Identifying strategies for successful implementation of primary healthcare teams: longitudinal case studies across three Canadian provinces

Primary care renewal has become an important goal of global health system reforms over the past four decades. Team-based care, "the provision of health services ... by at least two health providers who work collaboratively with patients and their caregivers..." is a core building block of high-performing primary care, and evidence demonstrates that it improves peoples' health outcomes and experiences of care, and reduces unnecessary healthcare use. Unfortunately, creating and sustaining team-based primary care models, is not easy or automatic and remains an important barrier to health system reform. Few studies have explored how primary care teams come together, and how they develop and adopt new ways of collaborative working. Specifically, there is a need for evidence to answer the questions of: 1) how teams form and develop over time; 2) what roles and functions patients, families, and communities play in these teams; and 3) how leadership can support effective teamwork, and sustainment of team-based care models. Our proposed project will address these gaps, by conducting a longitudinal investigation of factors which impact the implementation and sustainment of team-based care models in British Columbia, Nova Scotia and Ontario. The primary objective of our research is: to explore how (intra- and inter-organizational) primary healthcare teams are formed, and how they evolve and adapt over time, to address the challenges of implementing and sustaining team models. Our project team comprises researchers from diverse disciplines, and representatives from decision-maker and provider groups, and will include patients and their families in each province. We will identify important factors and contextual variations which impact the development of teams, explore how patients and families participate in teams, and how leadership supports team development and effectiveness. This work will guide implementation of team-based care and support health system reform in Canada.