Abstract
BACKGROUND: Engaging frontline clinicians and staff in quality improvement is a promising bottom-up approach to transforming primary-care practices. This may be especially true in federally qualified health centers (FQHCs) and similar safety-net settings where large-scale, top-down transformation efforts are often associated with declining worker morale and increasing burnout. Innovation contests, which decentralize problem-solving, can be used to involve frontline workers in idea generation and selection. OBJECTIVE: We aimed to describe the ideas that frontline clinicians and staff suggested via organizational innovation contests in a national sample of 54 FQHCs. INTERVENTIONS: Innovation contests solicited ideas for improving care from all frontline workers-regardless of professional expertise, job title, and organizational tenure and excluding those in senior management-and offered opportunities to vote on ideas. PARTICIPANTS: A total of 1,417 frontline workers across all participating FQHCs generated 2,271 improvement opportunities. APPROACHES: We performed a content analysis and organized the ideas into codes (e.g., standardization, workplace perks, new service, staff relationships, community development) and categories (e.g., operations, employees, patients). KEY RESULTS: Ideas from frontline workers in participating FQHCs called attention to standardization (n?=?386, 17%), staffing (n?=?244, 11%), patient experience (n?=?223, 10%), staff training (n?=?145, 6%), workplace perks (n?=?142, 6%), compensation (n?=?101, 5%), new service (n?=?92, 4%), management-staff relationships (n?=?82, 4%), and others. Voting results suggested that staffing resources, standardization, and patient communication were key issues among workers. CONCLUSIONS: Innovation contests generated numerous ideas for improvement from the frontline. It is likely that the issues described in this study have become even more salient today, as the COVID-19 pandemic has had devastating impacts on work environments and health/social needs of patients living in low-resourced communities. Continued work is needed to promote learning and information exchange about opportunities to improve and transform practices between policymakers, managers, and providers and staff at the frontlines.
