Grassroots efforts became embedded at all system levels Early efforts in patient engagement for patient safety and quality grew out of the grassroots work of patients, clinicians, and leading healthcare organizations in patient and family-centred care.27,28,29,30,31 The Canadian Foundation for Healthcare Improvement (CFHI) supports organizations to pilot and test projects related to patient enga [...] At the provincial or territorial levels, jurisdictions launched structures and strategies to progress safe and quality care through patient engagement and patient and family-centred care: Saskatchewan’s 2009 Patient First review included patient and caregiver opinions in setting priorities for provincial health system reform.33 These priorities continue to shape progressive change that embeds “P [...] Challenges and enablers to patient engagement “Patients and families face challenges, the most critical being the need to convince more healthcare organizations and service providers to engage patients and families in every aspect of patient safety initiatives. [...] Partnership and collaboration is the organizational culture and patient engagement is a visible and lived value tied to a commitment to patient and family-centred care. [...] Effective patient engagement and patient-centred care leaders:87,88 Are visible champions (e.g., share patients’ care experiences; report on patient partnerships and engagement impacts to the board, staff, and patients; and communicate the organization’s commitment to patient engagement) Link patient engagement efforts to other organizational strategies (e.g., improve care processes and outcom