To clarify priorities for a continuous quality improvement patient care strategy, the Cape Breton District Health Authority (CBDHA) commissioned a collaborative and comprehensive assessment of real-world practice needs of primary care practitioners. A team of community physicians, nurses, CBDHA staff and consultants designed a questionnaire, which was completed by 44% (n = 53) of the target providers. The results were then vetted in three discussion groups of randomly selected providers (n = 21), with an overall primary provider participation rate of 49%. The most frequently cited clinical improvement needs and opportunities were enhanced team care (85%), more rapid specialist consultations on mental health problems (76%) and participation in quality improvement initiatives (71%) and audits (67%). The two principal disease targets for improved management were diabetes and mental health disorders. Ideal clinical team structure was seen to include dietitians, social workers, nurses and physicians, but this was balanced by concern as to how such teams might be trained and remunerated. Improved office efficiency was also a priority for 73% of providers, although 52% were users of electronic medical records (EMRs). Experienced EMR users were generally happy with their systems' performance; new users, however, had great concern with low interoperability and inadequate operational support. Discussions also confirmed the opinion of 71% of the survey respondents who felt that seeing patients within one week of demand for care was appropriate and that patient expectations of more timely access were unrealistic. Motivating patients' behaviour change and dealing with their social concerns were considered overly time consuming and were thought more appropriately managed by non-physician professionals. Overall, the high participation rate and enthusiastic discussions suggest the primary care practitioners of CBDHA are engaged in understanding their practice issues and opportunities and have a strong desire to make things better. On the other hand, innovative patient-centred changes may represent more than a small challenge if physicians do not, for example, accept that time to access is patients' most compelling quality issue. Such value dichotomies indicate a need for better concordance of all stakeholders' perceptions of key issues so that realistic strategic goals can be set, and met. Providers' perception that collaboration will improve care quality highlights a specific opportunity for a care strategy that fosters and tests team-based initiatives, including patient self-management of behaviour change and flexible EMR support. In summary, primary care providers and policy makers within CBDHA believe that things can be better, and they are looking to collaborative actions guided by ongoing research to grasp that future.

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