Understanding the issues in advancing quality in Canadian primary healthcare requires some comprehension of systems theory as it applies to healthcare, as well as an understanding of the context of Canadian primary healthcare, particularly the roles of family physicians. With that background, one is then prepared to appreciate the current challenge in advancing the quality agenda, where provider learning of the content and skills of quality improvement and leading change, models of community or regional governance, and infrastructure such as information technology and its necessary supports for interoperability with other healthcare systems, are all primitive. For primary care providers, driven in large part by their desire to improve the health of the individuals and populations they serve, "Framework for Advancing Improvement in Primary Care" is a welcome guide for direction in how to begin their quality journey. The framework provides the map with the destination (the Institute for Healthcare Improvement's Triple Aim) and roads to get there (six characteristics of high-performing primary healthcare systems). Finally, our ability to improve the system builds from partnerships with our practice citizens – we need to move beyond the patient care construct.

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