| Certain individuals play key roles in shaping organizations, institutions, and society. These actors break with the dominant system and develop alternative arrangements, including through the formation of new programs, organizations, and industries (DiMaggio, 1988). Due to the impact of these institutional entrepreneurs, it is important to understand what leads to their behavior and how they enact change. For this dissertation, I explore these questions with two studies in the context of integrative medicine. First, I provide background on the empirical context. Then, in study one, I use two qualitative cases of integrative medicine programs to investigate the tactics institutional intrapreneurs use to embed new practices and values into the structure of the organization. I find that intrapreneurs draw on four categories of tactics aimed at finding common ground and that their success depends in part on their sources of political capital. This study reveals the importance of working within the structure of the organization to bring about incremental, institutional change. In the second study, I conduct a survey of physicians to explore what leads individuals to behave as institutional entrepreneurs and take different paths, including through intrapreneurship or extrapreneurship. I find that personal experiences in work organizations and social change activities affect institutional entrepreneurship and its paths. This prompts future research on the effect of learning in organizations on entrepreneurial behavior. Overall, this dissertation contributes to the literature on institutional entrepreneurship, institutional change, and institutional research in healthcare. |
