This page was last updated:
13. okt '15 kl. 16:27

Where do you begin?

Improving quality in family practice can be daunting:

  • How do you get started?
  • How do you prioritize all the things you want to improve?
  • Are you sure you are doing everything you can to facilitate the process?
  • Do you ever worry about missing reports or test results?
  • Are you as good as you think you are in immunization?
  • Do you know how to conduct an audit of your practice?
  • Do you know how to seek feedback from your patients?

McMaster University and the Ontario College of Family Physicians have developed, tested, refined, validated and revised a comprehensive set of quality and safety performance indicators to assess a family practice in Canada that was available in the 2010 edition of the Quality Book of Tools; it is part of an interdisciplinary, voluntary assessment Quality program.

Indicators from New Zealand’s Aiming for Excellence, Australia’s Standards for General Practice; the European Practice Assessment, the UK Quality and Outcomes Framework, and the Canadian Institute of Health Information’s Pan Canadian Indicators were compared with the Quality Tool (Healthcare Quarterly 2013;16(1):39-45).

The 'orphan' indicators were validated through a Delphi process involving primary care and quality experts in Canada. The results are incorporated into the new book.

Five Guiding Principles

  • Voluntary
  • Self-reflection
  • Patient/consumer involvement
  • Interdisciplinary teams
  • Continuous quality improvement (CQI)

Eight new categories, 6 based on the Institute of Medicine aims for the 21st century (safe, effective, patient-centered, timely, efficient and equitable) and 2 based on the Ontario Health Quality Council’s reporting framework attributes of a high performing health system (appropriate resources, integrated) form the backbone of the Tool.

A total of 70 indicators with associated defining criteria and a further information section with helpful web linked tools complete the Tool.

The Authors

Cheryl Levitt (Professor & Family Doctor) and Linda Hilts (Assistant Professor & Registered Nurse) of McMaster University, Canada, with involvement of the Ontario College of Family Physicians, have published a book called Quality in family practice Book of Tools.

The book is available free for download or purchase at and is a comprehensive set of practice management and clinical indicators for use in family practices.

The authors are working on a set of teaching modules for Getting Started with quality in family practice.

These modules will help become available over the next year, so stay tuned.

Cheryl Levitt

Cheryl Levitt is a Family Physician and a Professor in the Department of Family Medicine at McMaster University. She was born in South Africa, trained at the University of the Witwatersrand in Johannesburg and interned at Baragwanath Hospital, Soweto.

Cheryl practiced rurally in British Columbia for 7 years and has been an academic family physician at McGill and McMaster Universities since 1984. She was Chair of the Department of Family Medicine at McMaster University from 1996-2006, President of the Ontario College of Family Physicians from 2005-2006 and is presently the Senior Research Advisor for the College of Family Physicians of Canada.She led the Quality in Family Practice project from 2000-2009.

Cheryl has published widely on primary care issues, medical migration of foreign doctors, gender equity and maternal and child health. She has received a number of awards including the Individual National Breastfeeding Seminar Award of Excellence in 1999, the South African Women for Women HEALTH Award in 2004, the Enid Johnson Award from the Federation of Medical Women of Canada in 2008, the Wonca Fellowship Award in 2010, the Jean Pierre Depins Award of the College of Family Physicians of Canada in 2010 for family medicine advocacy, and the YWCA Woman of Distinction Award for Health Wellness for the City of Hamilton in 2011.

Linda Hilts

Linda Hilts started her nursing career as an operating room nurse in cardiovascular surgery at Hamilton General Hospital. She worked part-time in rehabilitation medicine with stroke and spinal cord patients at Holbrook, Chedoke Hospital, before joining VON and later CCAC.

After completing a BScN from McMaster and then a MEd from Brock University, Linda worked at the Hamilton Civic Hospitals in a newly created position of patient education coordinator. She started working for Stonechurch Family Health Centre in 1998 as a family practice nurse and became involved in resident education, becoming the education coordinator for Stonechurch and then FHT coordinator. Linda has been the nursing consultant for the Quality in Family Practice program since 2002.

Linda has won a number of awards for her work in primary care, including the Sibley Award for part-time faculty at McMaster University and the Ted Evans Scholarship Award for exemplary practice in the four principles of family medicine.

Since retiring from full-time work in 2009, she has continued to work as a primary care consultant with a focus on OSCAR clinical training and improving quality in primary care settings through the Quality in Family Practice program.

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