Case Study: Using Reverse Brainstorming to Improve Staff Retention in a Rural Health Clinic

Learning with ACRE - 033

Jul 03, 2025

Context

In a rural district of the Eastern Cape, South Africa, a small public health clinic faced a persistent and increasingly urgent challenge: high staff turnover among nurses, administrative personnel, and support workers. The frequent loss of experienced team members disrupted patient care, overburdened remaining staff, and weakened team morale. Exit interviews consistently cited burnout, poor workplace morale, limited career growth, and a lack of recognition as the main reasons for departure. With strained resources and a growing patient load, leadership had tried several traditional approaches, such as short-term wellness workshops, minor salary adjustments, and internal mentorship efforts, but these had produced minimal impact.

Recognising that conventional strategies were no longer sufficient, the clinic’s management team reached out to a regional healthcare NGO for support. Together, they decided to experiment with a creative problem-solving method, reverse brainstorming, to approach the challenge from a new perspective. Their goal was to co-create innovative, low-cost, and implementable ideas that would improve staff morale and retention over the coming year, while fostering a greater sense of shared purpose and inclusion.

Designing the Session

A facilitator with experience in design thinking and healthcare innovation was brought in to lead a structured half-day reverse brainstorming session. The group included 18 participants drawn from a range of roles across the clinic and its supporting network: nurses, receptionists, maintenance staff, supervisors, community health workers, and district health administrators. This diverse representation was key to generating solutions that reflected a wide range of lived experiences within the clinic.

The facilitator opened the session by framing the challenge: “How might we retain staff and create a more supportive work environment?” After a brief discussion to align understanding, this was intentionally reversed into the provocative question: “How could we drive staff away faster?” Participants were encouraged to explore this question playfully and without inhibition.

To set the tone, the facilitator used warm-up games involving creative wordplay and image association. Participants were then divided into small mixed-role groups to encourage cross-pollination of ideas. Flip charts, sticky notes, and visual templates were provided to capture every contribution. The open atmosphere, supported by light refreshments, music, and an informal seating arrangement, helped break down power dynamics and build psychological safety.

Reverse Brainstorming in Action

Within 30 minutes, the groups generated more than 40 intentionally “terrible” ideas that would worsen staff experiences. These included:

Assign erratic, unpredictable shift schedules.
Cancel lunch breaks and penalise resting.
Ignore all staff suggestions and feedback.
Publicly criticise team members for mistakes.
Deny access to any training or growth opportunities.
Create isolation by discouraging social interaction.
Keep team achievements invisible.

After the laughter subsided, the facilitator guided the group through a structured flipping exercise. Each negative idea was transformed into a constructive proposal through individual reflection followed by group discussion. The tone shifted as participants began to recognise how many of the negative practices, while exaggerated, reflected real frustrations they had not previously voiced.

The flipped ideas included:

Implement staff-informed rota systems that are fair and consistent.
Protect regular break times and create shared communal spaces.
Establish monthly staff feedback forums with actionable follow-up.
Celebrate successes through team shout-outs, emails, and a recognition board.
Develop a mobile skills academy with short in-clinic training modules.
Host team tea breaks to encourage informal social connection.
Document and display team achievements visibly in public areas.

These solutions were grouped into themes: Work-Life Balance, Voice and Agency, Celebration and Visibility, and Learning and Development. Each participant voted on the initiatives they felt would have the greatest impact. The top-rated concepts were taken forward for implementation.

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Outcomes

Three priority pilot initiatives were launched within the next three months:

Staff Recognition Wall – A colourful bulletin board in the clinic’s main corridor celebrating team contributions, kind words from patients, and professional milestones.
Weekly Wellness Rota – A rotating programme featuring low-cost relaxation activities such as guided stretching, shared storytelling, or gratitude circles, facilitated by different staff members.
Learning Access Scheme – Monthly on-site skills development sessions in collaboration with a local nursing college, covering both clinical and soft skills.

The results were noticeable within six months:

Job satisfaction, as measured through anonymous staff surveys, rose by 30%.
Annual nurse turnover dropped by 40% compared to the previous year.
Peer-to-peer support increased, with staff voluntarily co-facilitating onboarding for new recruits.
Interpersonal tension decreased, and collaboration across roles improved significantly.

One nurse shared, “It’s the first time I’ve felt like my ideas matter and are actually shaping how we work here.” Another staff member remarked, “It used to feel like we were just surviving the week. Now it feels like we’re building something together.”

Lessons Learned

The reverse brainstorming session not only surfaced fresh ideas but catalysed a wider cultural shift in the clinic. It taught the team several key lessons:

Humour Builds Safety – The playful nature of the exercise helped ease tension and encouraged honesty.
Inversion Reveals Truth – Looking at the problem through a negative lens allowed staff to name issues that felt too difficult to raise directly.
Collaboration Unlocks Creativity – Cross-role discussions surfaced simple but powerful ideas that were hidden in plain sight.
Structure Supports Depth – Having a clear process helped participants stay engaged and ensured follow-through.

Importantly, the session also demonstrated that complex challenges like staff retention can be reframed and addressed using accessible, inclusive tools. Inspired by its success, the clinic has since adapted reverse brainstorming to explore other persistent problems, including patient appointment no-shows, medicine stock-outs, and team communication breakdowns.

What began as an experimental workshop has become a foundational tool in the clinic’s culture of continuous improvement—proving that sometimes, thinking backwards is exactly the way forward.

Join us at ACRE29, Africa’s Premier Creativity and Creative Thinking Conference in 2025 at Klein Kariba, South Africa! https://acreconference.com

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