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The lean startup approach (LSA) is extensively utilized by early-stage entrepreneurs, with “pivot” serving as a key pillar. However, there is a research gap concerning the boundary conditions impacting LSA and pivot decisions, especially when addressing societal challenges, as in the context of transformational entrepreneurship. In this regard, the healthcare sector, further compounded by a lack of research on startups and scale-ups, presents an embraced opportunity to provide multiple contributions for both theory and practice.

The present investigation employs a grounded approach to explore the experiences of the co-founders of a fast-growing Italian e-health startup. A narrative strategy was employed to organize conditions and evolving strategic action/interactions into three different pivoting phases of the startup – before the pivot, its enactment and aftermath – with primary and secondary data collected over a period of one year.

Pivoting in digital healthcare unfolded as a liminal experience marked by factors such as high regulation, multiple stakeholders, technological and symbolic ambivalence, resource-intensive demands and institutional actors acting as pathway pioneers, leading to an information overload and unforeseeable uncertainty to manage. These factors challenge entrepreneurs' ability to attain optimal distinctiveness, presenting the paradoxical need for vertical flexibility for scaling up.

By uniquely illuminating the sector’s constraints on entrepreneurial phenomena, this study provides a valuable guide for entrepreneurs and institutional actors in addressing societal challenges.

This study introduces a process model of transformational information crafting when pivoting, highlighting the role of entrepreneurs' transformational stance and platform-mediated solutions as engines behind strategies involving information breaking and transition, preceding knowledge-driven integration strategies.

This chapter examines the role extracurricular activities have in developing higher education (HE) student’s entrepreneurial competencies and capabilities. Specifically, this chapter examines: What type of students participate in extracurricular activities? Why do students choose to participate? and What activities offer for entrepreneurial competency and capability development. An electronic survey (e-survey) collected pre- and post-data from two groups: Group A – students participating in extracurricular enterprise and entrepreneurship (EEEx) activities (n = 119); and Group B – students engaged in non-enterprise-related extracurricular activities (n = 72). Findings indicated that students in both groups were motivated to engage in extracurricular activities to enhance their skills, fulfil personal interests and enhance their employability. Utilising Morris, Webb, Fu, and Singhal’s (2013) entrepreneurial competencies list as a model, there were found to increase in all but one competency (creativity) for Group A, yet for the control group, most competencies decreased. Independent sample T-tests demonstrated that there was no significant difference in the final ratings of entrepreneurial capability between Group A and Group B, however, the degree of improvement for perceived entrepreneurial capability, pre-to-post, for those participating in enterprise activities was substantially higher than the control group. Finally, students participating in EEEx activities were more likely female, studying a programme within the Business School, and in the second or final stage of their programme. This chapter demonstrates the value that EEEx activities provide in a competency context for students and tasks educators with considering how to develop and signpost specific entrepreneurial competencies and capabilities.

This chapter provides an overview of entrepreneurship clubs. It charts the development of these organisations, as a form of extracurricular activity. It introduces different forms of entrepreneurship clubs, such as Junior Achievement (JA) and Enactus, and explains how they grew from 1919 to the present. It also illustrates the differences between self-organised clubs, organised programs using clubs as a learning method, structured societies and nationally organised cooperative societies. The second part introduces research on student clubs in entrepreneurship education. It explores the benefits of clubs. It shows that clubs assist student learning, enable the acquisition of practical skills and improve college attendance, employment opportunities and career attainment. We argue that entrepreneurship clubs have improved student learning outcomes in entrepreneurship and simulated entrepreneurial learning, while impacting student self-efficacy and intentionality as well as improving employability and social learning. The final part of the chapter provides advice and tips for educators advising student-run entrepreneurship clubs. Ultimately, the chapter explains how student clubs have developed, why they are important for student learning and how advisors can support them.

The contemporary focus on extracurricular activities, here the educational incubator environment, accentuates a need to understand what we offer students in terms of the curricular and extracurricular learning environments when situated in the same higher education institution (HEI). Current research points towards breaking down the invisible barriers and silo thinking. In this conceptual study, we apply the Didaktik triangle as a theoretical and conceptual framing to make comparisons of structurally based conditions for curricular and extracurricular entrepreneurship education (EE). We present a framework that helps bridge the ‘what’, ‘why’, and ‘how’ questions in the two different learning spaces and, thereby, conjoin educators and consultants in possible pedagogical discussions on how they work with the students. The suggested bridge frames a wider ‘why’ and adds a more holistic and cohesive view of the two different types of settings. Our study contributes to the literature on how to bridge the blurred lines between curricular and extracurricular activities and break down the silos. The framework can act as an inspiration for entrepreneurship educators and practitioners who wish to provide more suitable and sustainable structures and develop a holistic learning environment.

With practical entrepreneurship capabilities becoming ever more important for all university graduates, whether they are starting their own business or adding value to an organisation by innovating, improving, and problem-solving, what role do business incubators (BIs) play in helping to develop these capabilities for students? This chapter aims to better understand the role of BIs as extra-curricular entrepreneurship activity in universities through a narrative account of business incubation practice in three institutions – two in England and one in Australia. Utilising a practice-led methodology, the study is underpinned by social capital theory and a critical realist ontological perspective on incubation’s mechanisms, processes, and structures. Across these examples, there are common underpinning principles of entrepreneurial learning and socio-economic development. However, there are differences in implementation regarding space for incubation. Where the BI is on campus and closely integrated with extra-curricular entrepreneurship activity, this results in a cohesive graduate startup community and ongoing peer support. With no BI present, the opposite is observed. The chapter argues that without the infrastructure to build and maintain a community of nascent entrepreneurs to benefit from sustained peer learning, there can be negative impacts on the entrepreneurs and a visible gap affecting the entrepreneurial ecosystem. The chapter concludes with a practice note providing practical considerations for university BIs in communicating the significance of the incubator peer group to prospective entrepreneurs to improve realistic expectations and potentially improve their reach to entrepreneurs who may be experiencing isolation during their startup journey.

Overcrowding continues to afflict emergency departments (EDs), and its attendant consequences are becoming increasingly severe. The burden of the COVID-19 pandemic is further escalating the situation worldwide. One of the most critical questions is how to adequately quantify what constitutes overcrowding and determine implications for operations management in improving service efficiency. This paper aims to discuss the aforementioned.

The authors propose the time and class complexity measures for ED service systems, taking into account important patient-level and system characteristics. Using an extensive data set from a Canadian ED, the authors investigate the performance of complexity-based measures in predicting service delays.

The authors find that the complexity measure is potentially more important than some well-known crowding metrics. In particular, EDs can improve service efficiency by managing the level of complexity within a desirable interval. Furthermore, complexity exposes how the interplay between demand-side behavioral changes and supply-side responses affects operational performance. Moreover, the results suggest that arrival patterns—the number of patients of each class arriving per time and times between events (arrivals and service completions)—increase the risk of service delays more than the demand volume.

This paper is the first to provide an extensive investigation into the application of the complexity-based measure for ED crowding. The study demonstrates potential values to be gained in ED service systems if complexity measure is incorporated into their operations management decisions.

The purpose of this study is to examine the underexplored link between entrepreneurship education (EE) and graduate employability in the higher education (HE) sector in the United Kingdom (UK).

The study draws on a thematic content analysis of semi-structured interviews with 45 professionals in UK HE, representing the “supply” side of EE.

The findings demonstrate a unidirectional link between EE and employability outcomes. This link is affected by societal, stakeholder-related, and teaching and learning-related factors.

Although the value of universities’ initiatives connecting EE and employability for economic development is emphasized, the study does not provide direct empirical evidence for this effect. Macroeconomic research is needed.

EE and employability would benefit from knowledge exchange between universities’ stakeholders and a broader understanding of what constitutes a valuable graduate outcome.

The study reveals the benefits of EE on a micro level. Participation in EE supports the connection between individual investments in HE and employability.

Based on human capital theory, many policymakers regard EE as a vehicle through which the relationship between investments in HE and career success on a micro level and economic growth on a macro level can be nurtured. Challenging this logic, the study highlights the potential of institutional theory to explain a contextualization of the link between EE and employability on a national level.

This chapter presents the findings of an extracurricular online beta test of a competition between students of the University of Wales Trinity Saint David and the International University of Malaya-Wales. The competition is intended to promote the concept of harmonious entrepreneurship and the creation of student-led harmonious enterprises that address the global sustainability challenge and deliver a triple bottom line in which profit, people, and planet are in harmony. It reveals that extracurricular learning can attract students from disciplines other than business and can educate the participants, both staff and students, not just about harmonious entrepreneurship but also how to identify and launch an innovative harmonious enterprise that addresses a sustainability challenge. The test identifies how the competition may be improved prior to its global launch and makes recommendations for students, educators, mentors, providers, and universities as to how it might best be implemented. Once revised and launched the competition will be further tested to better understand how extracurricular learning can help advance the delivery of both entrepreneurship and sustainability education in universities and colleges around the globe.

This chapter contributes to the scholarship of teaching and learning in extracurricular enterprise and entrepreneurship education. It draws on research from two annual ‘Business Challenge Weeks’ (BCW) held at Oxford Brookes University in 2021 and 2022, in which teams of postgraduate students from three faculties worked on external client projects, supported by an academic mentor. It presents and discusses findings derived from a survey and interviews conducted after the second of these years. The chapter takes a transdisciplinary perspective, after Budwig and Alexander (2020), Piaget (1972) and Klein et al. (2001) and explores the relationship between this and the enterprise and entrepreneurship development pipeline set out by QAA (2018). It analyses the experiences of the three main participating groups engaged in the challenge weeks – students, external clients and academic mentors – and explores the organising challenges inherent in multiparty pedagogical initiatives. The chapter contributes to knowledge in this area by revealing and reflecting on the motivations and expectations of the three participant groups, the roles they played during the week and the outcomes they reported. It also expands understanding of transdisciplinary enterprise pedagogy.