title: The role of institutional entrepreneurs in reforming healthcare.
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.
authors: University of Warwick, Business School, Warwick Business School, Coventry CV4 7AL, United Kingdom. Electronic address: andy.lockett@wbs.ac.uk.
authors: Andy
authors: A
authors: Lockett
authors: University of Warwick, Business School, Warwick Business School, Coventry CV4 7AL, United Kingdom; University of Nottingham, United Kingdom. Electronic address: graeme.currie@wbs.ac.uk.
authors: Graeme
authors: G
authors: Currie
authors: University of Nottingham, United Kingdom. Electronic address: justin.waring@nottingham.ac.uk.
authors: Justin
authors: J
authors: Waring
authors: University of Sheffield, United Kingdom. Electronic address: R.L.Finn@sheffield.ac.uk.
authors: Rachael
authors: R
authors: Finn
authors: University of Leicester, United Kingdom. Electronic address: gpm7@leicester.ac.uk.
authors: Graham
authors: G
authors: Martin
mesh_terms: D016520:Entrepreneurship; D033142:Genetic Services / Q000458:organization & administration; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D009369:Neoplasms / Q000235:genetics; D009936:Organizational Innovation; D024382:Professional Role; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom