title: Role of institutional entrepreneurship in building adaptive capacity in community-based healthcare organisations: realist review protocol.
abstract: BACKGROUND
  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
  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.
  
  
  BACKGROUND
  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.
  
  
  BACKGROUND
  CRD42015026487.
authors.affiliation: Faculty of Medicine and Biomedical Sciences, School of Public Health, The University of Queensland, Herston, Queensland, Australia.
authors.forename: Sweatha
authors.initials: S
authors.lastname: Iyengar
authors.affiliation: Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Katz
authors.affiliation: Faculty of Medicine and Biomedical Sciences, School of Public Health, The University of Queensland, Herston, Queensland, Australia.
authors.forename: Jo
authors.initials: J
authors.lastname: Durham
mesh_terms: D057191:Capacity Building / Q000592:standards*; D003153:Community Health Services / Q000592:standards*; D016520:Entrepreneurship / Q000592:standards*; D012107:Research Design; D012196:Review Literature as Topic
keywords: adaptive capacity; capacity building; community-based organisation; institutional entrepreneurship; non-profit; realist review