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How healthcare organisations can act as institutional entrepreneurs in a context of change

Mylaine Breton (Department of Community Medical Science, University of Sherbrooke, Longueuil, Canada)
Lise Lamothe (Department of Health Administration, University of Montréal, Montréal, Canada)
Jean-Louis Denis (Department of Public Administration, École nationale d'administration public, Montréal, Canada)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 11 March 2014




The aim of this paper is to illustrate and discuss how healthcare organisations can act as institutional entrepreneurs in a context of change.


The authors conducted an in-depth longitudinal case study (2005-2008) of a healthcare organisation in the province of Quebec, Canada. Data collection consisted of real-time observations of senior managers (n=87), interviews (n=24) with decision-makers and secondary data analysis of documents.


The paper reports on the extent to which entrepreneurial healthcare organisations can be a driving force in the creation of a new practice. The authors analyse the development of a diabetes reference centre by a healthcare organisation acting as an institutional entrepreneur that illustrates the conceptualisation of an innovation and the mobilisation of resources to implement it and to influence other actors in the field. The authors discuss the case in reference to three stages of change: emergence, implementation and diffusion. The results illustrate the different strategies used by managers to advance their proposed projects.

Research limitations/implications

This study helps to better understand the dynamics of mandated change in a mature field such as healthcare and the roles played by organisations in this process. By adopting a proactive strategy, a healthcare organisation can play an active role and strongly influence the evolution of its field.


This paper is one of only a few to analyse strategies used by healthcare organisations in the context of mandated change.



This article benefited from the insightful contributions and comments of Dr Raynald Pineault, Professor Emeritus, University of Montreal. Also, this paper was submitted at the 2011 annual meeting of Administrative Science Association of Canada. The authors thank two anonymous reviewers for their helpful comments. This study was part of the “Governing Change and Changing Governance in Health Care Systems and Organisations” project funded by the Canadian Institutes of Health Research (CIHR; 2005-2008).


Breton, M., Lamothe, L. and Denis, J.-L. (2014), "How healthcare organisations can act as institutional entrepreneurs in a context of change", Journal of Health Organization and Management, Vol. 28 No. 1, pp. 77-95.



Emerald Group Publishing Limited

Copyright © 2014, Emerald Group Publishing Limited

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