The Ottawa Hospital (TOH) is focused on providing safe, high-quality care to its patients. TOH has identified physician engagement as a critical factor for improving the quality of care they provide. The physician engagement strategy developed at TOH involved a qualitative inquiry into the impediments and facilitators of engagement. Using concurrent focus groups, researchers collected and analyzed the physicians' perspective regarding engagement. A systematic analysis of the verbal data was used to construct a statement of mutual understanding between the physicians and the hospital (physician engagement agreement). The process of developing this agreement is the focus of this article.