Table 2.

Recommendations that achieved consensus to retain

Domain	Recommendation (% panellist who rated Likert scale 6 or 7 to retain)
Engagement approaches 5/6 retained	Patient/family advisors with appropriate skills should be engaged in decisions for hospital activities whenever possible, including governance, strategy planning and designing, developing, evaluating or improving facilities, programmes, healthcare services, care practices, quality and safety or resources/materials (86.2)
	Hospitals should establish and maintain at least one Patient and Family Advisory Committee (87.9)
	In addition to one or more Patient and Family Advisory Committee’s, hospitals should engage patient/family advisors using multiple forms of engagement (eg, standing committees, project teams) (96.5)
	Patient and family engagement should take place in-person whenever possible to build rapport, but virtual options and technology should be offered to enhance convenience and connectivity and suit diverse preferences (**please rate this for a non-pandemic context) (83.3)
	Hospitals should employ a range of approaches to engage patient/family advisors including collaboration (eg, member of project teams or committees), consultation (eg, surveys, interviews, focus groups) or blended approaches (eg, collaboration and consultation approaches for the same initiative) (93.1)
Strategies to identify and integrate diverse perspectives 4/5 retained	Hospitals should build patient/family engagement programmes that welcome persons with diverse experiences, characteristics, abilities and resources representative of the communities they serve, and do so in a culturally safe manner or setting (98.3)
	Hospitals should recruit patient/family advisors using a range of strategies (eg, social media, email, newspaper ads, word of mouth, through community organisations) and in languages or settings tailored to the community they serve to achieve diversity (91.2)
	In prioritising what benefits many, hospitals should also use a health equity lens to ensure that they are improving quality of care for at risk populations in their community (98.2)
	Hospitals should ensure that there is ongoing recruitment and onboarding of new patient and family advisors to enhance diversity and supplement the contributions of long-standing experienced patient/family advisors (96.6)
Strategies to enable patient/family engagement 9/14 retained	Once recruited, hospitals should provide patient/family advisors with ongoing support and education about roles and responsibilities, organisational culture and strategic priorities to prepare them for engagement, possibly through mentorship by existing experienced patient/family advisors (96.5)
	In advance of deployment, hospitals should orient patient/family advisors to the background, purpose, and goals of a specific committee or project (eg, share documents, meet with project or committee leader) (96.6)
	In advance of meetings or activities, hospitals should provide patient/family advisors with agendas, background information, briefing material and the name of a liaison who can answer questions to help them prepare and then actively participate (100.0)
	Hospitals should train project leaders, committee chairs, healthcare workers and staff on how to foster a team environment, and effectively engage with and support patient/family advisors (89.7)
	Hospitals should involve patient/family advisors in reviewing and delivering training to existing healthcare workers and staff, and orienting new healthcare workers/staff to patient engagement (84.5)
	Hospitals should engage patient/family advisors early and throughout planning or improvement activities (94.8)
	At the outset of new committees or projects, the chair should explicitly establish roles and responsibilities collaboratively with and for all involved including patient/family advisors and healthcare workers, and prospectively revisit roles as projects evolve (89.3)
	Hospital healthcare workers and staff should demonstrate that they value patient/family advisor input and decisions by meaningfully engaging with patient/family advisors, basing decisions on their perspectives and telling patient/family advisors that they are valued (89.1)
	Hospitals should routinely check with patient/family advisors to confirm that interim or near-to-final decisions or outputs accurately captured their perspectives and explain why, if any, were not captured (87.7)
Strategies to champion patient/family engagement 9/11 retained	Hospitals should convey an organisational commitment to patient/family engagement by acknowledging it in their hospital values statement and strategic plan, and continuously update values/strategic plan as patient/family engagement evolves (94.6)
	Hospitals should foster an organisation-wide culture of respect and support for patient/family engagement (100.0)
	To establish a philosophical commitment, hospitals should promote the view that patient/family advisors bring diverse expertise, skills and perspectives, which should be valued equally to those of healthcare workers (82.8)
	Senior administrative and clinical leaders should model patient/family engagement (98.1)
	Hospitals should share results or outcomes with involved patient/family advisors so that they are aware of how their input and decisions contributed to planning and improvement (100.0)
	The hospital [Chief Executive Officer] and board members should visibly endorse patient/family engagement by promoting it throughout the hospital to all staff and patients (eg, in waiting rooms) to create awareness of how patient/family advisors worked with healthcare workers/staff on planning and improvement (87.5)
	Hospitals should share patient/family engagement opportunities, activities, outputs and impacts with the broader community through various platforms as a means of patient/family advisor recruitment and to create awareness about how the hospital is addressing their needs (93.1)
	Chairs of standing committees or project teams should assess acceptability in advance, and then routinely consult with patient/family advisors throughout meetings to ensure they understand acronyms, medical terms or issues under discussion, ask if they have any questions, or wanted to articulate ideas or feedback, and adjust pace as necessary (80.8)
	Hospitals should include at least one patient/family advisor on the Board or Committees of the Board as voting members (80.0)
Hospital capacity for patient/family engagement 5/12 retained	Hospitals should allocate dedicated operational funding to nurture and maintain patient/family engagement including one or more Patient and Family Advisory Committee’s and other engagement activities (84.2)
	Hospitals should encourage healthcare workers to participate in patient/family engagement, and recognise their efforts (eg, in annual performance reviews) (80.0)
	Hospitals should ideally employ a dedicated patient engagement manager to promote and support patient/family engagement, or include this responsibility in an existing closely-related portfolio (eg, patient relations manager, human resources personnel) (88.7)
	Hospitals should employ dedicated patient engagement staff who are driven by person-centred values and possess skills in reflective listening, compassionate communication, and project coordination and facilitation (84.5)
	Hospitals should regularly evaluate patient/family engagement practices and make improvements based on patient/family advisor, healthcare worker and staff feedback, and reflection on what worked and what did not work (93.0)