TY - JOUR T1 - Providing high-quality care in primary care settings JF - Canadian Family Physician JO - Can Fam Physician SP - e281 LP - e289 VL - 60 IS - 5 AU - Marie-Dominique Beaulieu AU - Robert Geneau AU - Claudio Del Grande AU - Jean-Louis Denis AU - Éveline Hudon AU - Jeannie L. Haggerty AU - Lucie Bonin AU - Réjean Duplain AU - Johanne Goudreau AU - William Hogg Y1 - 2014/05/01 UR - http://www.cfp.ca/content/60/5/e281.abstract N2 - Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices’ pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. ER -