A qualitative study of the grassroots development of interprofessional primary care teams

BACKGROUND: Primary care access is universally a critical health system concern. Decades of research shows that continuous, comprehensive, team-based care promotes greater access to promotional, preventive, and therapeutic care. In Canada, health system investments in team-based primary care models have not yet supported consistent implementation and uptake across the country. As a result, some family practices have taken a grassroots approach to realising team-based care. AIM: To explore the factors and processes that support the successful grassroots development of team-based family practices. DESIGN AND SETTING: Using a qualitative multiple case study design, we investigated the experiences of Canadian family practices that engaged in self-initiated efforts to develop or transform into a team-based care model in Canada. METHOD: Case-relevant documents and interviews with practice leaders were analysed using an unconstrained approach to qualitative description. Data collection and analyses were guided by the theory of social innovation. RESULTS: Transformation processes were complex and multifaceted. Common activities across all cases were: developing business cases; obtaining funding; collaborating with provincial or regional governments, health authorities, and community members; ensuring buy-in from practice members; and securing space and human resources. These efforts supported alignment with local healthcare needs. Practice leaders uniformly declared that the change fostered positive outcomes, including improved access and attachment, more efficient workflows, and reduced emergency department visits. CONCLUSION: Those interested in promoting team-based family medicine should advocate for a balance of government investment and practice-level autonomy over development, which supports provider buy-in and community-appropriate innovation and responsiveness in care delivery.