Projects
Building High-Performing Primary Care Systems in Canada
This program of research examines whether and how Canadian jurisdictions are implementing the structural attributes required for high-performing primary care systems. Using comparative policy analysis, document review, and key informant interviews across provinces and territories, the work assesses progress over time in areas such as governance, patient attachment, interprofessional teams, payment reform, data infrastructure, and accountability. Findings from this research, published in The Milbank Quarterly, demonstrate uneven implementation, persistent structural gaps, and limited system-level accountability. The project has informed provincial reform strategies and now underpins Canada’s first national Primary Health Care Standard, translating empirical evidence into accreditation and system design tools.
Developing Government-Level Primary Care Strategy and Vision
This project stream focuses on how governments articulate, align, and operationalize long-term strategies for primary care system transformation. The work examines the role of explicit policy vision, strategic coherence, and sustained stewardship in shaping reform trajectories across jurisdictions, with attention to how strategy translates into governance, investment, and implementation decisions. A core ongoing project draws on input from diverse stakeholders—including policymakers, clinicians, researchers, patients, and system leaders—to inform the development of a national primary care strategy. Using mixed methods and consensus-oriented approaches, this work supports the creation of a shared, evidence-informed vision for primary care that can guide coordinated, system-wide reform.
Primary Care-Led Governance and Health Neighbourhoods
This project examines how governance structures shape accountability, coordination, and performance in primary care systems. The research focuses on meso-level governance models—such as health neighbourhoods and primary-care-led networks—and how they enable integration across community, specialty, and social services. Using mixed methods and comparative case studies, the project analyzes governance arrangements across Canadian provinces and internationally through collaborations with partners in the United Kingdom, Australia, and New Zealand. Findings are informing provincial reform efforts in Ontario, Alberta, Newfoundland and Labrador, and British Columbia, while contributing to international learning on effective primary-care-led governance models.
Integrating Primary Care with Specialized and Community Services
This work stream examines how primary care can act as a coordinating hub across specialized care, community services, and public health. This work focuses on governance and accountability structures that support shared responsibility, smoother transitions, and reduced fragmentation, particularly for people with complex needs. A key ongoing project explores integrated governance models involving community pharmacy, examining how pharmacists can be embedded within primary-care-led systems through aligned incentives, shared accountability, and data integration.
Interprofessional Primary Care Teams and Workforce Reform
This body of work investigates how team-based primary care models function in practice, and which structural conditions support high-performing teams. In collaboration with national and provincial partners, the research examines role clarity, remuneration models, intrinsic and extrinsic motivations, and measures of team functioning and effectiveness. The project has produced conceptual frameworks for understanding team performance and has generated policy-relevant evidence on how payment structures and organizational supports influence collaboration and provider experience. An ongoing comprehensive review of the evidence examines the effectiveness of interprofessional teams, as well as enablers and constraints influencing their performance. Outputs are informing workforce policy, team implementation strategies, and evaluation approaches across Canadian jurisdictions.
Primary Care Workforce Preparedness and Capability Development
This work stream examines how well the primary care workforce is prepared to meet contemporary population needs and system expectations. It focuses on the competencies, supports, and structural conditions required for high-performing practice across career stages. A central component of this work is the development and validation of a national Capability Framework for Family Medicine , which defines the system-facing capabilities required of high-performing family physicians and aligns training with population health needs and evolving delivery models. Complementary research explores preparedness gaps, supports, and misalignments between training and real-world practice and the factors that determine the scope of practice decisions of family physicians. Together, this work informs postgraduate education, workforce planning, and policy discussions on readiness for practice.
Patient Attachment and Empanelment in Primary Care
This project examines how patient attachment and empanelment function as foundational structures for continuity, accountability, and population-based care in primary care systems. Drawing on policy analysis and mixed methods research, the work explores how attachment models are defined, implemented, and measured—as well as how they affect system performance. Findings from this stream have informed standardized definitions of attachment and national policy discussions on accountability.
Equity, Patient Voice, and Participatory Co-Design in Primary Care Systems
Our program centres equity, patient voice, and lived experience as core elements of primary care system design. We examine how policies, delivery models, and care practices can better reflect the needs and priorities of communities that have been historically underserved or excluded, with a strong emphasis on meaningful engagement and co-design. Recent work includes equity-focused COVID-19 research that partnered with patients, community members, clinicians, and system leaders to co-develop recommendations for future pandemic preparedness and vaccination access strategies. An ongoing collaboration with Royal Victoria Regional Health Centre brings together patient and provider perspectives to inform the co-design of a digital tool that supports values-based goals-of-care discussions.
Digital Health, AI, and Responsible Innovation in Primary Care
This project explores how digital health technologies—including virtual care, mobile health, and artificial intelligence—can enhance access, continuity, and equity in primary care systems. The research critically examines governance, ethical considerations, and implementation challenges associated with digital innovation. Early work in this area produced some of Canada’s first analyses of mobile health interventions for opioid-related harm and highlighted risks of digital inequity. Another key output is an early exploration of the regulatory, ethical, and implementation challenges associated with AI adoption in health systems. Current work informs national conversations on responsible digital adoption.
Rethinking Research Impact, Productivity, and Excellence
This work stream examines how research impact and excellence are defined, measured, and rewarded within primary care and academic health sciences. It challenges traditional metrics that prioritize publication volume and funding totals while undervaluing policy influence, community-engaged research, equity-focused work, and system-level change. Recent work includes nationally recognized analyses of the intersecting impacts of racism, sexism, and parenthood on research productivity in primary care . Building on these findings, recent work aims to develop alternative frameworks for assessing impact that better reflect real-world influence on policy, practice, and health system transformation.
Pan-Canadian and Global Learning Infrastructure for Primary Care Innovation
Building on critiques of Canada as a “country of perpetual pilot projects,” this project aims to strengthen the system’s capacity to evaluate, learn from, and scale primary care innovations. The work focuses on developing shared evaluation frameworks, classification approaches, and learning infrastructure that support cross-jurisdictional knowledge transfer within Canada and internationally. An ongoing stream brings together diverse stakeholders to inform coherent government-level primary care strategies, ensuring that learning from innovation feeds directly into policy vision, planning, and accountability. In partnership with national and international organizations and system leaders, the project seeks to move beyond isolated innovation toward cumulative, evidence-informed system transformation.