About The Quality Book of Tools

This Quality Book of Tools has been evolving in Ontario, Canada, over the past ten years. In 2000, Dr. Ronald MacVicar, a general practitioner from Inverness in Scotland, offered to help us develop a tool for assessing quality in family practice as part of his sabbatical at McMaster University in Hamilton. Working with local family doctors, we developed an early version called the Hamilton Tool. It was based on the Scottish Quality Practice Awards, which was a well-established program in Scotland. We added some additional indicators to make it more applicable to Hamilton. In 2003, we, at McMaster University, partnered with the Ontario College of Family Physicians, to obtain funding from the Ontario MOHLTC to develop a Quality tool that could be used in family practices throughout Ontario. Adopting elements from New Zealand and Australia, we drafted a tool to test in the Quality in Family Practice program (a voluntary quality assessment program – for more information see www.qualityinfamilypractice.com) in a variety of family practices, in two phases, in 2005 and 2007. In 2008-2009, we undertook an international review of primary care quality-assessment tools and a modified Delphi process with Canadian experts to validate the indicators we had drafted. Over the past year, we have rewritten, refined and categorized the indicators to align with the work being done in quality at the Ontario Health Quality Council and the Institute of Medicine in the United States.

This is the first edition of the Quality Book of Tools. It will continue to evolve as the work progresses and as we discover better ways to measure and assess the quality of family practices in Ontario.

The Quality Book of Tools is intended to help family doctors and other primary care providers, teachers, researchers and decision makers assess and evaluate the complex nature of primary care. The Tool allows users to categorize the activities of family practices into practice management and clinical effectiveness. The intention is that family practices will use the indicators to facilitate the measurement of performance in family practices, both practice management and clinical.

The Introduction to the Quality Book of Tools includes some details of the history of the Tool’s development and guidance on how to use it. Each of the eight chapters that follow comprises a category, with indicators and criteria specific to a particular part of the practice. Further information, in the form of links to key sites, is provided to help guide the development of improvement processes based on best practices. The up to date links have been collected in a resource database that can be found at quality.resources.machealth.ca.

None of this would have been possible without the administrative skills of Carol Lane, Wendy Chin, Katherine Li and Betty Ho whom we want to thank for helping us convert a messy manuscript into this publication. Thanks also to David Price, Lisa Dolovich, Jan Kasperski and Jennifer McGregor, for reviewing the manuscript and providing helpful suggestions and Dr. Anthony Levinson for creating the resource database. We are grateful to the Department of Family Medicine at McMaster University and the Ontario College of Family Physicians for their ongoing support of this project.

Cheryl Levitt & Linda Hilts
Hamilton, Ontario, November 2010

  • Criteria Symbols

    Legal and Safety – required by law*

    Essential – required to demonstrate best practice

    Desirable – required to demonstrate additional quality

    (*Assumptions about indicators are based on the nature of these indicators and the regulations that qualify them)