High-quality care is evidence-based care and timely response to patients’ needs

Physician lead active in sharing the vision with other physicians and nurse

Chief secretary active in sharing the vision with the support staff

High-quality care is the right service, at the right time, in the right place, by the right person

Vision of quality threatened by merger of the CHC with the HSSC

Lost one-third of its physicians when the rest opted to become an FMG to retain control over their vision and resources

High-quality care is evidence-based care and continuity of care

Professional isolation (“silos”) within the CHC meant that vision of high-quality care was shared among physicians, but did not correspond to that of nurses or support staff

High-quality care is continuity of care, respect, and empathy

Small team; vision is easily shared informally

High-quality care is continuity of care with a strong emphasis on accessibility

Tensions between members of the team focused on population needs (access to care) and those focused on high-quality care for the registered patients

Cooperation as a central guiding principle for teamwork

Nurse’s role mostly in managing accessibility and response to unexpected needs of patients, working hand in hand with the team of physicians

Systematic follow-up of chronic diseases by nurses initially implemented, but when 1 nurse left on sick leave, the team (physicians and remaining nurses) collectively decided to refocus nurses’ role on case management and improving accessibility

Very little control over their resources. Physicians organized continuing medical education sessions to standardize their clinical practice and did a lot of ancillary tasks (faxes, telephone calls, managing appointments)

Each physician worked autonomously as a solo practitioner

Secretaries who had been at the practice for a long time knew each physician’s preferences well and had impressive knowledge of individual patients

Priority given to registered patients, who have privileged access to walk-in consultation

FMG nurse devoted to systematic follow-up of chronic diseases

Responsibility toward registered patients only

Community involvement (disease prevention and health awareness initiatives)

Ambivalence about the FMG model, seen as restricting the practice’s autonomy

Responsibility toward registered patients only

Difficulties in reaching target patient registration

Pressure coming from authorities’ conflicting view of nursing practice in an FMG

Responsibility toward registered patients mostly

Drastic reduction in walk-in consultations (4 half-days per week) generated a lot of dissatisfaction from the public

Responsibility toward registered patients only

Precariousness of such a personalized organization

Recruitment as a substantial challenge because practice model no longer consistent with younger doctors’ reality

Responsibility toward both their registered patients and unregistered population

Physician lead seen as a regional leadership figure for the FMG model and PC innovations