Table 3 Extracted quotations illustrating strategies for effective engagement

Building trust and collaborative relationships

“The maintenance of trust could not be assumed… Once trust was developed it was just as important to find some early wins to show progress was being made.” [13].

“Prioritizing policies that encourage aligned planning processes for both primary care and public health could bring partnerships together to explore and identify shared priorities for limited resources. Undertaking shared strategic planning may help partnerships identify and prioritize barriers to address collaboratively” [15].

Targeted engagement strategies as one size does not fit all

“A very personal and iterative approach [was used] to engaging [primary care physicians]. This approach required a high level of oversight by the team and [primary care lead], which is resource intensive and may be challenging to scale to other sites.” [20].

Physician leadership and collective voice

“Leveraging physician champions and establishing innovation-values fit between programs and physicians were critical parts of engagement. In addition to generating a positive innovation climate, these approaches informed innovation policies and procedures as well as how programs tried to prove their value to physicians, often through emphasizing increased workflow efficiency and minimal time investment.” [23].

“Working with structures that were designed to give physicians a collective voice helped build relationships, find common ground, encourage dialogue and enhance continuity.” [13].

Open and intentional communication strategies

“The tensions identified in the interviews were often recalled as hidden and unacknowledged in the interactions between partners… Honest conversations and structures for communication were necessary. Through conscious dialogue, they could surface and work through tensions that developed when changes were made to how services were designed and delivered. These efforts have not been easy or straightforward. They have taken a long period of time, as foundations of commonly agreed-upon and deliberately purposeful actions have required an understanding of others’ contexts.” [13].

“Whereas an earlier narrative included the term ‘rolling-out reform,’ senior administrators later spoke of ‘facilitating reform.’ There was also an effort to brand their new approach as the ‘Northern Health way’.” [14].

Clinically relevant initiatives and straightforward initiatives

“Approaches like this allowed NH and physicians to develop working relationships focused on improving care for the people they served, which allowed tensions to be identified, managed and worked through. Actions were focused on what could be done together to improve patient care, such as the creation of an unattached patient clinic, the development of a family practice clinical teaching unit and actively helping people learn about others’ working contexts.” [13].

“The initiatives most likely to meet their objectives were those in which acceptability elements directly facilitated physicians’ achievement of an outcome for which they were accountable. Such direct, meaningful relatedness between acceptability and accountability was exemplified by initiatives that provided support for a specific, easily observable behaviour, such as electronic medical record adoption or patient attachment.” [21].

Financial incentives

“[Primary care networks] were set up to be attractive to physicians – proposals suggested that family physicians could improve work/life balance, improve quality of care for patients, and receive small financial incentives for engaging in planning processes. Physicians were reimbursed for time spent at meetings, program development and other planning activities, that were otherwise not funded. In addition, money was available to hire a wide range of health professionals.” [19].