Table 2.

Highlights on the 3 areas of compromise for the 5 cases

Developing a shared vision of high-quality care
  • 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

Aligning resources with the vision
  • 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

Balancing professional aspirations and population needs—pressures from the external environment
  • 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

  • CHC—community health centre, FMG—family medicine group, HSSC—health and social services centre, PC—primary care.