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The purpose of this study is to scrutinize the connection between creativity and innovation in the context of public healthcare. This is achieved by applying the theoretical concept of employee-driven innovation (EDI) to explore employees’ perceptions of their creative engagement in innovation processes, as well as to capture the managerial implications of setting up such processes in the sector.

A critical discourse analysis (CDA) is applied as a methodological lens to capture the interaction between the macro-level production and meso-level distribution of innovation discourse (top-down), and the micro-level perception of, and response to, the same (bottom-up). This study is based on a qualitative approach and is set in the public healthcare system of the Autonomous Province of Trento, Northeast Italy. In total, 26 semi-structured interviews were conducted with 22 healthcare professionals. For triangulation purposes, observation and document analysis were also performed.

The findings of this study reveal that tensions are present between the macro-level discourses and the meso-level strategies around innovation, and the micro-level perceptions of employees’ creative engagement in innovation processes. Healthcare professionals’ creative efforts are not easily recognized and supported by top management, which in turn does not receive a framework of reference in policies acknowledging the importance of human skills and creativity in innovation processes.

That this is a single case study implies a limitation on the generalizability of its results, but the results may nevertheless be transferable to similar empirical contexts. Therefore, a multiple case study design would be preferable in future studies in order to study EDI strategies and policies across various types of organizations in the public sector. Moreover, apart from CDA, other theoretical and methodological lenses can be applied to investigate the interaction between top-down organizing and bottom-up responses to innovation.

This study contributes to the EDI literature by providing a more integrative understanding of EDI in the public sector, demonstrating the importance of scrutinizing the interactions between employees and top-level management.

Across the public sector, and especially in the delivery of health and social care and support, practicing innovation is a difficult and seldom rewarding activity. The organisational barriers inhibiting innovation adoption in healthcare settings have been widely discussed. What is less well understood is what motivates staff to persist with innovation efforts despite these barriers. This paper contributes to recent studies of the role of care and compassion in innovation processes within social care settings not only to generate new insights into the motivations underpinning innovation efforts but also to help illuminate how staff overcome barriers to innovation.

We crafted a series of vignettes from our recent ethnographic studies of innovation across the health and social care sectors in Australia and Denmark, involving semi-structured interviews, observation and field notes. Within the Danish case, we explore an instance involving a formal organisational focus on identifying and sustaining innovation within local service deliver. With the Australian case, we present an informal approach, where the process of identifying and sustaining innovation derives from moments of spontaneous employee engagement and initiative.

Reflecting on the examples of “frugal innovation” presented in these vignettes, the major contribution of this study is to situate care and compassion as critical social, affective and material aspects of the practice of innovation in health and social care settings. Our analysis indicates how the practice of innovation is shaped by diverse relations of caregiving, where compassion emerges as a key source of motivation, aspiration and application that inspires staff to seek novel solutions to enduring healthcare challenges.

We develop our argument with reference to recent interdisciplinary orientations to care and compassion in the healthcare literature, incorporating contributions from feminist scholars and the ongoing articulation of feminist care ethics in the study of innovation.