235 The springview resilience framework: a clinician-led model to foster joy, equity, and sustainability in solo primary care practices

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Context This work unfolded in Springview Family Practice, a solo family medicine clinic in downtown Halifax, Nova Scotia, Canada, serving ~2,200 registered patients (30% living with chronic conditions like diabetes, COPD, or hypertension). The core team included one primary physician (Dr. Safakish), two administrative/clinical staff members, and clinic manager Jiawei Ji. The focus was on an overburdened workforce delivering equitable care amid Canada’s primary care crisis, where solo practices handle disproportionate administrative and regulatory loads without team-based support.Problem Solo family physicians in Canada face crippling burnout—50% report exhaustion from excessive documentation, no-show rates (up to 24%), prolonged wait times (35+ days for non-urgent care), and regulatory shifts (e.g., 2023 transition to longitudinal funding models), eroding joy in work and equity for vulnerable patients. In our clinic, this manifested as a 6.5-day work-week, minimal vacation (2 weeks/year), stalled professional growth (3.5 teaching hours/week), and delayed access, risking attrition and suboptimal chronic care.Assessment of problem and analysis of its causes We began with a baseline audit (Jan–Dec 2021) using EMR data to quantify burdens: monthly visits (median 432), no-show rates (24.3%), third next appointment time (median 35 days, range 8–54), and physician logs for work-hours/CME. Root-cause analysis via staff debriefs (n=2) and PDSA-informed fishbone diagramming revealed interconnected causes: inefficient documentation (manual notes), fragmented admin (physician-led), and unaddressed fulfillment gaps (no protected teaching time).Intervention The Springview Resilience Framework (SRF) introduced three sequential pillars in five iterative phases (assessment, customization, deployment, coaching, monitoring), repeatable via PDSA cycles:Pillar 1: Workload Stabilization – AI-assisted dictation, templated notes, staff-diverted admin (e.g., reminders via patient software), and dedicated same-day slots to cut no-shows/documentation by 50%.Pillar 2: Regulatory Risk Control – Checkbox templates for point-of-care compliance, routine college regulation reviews, double-check workflows, and post-2023 longitudinal audits for funding stability.Pillar 3: Professional Fulfillment – Scheduled time for teaching/CME, with credit tracking to sustain engagement and support award-winning medical school preceptorships. Changes were customized for our small team.Strategy for change Implementation spanned Jan 2022–Dec 2024 in phased PDSA cycles (3–6 months each), starting with Pillar 1 pilots. Timelines: Q1 2022 (reminders/AI rollout); Q3 2023 (regulatory audits post-funding shift); Q1 2024 (fulfillment blocks). Staff co-led via coaching sessions for feedback-driven tweaks (e.g., ditching unused templates); members reported high satisfaction with the improved work environment. Dissemination included regional QI webinars and Dalhousie preceptorship shares; patient groups received updates via clinic newsletters, with unsolicited praise for higher access and faster responses.Measurement of improvement We tracked primary outcomes (patient flow via monthly fee-for-service billing; third next appointment time via 61 EMR samples; in-clinic efficiency) and secondary (work-week/vacation/teaching hours; CME credits) using spreadsheet medians/ranges, with line charts for trends. Analytical methods: Pre/post comparisons (baseline 2021 vs. intervention 2022–2024), percentage changes, and p<0.01 for visit volumes (95% CI 38–46%). Balancing measures: Complaint logs and qualitative feedback. Final results: Visits +42% (432 to 615/month); waits -48.6% (35 to 18 days); no-shows -20.7 pp (24.3% to 3.6%).Patient and public involvement Patients or the public were not involved in the design, conduct, reporting, or dissemination of this project, consistent with its internal QI focus on clinic operations. Post-intervention, unsolicited feedback (verbal, emails, holiday cards) increased, reflecting improved access for chronic needs. Future cycles will add structured patient-experience measures (e.g., brief surveys) for direct input, aligning with Quadruple Aim equity.Effects of changes SRF resolved core problems, boosting visits to 7,380/year (equitable chronic access) and enabling same/next-day bookings with zero delay complaints since 2024. Physician sustainability soared: Work-week to 5 days; vacation to 5 weeks; teaching to 4.5 hours/week; CME +139% (47 to 112 credits/year). Staff felt ‘empowered’ in admin roles, curbing burnout. Challenges: Initial tech resistance (resolved via coaching); sustained via LFM audits. Long-term: Replicated in 5+ regional clinics, spreading joy without efficiency traps.Lessons learned Iterative coaching ensured staff buy-in—retaining only useful changes—but fulfillment gains (e.g., teaching) amplified morale faster than anticipated. Micro-coaching proved essential for engaging busy physicians, allowing effective discussions amid daily demands without adding burden. If restarting, we’d prioritize practice stability and focus on reducing administrative workload.Messages for others Empower solo/rural teams with layered QI like SRF—stabilize loads first to unlock joy and equity, transforming burnout into purpose (e.g., via free toolkit QR on poster). For systems: Fund clinician-led models to retain talent, yielding 42% access gains at zero cost. We’d value global peers’ adaptations: How can we co-scale fulfillment amid shortages? Your input could spark a resilience movement.Ethics Approval This clinician-led quality-improvement initiative analyzed de-identified, aggregate service data (e.g., visit volumes, wait times) with no patient-level interventions or identifiers. Per regional QI-vs-Research decision tools and national ethics policy, it was approved as exempt from Nova Scotia Health Authority Research Ethics Board review.

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