The objective of this study was to identify the practice of innovation in primary healthcare in the second-largest county, by population, in the state of Rio Grande do Sul, Brazil. The methodology employed case studies of multiple units of analysis, where various studies were simultaneously conducted. Forty-five semi-structured interviews were carried out with the directors of basic health clinics, followed by content analysis, beginning with the construction of a system of categories based on the literature. Fifty-six innovations in total were identified: Eighteen were innovations of products (goods and/or services), fifteen in processes, eleven in marketing, and twelve were organizational innovations. Studies that focus on and highlight innovation in primary healthcare facilitate changes, improvements, and alternatives in the form of services provided to the population, serving as a basis for the formulation of public health policy. Finally, we also highlight the limitations and opportunities of future research.