Fooks et al. (2015) propose patient-centred care and engagement as “levers for change” in a healthcare system increasingly challenged to care for patients living with complex chronic illness. Patient-centred care, engagement and experience are presented as inherently relational concepts, but who is included under that relational umbrella is less clear. Using the rubric of “finding common ground” from the model of patient-centred care described by Hudon et al. (2011), I argue for including provider perspectives, not just patient/family. Otherwise the envisioned conversations of "change" will be missing the voices of those expected to facilitate the meaningful relational engagement of patients and the process of shared decision-making. I also discuss relational communication competence as a key factor in successful patient-engagement, patient-centred care and, ultimately, the healthcare experience. Without attention to both these elements – broadening the understanding of therapeutic relationship to encompass all contributing stakeholders and the relational communication competency so necessary to this endeavour – whatever consensus we reach will be missing important aspects related to actionable content and process, both of which are needed to guide the development of relevant metrics. Without metrics, we will lack rigorous "evidence" with which to make the case that patient-centred care and engagement are indeed "levers" for positive system reform.

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