Background: Patient and caregiver engagement is a core component of high quality health care systems. The Covid-19 pandemic revealed the fragility of patient and family engagement that was not as firmly rooted in the health system as expected. Objectives: To identify key enablers to sustaining patient engagement activities during times of high health system stress (e.g., the COVID-19 pandemic).   Methods: A series of case studies were conducted across 5 Canadian provinces and included both health service delivery and social care organizations at local, regional, and provincial levels, as well as health organizations that support improvements in care and patient engagement. 1-1 interviews were conducted with patient partners and organizational leaders from each of the case sites. An inductive thematic analysis was conducted to identify core themes (enablers) to sustaining patient engagement activities during the pandemic.  Findings: The following themes represent key enablers to sustaining patient engagement activities during the pandemic: 1) Strong Connection between Organizational Leaders and Patient and Care Partners; 2) Maturation of Context including Entrenched Philosophy of Patient and Family Centred Care; 3) Giving Patient and Care Partners the Space to Lead, Build and Sustain Relationships; 4) Willing Partnership through Meaningful Activities; and 5) Creating New Mechnisms for Engagement.  Conclusions: The Covid-19 pandemic challenged the culture that patient engagement efforts require to thrive and revealed the tensions that exist in creating person-centred policies and practices during times of crisis. We have learned from many organizations where not only engagement practices and philosophies survived but were able to thrive. Moving forward, we can consider engagement capabilities in the broader ecosystems of health where engagement needs to grow. We can seek to understand the instrumentality of engagement efforts but also the democratic forces of engagement and dialogic understanding brought about through opportunities for learning and unlearning.