Fiery Spirits in the context of institutional entrepreneurship in Swedish healthcare

Integration intrapreneurship: implementing innovation in a public healthcare organization

AIM

As global events impact the way organizations operate and innovate in response to regional, workforce and consumer needs, the concept of intrapreneurism is attracting growing interest from policymakers and executives, particularly within the healthcare sector. The aim of this study was to capture the key learnings from the implementation of a telementoring pilot, to understand how intrapreneurship can embed innovation within an established organization to effect more integrated healthcare.

PURPOSE

A qualitative approach was used with a phenomenological lens to explore the key learnings of the Project ECHO^® (Extension for Community Healthcare Outcomes) pilot implementation to provide an understanding of what the project team's strategies and tactics were during the process of embedding a new business innovation. The implementation and piloting of Project ECHO^®, a telementoring model, in a large-scale public healthcare organization in Queensland, Australia, was investigated as an exemplar of integration intrapreneurship.

FINDINGS

Through an inductive approach, this qualitative study found the implementation of the Project ECHO^® pilot had specific dimensions and strategies/tactics which were exemplars of intrapreneurism. The organizational context and workforce characteristics described in this study presented new knowledge of how intrapreneurs implemented an innovation to address fragmentation of healthcare service delivery, professional isolation and instances of low-value care. This research contributes to a better understanding of the strategic and tactical approaches to implementing intrapreneurial innovations within a public healthcare organization, with learnings that can be adapted by intrapreneurs in other contexts.

Impact of Entrepreneurship on the Quality of Public Health Sector Institutions and Policies

The purpose of this paper is to investigate whether public health entrepreneurship principles implementation in the public health sector are alternative ways of promoting an immediate improvement of healthcare infrastructure. To contribute to the literature on the impact of public health entrepreneurship on public healthcare infrastructure, we estimate two empirical models, with the first model having institutions and the second model having public healthcare policies as the dependent variable. Our empirical analysis is based on the WHO international health regulation data for all WHO member countries (in order to achieve a balanced panel, we decided to retain 192 of them), covering the period from 2010 through to 2019. The main results obtained using a Poisson panel regression indicate a positive relationship between employing more entrepreneurship within public healthcare and the quality of public healthcare infrastructure represented through institutions and policies. This study produces several contributions to the stream of research on public health entrepreneurship. First, it makes a theoretical contribution in the way that it fills the lacking literature on the relationship between entrepreneurship within the public health sector and efficiency of country-specific public healthcare infrastructure. Second, it offers an empirical quantitative analysis of entrepreneurship that is generally lacking. Concerning policy implications, the third contribution of this paper is the provision of evidence showing alternative ways to improve healthcare infrastructure other than traditionally observed investments in physical infrastructure.

Using institutional entrepreneurship to understand the role of innovation teams in healthcare: a longitudinal qualitative study

OBJECTIVES

We draw on institutional theory to explore the roles and actions of innovation teams and how this influences their behaviour and capabilities as 'institutional entrepreneurs (IEs)', in particular the extent to which they are both 'willing' and 'able' to facilitate transformational change in healthcare through service redesign.

DESIGN

A longitudinal qualitative study that applied a 'researcher in residence' as an ethnographic approach.

SETTING

The development and implementation of two innovation projects within a single public hospital setting in an Australian state jurisdiction.

PARTICIPANTS

Two innovation teams, with members including senior research fellows, PhD scholars and front-line clinicians (19 participants and 47 interviews).

RESULTS

Despite being from the same hospital, the two innovation teams occupied contrasting subject positions with one facilitating transformational improvements in service delivery, while the other sought more conservative improvements. Cast as 'IEs' we show how one team took steps to build legitimacy for their interventions enabling spread and scale in improvements and how, in the other case, failure to build legitimacy resulted in unintended consequences which undermined the sustainability of the improvements achieved.

CONCLUSIONS

Adopting an institutional approach provided insight into the 'willingness' and 'ability' to facilitate transformational change in healthcare through service redesign. The manner in which innovation teams operate from different subject positions influences the structural and normative legitimacy afforded to their activities. Specifically, we observed that those with the most power (organisational or professional) to bring about transformational change can be the least willing to do so in ways which challenge current practice. Those most willing to challenge the status quo (more peripheral organisation members or professionals) can be least able to deliver transformation. Better understanding of these insights can inform healthcare leaders in supporting innovation team efforts, considering their subject position.

Navigate Your Health: A Case Study of Organisational Learnings from an Integrated Care Pilot for Children and Young People in Care

Introduction:

Three peak organisations in Queensland, Australia partnered with consumers and other health and social sector partners to co-design and pilot the first known integrated, health navigation model to improve outcomes for children and young people in care in Australia.

Description:

An Organisational Learning theoretical lens has been used to present a narrative case study of findings structured as key learnings from the Navigate Your Health pilot to inform quality improvement, scalability and program sustainability. A developmental evaluation was completed whereby semi-structured interviews, focus groups, surveys, chart reviews, database excerpts and economic modelling was completed alongside project documentation analyses to create an evaluation framework.

Discussion:

Findings highlighted the agency partners’ drive to foster a more integrated and person-centred approach to care. The pilot’s aim of improving health outcomes for a vulnerable population were achieved through a co-designed process which provided additional insights regarding partnerships, improvement, scalability and sustainability.

Conclusion:

Inter-agency responses to system fragmentation provide significant organisational learning opportunities. System integration is achievable through strengthened partnerships that can be sustained beyond a pilot phase to improve health outcomes for vulnerable/priority populations.

Executive Decision-Making: Piloting Project ECHO® to Integrate Care in Queensland

Introduction:

A Queensland project team secured grant funding to pilot Project ECHO®, a telementoring model, to drive vertical and horizontal integration across paediatric, education and primary care services. This study sought to understand what influenced healthcare executives’ decision-making processes to organisationally commit to and financially invest in the pilot proposal within an organisational context.

Theory and Methods:

A phenomenological approach methodology was adopted to investigate healthcare executives’ conscious decision-making processes. Semi-structured interviews with key stakeholders were conducted alongside project documentation analyses to create a thematic framework.

Results:

The qualitative thematic analysis identified five key themes that influenced the decision-making processes of healthcare executives to invest in Project ECHO® as an integrated care pilot. The themes were: (i) personal experiences, (ii) benefits, (iii) risks, (iv) partnerships, and (v) timing. Executives’ reflections explored how their decision-making processes considered the intrapreneurial project team as an indicator of future sustainability.

Discussion:

Findings highlighted healthcare intrapreneurs’ drive to foster more integrated and people-centred approaches to care. Intrapreneurial aims of financial sustainability, ongoing improvement and scalability of the proposal positively influenced investment confidence.

Conclusion:

Intrapreneurial champions must provide a compelling narrative to convince executive decision-makers that benefits will outweigh risks, that integration is achievable through strengthened partnerships as well as future sustainability beyond the pilot phase.

Organizational Identity Struggles and Reconstruction During Organizational Change: Narratives as symbolic, emotional and practical glue

The article offers a novel perspective on the formation of organizational identity (OI) during major organizational change. The empirical context of our studies is the establishment of a new acute care department and the reorganization of care, where nurses and managers struggle to construct and reclaim a legitimate identity within the hospital and simultaneously strive to gain a leading position among acute care departments in the country. We use Bourdieu’s theoretical ideas combined with a focus on narratives as an original and fertile perspective for studying OI. We propose that OI is inherently temporal, embodied and socially configured and cannot be separated from the institutionalized context of its setting because it is interlaced with (in this case) health professional logics. We show how OI is constructed through the strategizing moves of managers and nurses. This includes their narrative constructions of their quest for care progression and a legitimate OI that function as symbolic, emotional and practical glue.

Role of institutional entrepreneurship in building adaptive capacity in community-based healthcare organisations: realist review protocol

INTRODUCTION

Over the past 3 decades, there has been a substantial shift to the marketisation of government-funded health services. For organisations traditionally buffered from the competitive pressures of for-profit enterprises, such as community-based organisations, this means developing the capacity to adapt to competitive tendering processes, shifting client expectations, and increasing demands for greater accountability. Drawing on ideas of institutional entrepreneurship, we believe that attempts to build adaptive capacity require the transformation of existing institutional arrangements. Key in this may be identifying and fostering institutional entrepreneurs--actors who take the lead in being the impetus for, and giving direction to, structural change. This study focuses on the strategies used by institutional entrepreneurs to build adaptive capacity in the community-based healthcare sector.

METHODS AND ANALYSIS

The research will use an adapted rapid realist review. The review will find underlying theories that explain the circumstances surrounding the implementation of capacity-building strategies that shape organisational response and generate outcomes by activating causal mechanisms. An early scoping of the literature, and consultations with key stakeholders, will be undertaken to identify an initial programme theory. We will search for relevant journal articles and grey literature. Data will be extracted based on contextual factors, mechanisms and outcomes, and their configurations. The analysis will seek patterns and regularities in these configurations and will focus on confirming, refuting or refining our programme theory.

ETHICS AND DISSEMINATION

The study does not involve primary research and, therefore, does not require formal ethical approval. However, ethical standards of utility, usefulness, feasibility, propriety, accuracy and accountability will be followed. The results will be written up according to the Realist and Meta-Review Evidence Synthesis: Evolving Standards guidelines. Once completed, findings will be published in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

CRD42015026487.