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

Olivia S Jung; Fahima Begum; Andrea Dorbu; Sara J Singer; Patricia Satterstrom

doi:10.1007/s11606-023-08294-1

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

J Gen Intern Med. 2023 Oct;38(13):2888-2897. doi: 10.1007/s11606-023-08294-1. Epub 2023 Jul 17.

Authors

Olivia S Jung^{1

2

3}, Fahima Begum⁴, Andrea Dorbu⁵, Sara J Singer⁶, Patricia Satterstrom⁷

Affiliations

¹ Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA. olivia.jung@ucla.edu.
² Laboratory of Innovation Science at Harvard, Harvard University, Cambridge, MA, USA. olivia.jung@ucla.edu.
³ Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA, USA. olivia.jung@ucla.edu.
⁴ Harvard College, Harvard University, Cambridge, MA, USA.
⁵ Laboratory of Innovation Science at Harvard, Harvard University, Cambridge, MA, USA.
⁶ School of Medicine and Graduate School of Business, Stanford University, Stanford, CA, USA.
⁷ Wagner Graduate School of Public Service, New York University, New York, NY, USA.

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.

Keywords: employees; federally qualified health centers; frontline workers; ideas; innovation; innovation contests; primary care; quality improvement.

MeSH terms

COVID-19* / epidemiology
COVID-19* / therapy
Humans
Pandemics*
Workplace