Engagement-Capable Environments - No Less Challenging than other Large System Changes

Kuluski et al.'s (2017) argument for including a more advanced form of health system performance management centred on "the experience of care," raises the major challenge of creating and sustaining engagement-capable environments. Here I briefly address frameworks that may be useful in meeting this challenge - Complex Adaptive Systems, Innovation Diffusion, Whole System Change. I also offer a personal perspective drawn from a successful citizen engagement experience, concluding with a perspective on the numerous challenges we have or are in the process of overcoming compared to the challenges of engagement-capable environments.