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The shift toward a circular economy (CE) represents a collaborative endeavor necessitating the presence of efficient frameworks, conducive contexts and a common comprehension. This research serves as a pivotal stride towards this goal, presenting an exclusive prospect for the investigation and fusion of these frameworks, with particular emphasis on the Quintuple Helix Model (5HM), into a unified theoretical framework that underscores the core principles of the CE. This study is centered on three pivotal questions aimed at decoding the CE transition in specific regional settings.

Adopting an abductive approach firmly anchored in a two-stage qualitative process, this study specifically merges the foundational principles from institutional theory, entrepreneurship literature and CE frameworks to provide insights into the dynamics of circular ecosystems, with a specific focus on the Huelva region in Spain.

The findings demonstrate significant potential in the CE, ranging from the integration of product and service systems to innovations in eco-industrial practices. Yet, a notable deficiency exists: the absence of institutional entrepreneurs, highlighting the essential role that universities can play. As recognized centers of innovation, universities are suggested to be key contributors to the transformation toward a CE, aligning with their societal and economic responsibilities.

This study highlights the importance of managing relationships with entities like SMEs and policymakers or academia for effective CE adoption. Policymakers can refine strategies based on the research’s insights, while the impact of university-driven circular ecosystems on sustainable societies is another crucial area for research.

The sustainability models cited in CE literature may not be comprehensive enough to prevent problem shifting, and it can be argued that they lack a sound theoretical and conceptual basis. Furthermore, the connections between sustainability objectives and the three levels of the CE operating system remain vague. Additionally, there is insufficient information on how regions foster the involvement of the environment in fivefold helix cooperation and how this impacts the CE.

Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation.

This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale.

The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure.

This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result.

Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.