As well as review the literature on the notion of institutional entrepreneurship introduced by Paul DiMaggio in 1988, we propose a model of the process of institutional entrepreneurship We first present theoretical and definitional issues associated with the concept and propose a conceptual account of institutional entrepreneurship that helps to accommodate them We then present the different phases of the process of institutional entrepreneurship from the emergence of institutional entrepreneurs to their implementation of change Finally, we highlight future directions for research on institutional entrepreneurship, and conclude with a discussion of its role in strengthening institutional theory as well as, more broadly, the field of organization studies

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How actors change institutions : Towards a theory of institutional entrepreneurship

We investigated an organizational field where competing institutional logics existed for a lengthy period of time We identified four mechanisms for managing the rivalry of competing logics that facilitated and strengthened the separate identities of key actors, thus providing a way for competing logics to co-exist and separately guide the behaviour of different actors We contribute to the institutional literature by showing that competing logics can co-exist and rivalry between logics can be managed through the development of collaborative relationships

Managing the Rivalry of Competing Institutional Logics

This review maps and critically evaluates the rapidly growing body of research in the strategy-as-practice field. Following an introduction on the emergence and foundations of strategy-as-practice, the review is structured in three main parts, based on the terminology, issues and research agendas outlined in the field. First, the paper examines the concepts of practitioners and praxis. A typology of nine possible domains for strategy-as-practice research is developed, based on the way that different studies conceptualize the strategy practitioner and the level of strategy praxis that they aim to explain. Second, the paper reviews the concept of practices, which has been adopted widely but inconsistently within the strategy-as-practice literature. While there is no dominant view on practices, the review maps the various concepts of practices that inform the strategy-as-practice field and outlines avenues for future research. The final section attends to the call for strategy-as-practice research to develop and substantiate outcomes that may better explain or inform strategy praxis. Five categories of outcomes are found within existing empirical studies, and an agenda for building upon this evidence is advanced. The paper concludes with a summation of the current state of the field and some recommendations on how to take strategy-as-practice research forward.

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Strategy‐as‐practice: A review and future directions for the field

When Karl Weick's seminal article, ‘Enacted Sensemaking in Crisis Situations’, was published in 1988, it caused the field to think very differently about how crises unfold in organizations, and how emergent crises might be more quickly curtailed. More than 20 years later, we offer insights inspired by the central ideas in that article. Beginning with an exploration of key sensemaking studies in the crisis and change literatures, we reflect on lessons learned about sensemaking in turbulent conditions since Weick (1988), and argue for two core themes that underlie sensemaking in such contexts: shared meanings and emotion. We examine when and how shared meanings and emotion are more and less likely to enable more helpful, or adaptive, sensemaking, and conclude with some suggestions for future research in the sensemaking field.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-6486.2010.00908.x

Sensemaking in crisis and change: Inspiration and insights from Weick (1988)

In this article, we theorize a novel approach to addressing the world’s grand challenges based on the philosophical tradition of American pragmatism and the sociological concept of robust action. Grounded in prior empirical organizational research, we identify three robust strategies that organizations can employ in tackling issues such as climate change and poverty alleviation: participatory architecture, multivocal inscriptions and distributed experimentation. We demonstrate how these strategies operate, the manner in which they are linked, the outcomes they generate, and why they are applicable for resolving grand challenges. We conclude by discussing our contributions to research on robust action and grand challenges, as well as some implications for research on stakeholder theory, institutional theory and theories of valuation.

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Tackling Grand Challenges Pragmatically: Robust Action Revisited

How do individual actors institute changes in established ways of working? Longitudinal research is the basis for our theoretical model showing how actors legitimize new practices by accomplishing three interdependent, recursive, situated “microprocesses”: (1) cultivating opportunities for change, (2) fitting a new role into prevailing systems, and (3) proving the value of the new role. These microprocesses are demarcated by an accumulating series of small wins that consolidate gains while facilitating continuing change efforts. Most accounts of institutional change focus on embeddedness as a constraint, yet our study shows how embeddedness can provide the foundation and opportunity for change.

Legitimizing a New Role: Small Wins and Microprocesses of Change

Objectives Explore the experience of patients undergoing colorectal surgery within an Enhanced Recovery After Surgery (ERAS) programme. Use these experiential data to inform the development of a framework to support ongoing, meaningful patient engagement in ERAS. Design Qualitative patient-led study using focus groups and narrative interviews. Data were analysed iteratively using a Participatory Grounded Theory approach. Setting Five tertiary care centres in Alberta, Canada, following the ERAS programme. Participants Twenty-seven patients who had undergone colorectal surgery in the last 12 months were recruited through purposive sampling. Seven patients participated in a codesign focus group to set and prioritise the research direction. Narrative interviews were conducted with 20 patients. Results Patients perceived that an ERAS programme should not be limited to the perioperative period, but should encompass the journey from diagnosis to recovery. Practical recommendations to improve the patient experience across the surgical continuum, and enhance patient engagement within ERAS included: (1) fully explain every protocol, and the purpose of the protocol, both before surgery and while in-hospital, so that patients can become knowledgeable partners in their recovery; (2) extend ERAS guidelines to the presurgery phase, so that patients can be ready emotionally, psychologically and physically for surgery; (3) extend ERAS guidelines to the recovery period at home to avoid stressful situations for patients and families; (4) consider activating a programme where experienced patients can provide peer support; (5) one size does not fit all; personalised adaptations within the standardised pathway are required. Drawing upon these data, and through consultation with ERAS Alberta stakeholders, the ERAS team developed a matrix to guide sustained patient involvement and action throughout the surgical care continuum at three levels: individual, unit and ERAS system. Conclusion This patient-led study generated new insights into the needs of ERAS patients and informed the development of a framework to improve patient experiences and outcomes.

https://bmjopen.bmj.com/content/bmjopen/7/6/e017002.full.pdf

Patients as partners in Enhanced Recovery After Surgery: A qualitative patient-led study

Aim The aim of this paper is to report on the findings from our research into the recent introduction of nurse practitioners in Alberta, Canada. Through an organizational research perspective, we identify the critical role of health care managers in developing a sustainable nurse practitioner role.

Background  Previous literature has focused on nurse practitioners themselves as the key factor in their integration into the health care system. Although they are qualified and organizationally well placed, managers of nurse practitioners have been overlooked as a critical part of implementation strategies.

Key issues  We interviewed 25 nurse practitioners and seven of their managers. Through our data analysis we identified three major challenges for managers: (1) clarifying the reallocation of tasks; (2) managing altered working relationships within the team; (3) continuing to manage the team in an evolving situation. Associated with these challenges, we propose leadership strategies that managers may find useful as they work through the consequences of introducing the nurse practitioner role. These strategies are:

•  encourage all team members to sort out ‘who does what’;

•  ensure that task reallocation preserves job motivating properties;

•  give consideration to how tasks have been allocated when issues identified as ‘personal conflict’ arise;

•  pay attention to all perspectives of the working relationships within the team;

•  facilitate positive relationships between team members;

•  lead from a ‘balcony’ perspective;

•  work with the team to develop goals that are not over focused on the nurse practitioner;

•  regularly share with other managers the experiences and lessons learned in introducing nurse practitioners.

Conclusion  For managers to be most effective, they need to address three challenges that are of a managerial, not clinical, nature. By implementing specific leadership strategies, managers of nurse practitioners can facilitate the introduction of the new role and improve its sustainability in health organizations.

Challenges and leadership strategies for managers of nurse practitioners.

The value of community development (CD) practices is well documented in the health promotion literature; it is a foundational strategy outlined in the Ottawa Charter for Health Promotion. Despite the importance of collaborative action with communities to enhance individual and community health and well-being, there exists a major gap between the evidence for CD and the actual extent to which CD is carried out by health organizations. In this paper it is argued that the gap exists because we have failed to turn the evaluative gaze inward-to examine the capacity of health organizations themselves to facilitate CD processes. This study was designed to explicate key elements that contribute to organizational capacity for community development (OC-CD). Twenty-two front-line CD workers and managers responsible for CD initiatives from five regional health authorities in Alberta, Canada, were interviewed. Based on the study findings, a multidimensional model for conceptualizing OC-CD is presented. Central to the model are four inter-related dimensions: (i) organizational commitment to CD, rooted in particular values and beliefs, leadership and shared understanding of CD; (ii) supportive structures and systems, such as job design, flexible planning processes, evaluation mechanisms and collaborative processes; (iii) allocation of resources for CD; and (iv) working relationships and processes that model CD within the health organization. These four dimensions contribute to successful CD practice in numerous ways, but perhaps most importantly by supporting the empowerment and autonomy of the pivotal organizational player in health promotion practice: the front-line worker.

Organizational capacity for community development in regional health authorities: a conceptual model

The Canadian public health sector’s foundational values of social justice and equity, and its mandate to promote population health, make it ideally situated to take a strong lead in addressing persistent and unacceptable inequities in health between socially disadvantaged, marginalized or excluded groups and the general population. There is currently much attention paid to improving understanding of pathways to health equity and development of effective population health interventions to reduce health inequities. Strengthening the capacity of the public health sector to develop, implement and sustain equity-focused population health initiatives – including readiness to engage in a social justice-based equity framework for public health – is an equally essential area that has received less attention. Unfortunately, there is evidence that current capacity of the Canadian public health sector to address inequities is highly variable. The first step in developing a sustained approach to improving capacity for health equity action is the identification of what this type of capacity entails. This paper outlines a Conceptual Framework of Organizational Capacity for Public Health Equity Action (OC-PHEA), grounded in the experience of Canadian public health equity champions, that can guide research, dialogue, reflection and action on public health capacity development to achieve health equity goals.

Kathy GermAnn

Papers

Legitimizing a New Role: Small Wins and Microprocesses of Change

Patients as partners in Enhanced Recovery After Surgery: A qualitative patient-led study

Challenges and leadership strategies for managers of nurse practitioners.

Organizational capacity for community development in regional health authorities: a conceptual model

A Conceptual Framework of Organizational Capacity for Public Health Equity Action (OC-PHEA).