Can primary care in Canada become a learning health system?

What if we were a learning health system?¹ What if family physicians and clinics across Canada were not trying in isolation to solve the same problems in primary care—access, workload, sustainability—but were learning systematically from one another about what is already working? Too often innovation in family medicine happens quietly, clinic by clinic. If family medicine in Canada is going to truly thrive, that must change.

That was the clear message I took from a recent Family Medicine Matters podcast conversation with Dr Emmett Harrison,² a family physician in Swift Current, Sask. Swift Current offers a powerful example of what a learning health system can look like. Harrison is a full-scope family physician, practising comprehensive clinic-based care, emergency, inpatient, and addictions medicine, medical assistance in dying, teaching family medicine residents, and serving as the physician lead for team-based care in his clinic.

Harrison’s clinic was an early pilot site for Saskatchewan’s Patient’s Medical Home³ vision. Rather than attempting to implement all 10 pillars of the model at once, the team deliberately focused on 3: improving patient access, embedding physician-led interdisciplinary teams, and committing to continuous quality improvement. Nurses were integrated into the clinic, working to the top of their scope. Tasks such as immunizations, Papanicolaou testing, and patient education were shifted. Chronic disease visits were redesigned as co-booked appointments, with nurses completing structured assessments, followed by a brief handover before the physician visit. Same-day nurse triage, supported by standardized protocols and full access to electronic medical records, helped redirect patients to the right care at the right time by the right type of provider.

The impact was impressive. In 2.5 years, 8000 physician visits were avoided or redirected without compromising care. Wait times to see a family physician dropped from over 40 days to about 14 days. Patients consistently reported high satisfaction with their care, stating they valued timely access and coordinated team care while still benefitting from knowing who their family doctor was.

Freed physician time was quickly filled with unmet patient needs and more complex care. With some tasks shifted to nurses, physicians were able to work at the top of their scope. A combination of a team approach, efficient workflows, and use of technology meant income was maintained, and work-life integration improved. Reducing both administrative burden, and the moral injury of not being able to see patients when they need care, was central to sustainability.

Team culture was critical to success. Daily team huddles—scripted, inclusive, and under 10 minutes in duration—create shared awareness and enabled rapid problem-solving. Quality improvement was embedded into daily work. A patient advocate contributed directly to improvement initiatives and communication strategies. Importantly, this work did not happen in isolation. Swift Current learned from other clinics, documented its workflows, and now supports teams across Saskatchewan that want to adopt the model. Harrison is clear that success required physician leadership, protected time, and a willingness to learn together.

This brings me back to my opening question: What if we were a learning health system? Family medicine in Canada does not lack innovation. What we lack is a system that consistently connects that innovation, makes it visible, and allows others to adopt it without starting from scratch. If we are serious about improving care access, sustainability, and joy in practice, we must stop struggling in parallel and start learning from one another.

Notes

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