Objective: Present and discuss the development and basic structure of a multilevel approach to strengthen patient and family engaged care, “The New Haven Recommendations on partnering with patients, families and citizens to enhance performance and quality in health promoting hospitals and health services”. Methods: A generic literature review was conducted followed by a Delphi procedure to prepare the New Haven Recommendations. From systems theory perspective, three conceptual levels are used to map action areas to enhance patient and family engaged care. Results: The recommendations propose a multilevel approach to enable patient, family, (and citizen representatives’) involvement (a) within direct service provision; (b) among hospitals and health services; (c) in planning healthcare delivery systems and policy. Conclusion: The New Haven Recommendations provide a strategic tool and practical recommendations, which can be used for reflection on current practices or generating new ways of thinking about patient and family engaged care. They support the development of patient and family engaged care as core aspect of high quality healthcare, and can contribute to achieving the Ottawa Charter’s claim of reorienting health services. Practice implications: The potential benefit of the multilevel approach is to reorient the basic culture of healthcare towards patient- and health-centered care.