Ideas from the Frontline: Improvement Opportunities in Federally Qualified Health Centers.

Publication date: Jul 17, 2023

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. We aimed to describe the ideas that frontline clinicians and staff suggested via organizational innovation contests in a national sample of 54 FQHCs. 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. A total of 1,417 frontline workers across all participating FQHCs generated 2,271 improvement opportunities. 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). 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. 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.

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Concepts Keywords
Clinicians employees
Innovation frontline workers
Pandemic ideas
Vote innovation
innovation contests
primary care
quality improvement


Type Source Name
drug DRUGBANK Etoperidone
disease IDO quality
disease MESH burnout
drug DRUGBANK Nonoxynol-9
disease MESH COVID-19 pandemic
disease VO USA
drug DRUGBANK Coenzyme M
disease VO population
disease MESH Heart attack
disease MESH stroke
disease MESH Asthma
pathway KEGG Asthma
drug DRUGBANK Cholesterol
disease IDO blood
disease VO immunization
disease VO organ
disease VO organization
disease VO efficient
drug DRUGBANK Methionine
disease VO vaccine
disease IDO site
disease MESH posture
disease VO time
disease VO effective
disease VO monthly
disease IDO process
disease VO VacA
disease IDO host
disease MESH pediatric obesity
disease VO efficiency
drug DRUGBANK Pentaerythritol tetranitrate
drug DRUGBANK Aspartame
drug DRUGBANK Etodolac
pathway REACTOME Reproduction
disease MESH Clostridioides difficile Infection
disease VO effectiveness
disease IDO intervention
disease MESH uncertainty
disease MESH Emergency
disease MESH professional burnout

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