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The role of institutional entrepreneurs in reforming healthcare

Author

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  • Lockett, Andy
  • Currie, Graeme
  • Waring, Justin
  • Finn, Rachael
  • Martin, Graham

Abstract

We draw on institutional entrepreneurship theory to analyse the dynamics of institutional change in a healthcare context. The focus of our interest is in the relationship between an institutional entrepreneur’s ‘subject position’, defined in terms of their structural and normative legitimacy within the existing institutional landscape, and the nature of the change enacted. We develop this approach through an examination of the implementation of new pathways for cancer genetic services within the English National Health Service. Employing comparative case analysis we show that those who have limited structural legitimacy under prevailing conditions are most willing to engender change, but also least able; whereas those who have strong structural legitimacy are most able, but often least willing. However, those who are able rhetorically to combine a balance of structural and normative legitimacy are most able to produce change. In doing so, we demonstrate the importance of the concept of institutional entrepreneurship to understand healthcare reform.

Suggested Citation

  • Lockett, Andy & Currie, Graeme & Waring, Justin & Finn, Rachael & Martin, Graham, 2012. "The role of institutional entrepreneurs in reforming healthcare," Social Science & Medicine, Elsevier, vol. 74(3), pages 356-363.
    • Handle: RePEc:eee:socmed:v:74:y:2012:i:3:p:356-363
    DOI: 10.1016/j.socscimed.2011.02.031
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    References listed on IDEAS

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    1. Sanjay Jain & Gerard George, 2007. "Technology transfer offices as institutional entrepreneurs: the case of Wisconsin Alumni Research Foundation and human embryonic stem cells," Industrial and Corporate Change, Oxford University Press and the Associazione ICC, vol. 16(4), pages 535-567, August.
    2. Martin, Graham P. & Currie, Graeme & Finn, Rachael, 2009. "Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the 'modernization' of the medical workforce," Social Science & Medicine, Elsevier, vol. 68(7), pages 1191-1198, April.
    3. Julie Battilana & Bernard Leca & Eva Boxenbaum, 2009. "How actors change institutions : Towards a theory of institutional entrepreneurship," Post-Print hal-00576509, HAL.
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    Cited by:

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    2. Sheard, Laura & Marsh, Claire & O'Hara, Jane & Armitage, Gerry & Wright, John & Lawton, Rebecca, 2017. "The Patient Feedback Response Framework – Understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study," Social Science & Medicine, Elsevier, vol. 178(C), pages 19-27.
    3. Berghout, Mathilde A. & Oldenhof, Lieke & Fabbricotti, Isabelle N. & Hilders, Carina G.J.M., 2018. "Discursively framing physicians as leaders: Institutional work to reconfigure medical professionalism," Social Science & Medicine, Elsevier, vol. 212(C), pages 68-75.
    4. Macfarlane, Fraser & Barton-Sweeney, Cathy & Woodard, Fran & Greenhalgh, Trisha, 2013. "Achieving and sustaining profound institutional change in healthcare: Case study using neo-institutional theory," Social Science & Medicine, Elsevier, vol. 80(C), pages 10-18.
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    7. Marit B Rise & Marit Solbjør & Aslak Steinsbekk, 2014. "Experiences from the implementation of a comprehensive development plan for user involvement in a mental health hospital: A qualitative case study," International Journal of Social Psychiatry, , vol. 60(4), pages 387-395, June.
    8. Mæhle, Per Magnus & Smeland, Sigbjørn, 2021. "Implementing cancer patient pathways in Scandinavia how structuring might affect the acceptance of a politically imposed reform," Health Policy, Elsevier, vol. 125(10), pages 1340-1350.
    9. Niezen, Maartje G.H. & Mathijssen, Jolanda J.P., 2014. "Reframing professional boundaries in healthcare: A systematic review of facilitators and barriers to task reallocation from the domain of medicine to the nursing domain," Health Policy, Elsevier, vol. 117(2), pages 151-169.
    10. Welter, Friederike & Smallbone, David, 2015. "Creative forces for entrepreneurship: The role of institutional change agents," Working Papers 01/15, Institut für Mittelstandsforschung (IfM) Bonn.
    11. Currie, Graeme & Dingwall, Robert & Kitchener, Martin & Waring, Justin, 2012. "Let’s dance: Organization studies, medical sociology and health policy," Social Science & Medicine, Elsevier, vol. 74(3), pages 273-280.
    12. Lakomaa, Erik & Sanandaji, Tino, 2021. "Exploring collective consumer innovation in health care: Cases and formal modeling," Research Policy, Elsevier, vol. 50(8).
    13. Baeza, Juan I. & Boaz, Annette & Fraser, Alec, 2016. "The roles of specialisation and evidence-based practice in inter-professional jurisdictions: A qualitative study of stroke services in England, Sweden and Poland," Social Science & Medicine, Elsevier, vol. 155(C), pages 15-23.
    14. Daskalopoulou, Athanasia & Palmer, Mark, 2021. "Persistent institutional breaches: Technology use in healthcare work," Social Science & Medicine, Elsevier, vol. 289(C).

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