physicians had to sit at the same table as their patient and talk about things that they weren’t doing well and that’s not easy… our physicians were uncomfortable (001 PE manager <100) The staff were very nervous about having a patient involved and there was a lot of tension in the room when I sat down at the table, I could feel it… We recognize that the staff are very intimidated by the fact that what they hear from patients are mostly complaints. That’s not who we want to be (007 patient/family teaching)
	PE is evaluated and improved	We always survey and get feedback from the patient and family advisors on how we can improve engagement, how we can improve their affiliation within a project based on interest, expertise and also looking at other improvements and engagement in a more efficient and effective way (032 corporate executive 100+)	–
Staff support	Staff encourage and are receptive to patient input	<Hospital name> has a way of treating all voices equally. There’s no feeling of hierarchy when you’re there. As a patient representative, the chief-of-staff does not make you feel like there’s a hierarchy (007 patient/family teaching) We’re not treated as add-on’s, we’re not treated as must do’s, or an irritant to the system, we’re treated as a resource that adds quality to the hospital experience (014 patient/family teaching)	One of the barriers is that as a patient-family advisor I certainly understand things from a patient perspective; but I’m not clinical. I don’t understand the acronyms; I certainly am not up to speed on a routine basis. So as an advisor you sit on a committee with highly skilled clinicians and doctors and surgeons and so on and it is sometimes somewhat embarrassing to ask questions that should be obvious but they’re not to patients (039 patient/family teaching) I think scheduling my attendance was a challenge. I wasn’t really part of those doodle polls to see when people were available. I think the structure of the meetings and when and how they took place was built around the availability of the leadership. I was sort of told when and where the meeting would take place and it was hoped that I could attend. So I don’t think I was on equal footing in that respect (029 patient/family 100+)