Continuum of engagement of persons with lived experience

Engaging persons with lived experience ranges from consultation to involvement, to partnership and shared leadership, depending on the desire of all involved (RNAO, 2015). The continuum of engagement (figure below) can guide the process of planning for engagement and assessing current engagement practices.  

Prior to initiating engagement strategies, it may be helpful to first assess whether your organization has been engaging persons with lived experience, and identify organizational practices that support engagement. Furthermore, depending on where on the continuum your organization is, an assessment can help to identify priority areas for improving, strengthening, or sustaining engagement practices. Approaches for planning and assessing engagement across the continuum are also summarized in the table below.

Characteristics and approaches for planning and assessing engagement across the continuum

  Consultation Involvement

Partnership and shared leadership

Description Participate to some degree, with limited power or authority to make decisions. Share some responsibility in making decisions and setting priorities.

Share power and responsibility. Active partner in setting agenda, identifying priorities and making decisions.


Sometimes asked to share health-care experiences/opinions or feedback/input.

Invited to provide input to quality/safety teams or committees, but not formally represented.

Sometimes included in decisions influencing health care.

Contributor in making recommendations that may influence health-care decisions (e.g., funding, new staff hiring, staff training).

Involved in making decisions about quality and safety (e.g., members on safety committees or quality improvement teams).

Representative on select organizational-level committees (e.g., advisory councils).

Equally represented on leadership committees/boards that make decisions that influence health care (e.g., resource allocation, funding).

Partner or co-lead on quality/safety committees (e.g., participate in establishing quality and safety strategic initiatives).

Member of effective and highly represented advisory boards/councils (e.g., increased influence over health-care decisions).

Approaches for Planning and Assessing Engagement

Ask persons/patients and families about their perceptions of engagement.

Ask staff about their perceptions of engagement.

Identify priorities based on the assessment.

Develop an action plan.

Involve organizational leadership to initiate and prioritize person engagement (e.g., on teams or committees).

Advocate with organizational leadership for engagement to be recognized as a vital component for safety and quality improvement.

Ask persons/patients and families about their thoughts on current engagement practices to see if these align with organizational priorities.

Ask staff for input on current engagement practices and identify possible gaps in knowledge and skill.

Assess the current participation of persons on teams/committees and identify priorities for expansion.

Involve senior leadership to expand person participation on teams and committees.

Reassess person perceptions and experiences of engagement to prioritize areas for sustained improvement.

Reassess staff perceptions and experiences of engagement to prioritize areas for sustained improvement.

Reassess person participation on committees and teams to identify areas for ongoing expansion (e.g., leadership committees).

Identify and share successful strategies with other organizations.

SOURCES : Carman et al., 2013; Kemper et al., 2013; Liang et al., 2018; Planetree, 2017; RNAO, 2015; Wieczorek et al., 2018, Sharma et al., 2016.