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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.

COVID-19 has profoundly shaped human interactions, and, within public healthcare systems, care relations. Through the lens of social suffering, this study explores how employee innovation is shaped by the pandemic crisis and different managerial approaches in the context of public geriatric care in Northeast Italy.

This study adopts a qualitative methodology. A total of 29 semi-structured, open-ended interviews were conducted with 23 healthcare professionals involved in geriatric care, with managerial and without managerial positions. Observation was integrated as auxiliary research to further capture on an operational level the interactions among the actors involved.

The COVID-19 crisis significantly shaped employee innovation for healthcare professionals, as the suffering it provoked in the system motivated and urged them to engage in innovative initiatives. Where employees’ engagement in innovation was recognized by the management, it was found that the suffering was mitigated, and creativity and solidarity emerged in the innovation process. Where top-down approaches did not recognize employees’ efforts and innovative initiatives, need-driven innovation and greater tensions came forward, enhancing the overall suffering in care relations and resulting in some employees considering leaving their profession.

This study is based on a single case study.

This study further highlights the employee participation in innovation as a crucial practical implication for sustaining the quality of public care and assistance. A practical implication emerging from this study suggests that “ordinary” healthcare professionals’ engagement in innovative initiatives and in their operationalization should be encouraged by the organization. In a system as complex as the public healthcare one, valuing the bottom-up, clinical inputs appears fundamental if innovation is to move away from mere technological adaptation to embrace a more comprehensive process, involving the professionals who are engaging in innovative endeavors. From a managerial point of view, adopting an approach that recognizes, supports and provides coordination to employee innovation seems instrumental to nurture an environment where employee voices feel heard, and creativity, solidarity and overall positive collaboration can occur. Thus, another significant practical implication includes the retention of healthcare professionals in the public sector in times of crisis.

With the outbreak of the COVID-19 pandemic, the necessity to explore the “human side” of innovation and its connection to emerging human needs during a crisis is growing. This study focuses on employee participation in innovation processes due to COVID-19, thus contributing to the employee-driven innovation (EDI) literature. Through the lens of social suffering, it scrutinizes the interactions between bottom-up perceptions and responses and top-down strategies in a public healthcare setting. Hence, this study addresses two major gaps present in EDI literature, for the most part focused on the private sector and on the managerial structures, tools and interventions.