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Ten tips for advancing a culture of improvement in primary care
  1. Tara Kiran1,2,3,4,
  2. Noor Ramji1,2,
  3. Mary Beth Derocher1,2,
  4. Rajesh Girdhari1,2,
  5. Samantha Davie1,
  6. Margarita Lam-Antoniades1,2
  1. 1 Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
  2. 2 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3 Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
  4. 4 Health Quality Ontario, Toronto, Ontario, Canada
  1. Correspondence to Dr Tara Kiran, Deptartement of Family and Community Medicine, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada; tara.kiran{at}


Embracing practice-based quality improvement (QI) represents one way for clinicians to improve the care they provide to patients while also improving their own professional satisfaction. But engaging in care redesign is challenging for clinicians. In this article, we describe our experience over the last 7 years transforming the care delivered in our large primary care practice. We reflect on our journey and offer 10 tips to healthcare leaders seeking to advance a culture of improvement. Our organisation has developed a cadre of QI leaders, tracks a range of performance measures and has demonstrated sustained improvements in important areas of patient care. Success has required deep engagement with both patients and clinicians, a long-term vision, and requisite patience.

  • primary care
  • quality improvement
  • teamwork
  • medical homes

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  • Correction notice This article has been corrected since it published Online First. One of the co-authors, Rajesh Girdhari's name was incorrectly displayed as Girdhari Rajesh.

  • Contributors TK drafted the manuscript and all authors critically reviewed it. All authors approved the final submitted version of the manuscript.

  • Funding Dr. Kiran is the Fidani Chair in Improvement and Innovation at the University of Toronto. She is supported as a Clinician Investigator by the Departments of Family and Community Medicine at St Michael’s Hospital and the University of Toronto. She is also supported by Health Quality Ontario and the Canadian Institutes of Health Research as an Embedded Clinician Researcher. The authors have not declared a specific grant for this research fromany funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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