The role of institutional entrepreneurs in reforming healthcare

Andy Lockett, Graeme Currie, Justin Waring, Rachael Finn, Graham Martin

Research output: Contribution to journalArticleResearchpeer-review

46 Citations (Scopus)


We draw on institutional entrepreneurship theory to analyse the dynamics of institutional change in a healthcare context. The focus of our interest is in the relationship between an institutional entrepreneur's 'subject position', defined in terms of their structural and normative legitimacy within the existing institutional landscape, and the nature of the change enacted. We develop this approach through an examination of the implementation of new pathways for cancer genetic services within the English National Health Service. Employing comparative case analysis we show that those who have limited structural legitimacy under prevailing conditions are most willing to engender change, but also least able; whereas those who have strong structural legitimacy are most able, but often least willing. However, those who are able rhetorically to combine a balance of structural and normative legitimacy are most able to produce change. In doing so, we demonstrate the importance of the concept of institutional entrepreneurship to understand healthcare reform.

Original languageEnglish
Pages (from-to)356-363
Number of pages8
JournalSocial Science and Medicine
Issue number3
Publication statusPublished - Feb 2012
Externally publishedYes


  • Cancer genetics
  • Healthcare reform
  • Institutional entrepreneurship
  • Institutional theory
  • Normative and structural legitimacy
  • UK

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