TY - JOUR T1 - Using institutional entrepreneurship to understand the role of innovation teams in healthcare: a longitudinal qualitative study JF - BMJ Open JO - BMJ Open DO - 10.1136/bmjopen-2020-046750 VL - 11 IS - 9 SP - e046750 AU - Angela Melder AU - Ian Mcloughlin AU - Tracy Robinson AU - Rick Iedema AU - Helena J Teede Y1 - 2021/09/01 UR - http://bmjopen.bmj.com/content/11/9/e046750.abstract N2 - Objectives We draw on institutional theory to explore the roles and actions of innovation teams and how this influences their behaviour and capabilities as ‘institutional entrepreneurs (IEs)’, in particular the extent to which they are both ‘willing’ and ‘able’ to facilitate transformational change in healthcare through service redesign.Design A longitudinal qualitative study that applied a ‘researcher in residence’ as an ethnographic approach.Setting The development and implementation of two innovation projects within a single public hospital setting in an Australian state jurisdiction.Participants Two innovation teams, with members including senior research fellows, PhD scholars and front-line clinicians (19 participants and 47 interviews).Results Despite being from the same hospital, the two innovation teams occupied contrasting subject positions with one facilitating transformational improvements in service delivery, while the other sought more conservative improvements. Cast as ‘IEs’ we show how one team took steps to build legitimacy for their interventions enabling spread and scale in improvements and how, in the other case, failure to build legitimacy resulted in unintended consequences which undermined the sustainability of the improvements achieved.Conclusions Adopting an institutional approach provided insight into the ‘willingness’ and ‘ability’ to facilitate transformational change in healthcare through service redesign. The manner in which innovation teams operate from different subject positions influences the structural and normative legitimacy afforded to their activities. Specifically, we observed that those with the most power (organisational or professional) to bring about transformational change can be the least willing to do so in ways which challenge current practice. Those most willing to challenge the status quo (more peripheral organisation members or professionals) can be least able to deliver transformation. Better understanding of these insights can inform healthcare leaders in supporting innovation team efforts, considering their subject position.Data are available upon reasonable request. ER -