title: Fiery Spirits in the context of institutional entrepreneurship in Swedish healthcare.
abstract: OBJECTIVE
  Clinical governance and leadership concepts can lead to more or less successful implementations of new clinical practice. The purpose of this paper is to examine how Fiery Spirits, as institutional entrepreneurs can, working in a team, implement sustained change in hospital clinical practice.
  
  
  METHODS
  This paper describes two case studies, conducted at two Swedish hospitals over a period of two years, in which changes in clinical practice were implemented. In both cases, key-actors, termed Fiery Spirits, played critical roles in these changes. The authors use a qualitative approach and take an intra-organizational perspective with semi-structured in-depth interviews and document analysis.
  
  
  RESULTS
  The new clinical practices were successfully implemented with a considerable influence of the Fiery Spirits who played a pivotal role in the change efforts. The Fiery Spirits persuasively, based on their structural and normative legitimacy and the adoption of learning processes, advocated, and supported change.
  
  
  CONCLUSIONS
  Fiery Spirits, given flexibility and opportunity, can be powerful forces for change outside the trajectory of management-inspired and management-directed change. Team members, when inspired and encouraged by Fiery Spirits, are less resistant to change and more willing to test new clinical practices.
  
  
  CONCLUSIONS
  The paper complements literature on how the Fiery Spirit concept aligns with concepts of clinical governance and leadership and how change can be achieved. Additionally, the findings show the effects of legitimacy and learning processes on change in clinical practice.
authors.forename: Nomie
authors.initials: N
authors.lastname: Eriksson
authors.forename: Sandor
authors.initials: S
authors.lastname: Ujvari
mesh_terms: D016520:Entrepreneurship; D007407:Interviews as Topic; D007857:Leadership; D008505:Medical Staff, Hospital; D019982:Organizational Case Studies; D010818:Practice Patterns, Physicians' / Q000592:standards*; D036301:Qualitative Research; D058996:Quality Improvement; D011787:Quality of Health Care; D013548:Sweden
keywords: Clinical governance; Clinical practice; Fiery Spirit; Healthcare management; Institutional entrepreneur; Organizational change