A high-performing primary care system is not defined by a single policy, delivery model, or funding reform. It is built on a coherent set of structural attributes working together to drive the quintuple aim. The Aggarwal-Hutchison Framework identifies the core system-level features that distinguish countries and jurisdictions that achieve sustained improvement from those that remain locked in cycles of short-term fixes.
This framework was developed through comparative policy analysis, longitudinal system assessment, and empirical evidence, and now underpins national system planning and evaluation frameworks. Each attribute represents a system function: when strong, it enables performance; when weak, it constrains it.
Explore the 13 attributes below. Each tile provides:
High-performing primary care systems are guided by an explicit, shared policy direction that defines the role of primary care as the foundation of the health system. This direction is anchored in public values, population needs, and patient preferences, and provides a long-term roadmap for transformation rather than a series of disconnected initiatives.
Effective governance provides the structural link between policy intent and frontline delivery. High-performing systems establish inclusive governance mechanisms at community, regional, and provincial levels that give primary care a collective voice and clear accountability for population health outcomes.
Patient enrolment establishes formal responsibility for a defined population, shifting primary care from reactive encounters to longitudinal stewardship. Attachment enables proactive prevention, chronic disease management, and performance measurement tied to a known population.
Team-based primary care integrates multiple professional roles to deliver comprehensive, coordinated, and person-centred care. Effective teams enable providers to work at the top of their scope and improve outcomes, particularly for people with complex needs.
High-performing systems embed patient and community voices in both care delivery and system design. Engagement extends beyond individual encounters to include participation in planning, evaluation, and improvement.
Payment models shape behaviour. High-performing systems use blended funding approaches to support continuity, comprehensiveness, teamwork, and population responsibility rather than volume alone.
Misaligned incentives undermine continuity, collaboration, and preventive care.
Effective digital infrastructure supports clinical decision-making, continuity, patient engagement, performance measurement, and integration across sectors. Technology is a system enabler, not an add-on.
Without interoperable systems, care remains fragmented and inefficient.
High-performing systems generate timely, actionable data to support improvement, accountability, and learning at all levels.
Without measurement, systems cannot distinguish activity from improvement.
Quality improvement capacity enables practices to adapt and improve over time. Learning is supported through facilitation, analytic expertise, and shared improvement infrastructure.
Improvement without support remains uneven and difficult to sustain.
System transformation requires leadership at the clinical, organizational, and system levels. High-performing systems deliberately develop leadership capability across roles and settings.
Without leadership capacity, reforms struggle to translate vision into action.
Primary care functions best as the coordinating hub of the health system, linking specialized care, community services, public health, and social supports. Effective integration moves beyond referral-based transactions toward shared responsibility for care planning, transitions, and outcomes-particularly for people with complex or ongoing needs.
When integration is weak, patients and families are left to navigate fragmented systems on their own, leading to duplication, delays, and avoidable harm. Strong integration allows primary care to coordinate care effectively, reduce burden on patients, and deliver more coherent, person-centred services.
Evaluation is embedded into the design and implementation of reforms rather than treated as an afterthought or external exercise. This enables systems to move beyond pilot projects toward informed decisions about adaptation, scale, or discontinuation.
Without systematic evaluation, systems repeat pilot projects without learning from them and struggle to distinguish promising innovations from ineffective ones. Embedded evaluation supports cumulative learning and more effective use of public resources.
High-performing systems invest in sustained research capacity to generate, interpret, and apply evidence in support of primary care policy and practice. This includes the people, partnerships, data access, and institutional supports needed to produce relevant, timely, and policy-relevant research.
Without dedicated research capacity, primary care reform is shaped by limited evidence and short-term priorities. Strong knowledge infrastructure enables systems to build evidence over time, support informed policy choices, and sustain improvement.
Objective: To strengthen faith education and leadership development through research-informed practices.
The Aggarwal-Hutchison Framework defines the structural attributes of high-performing primary care systems and provides the analytic foundation for our work. We use the framework to guide research design, evaluation, and knowledge translation across our projects. Click through each element to learn more.
