UKWON Ltd, Nottingham, UK.
J Health Organ Manag. 2010;24(5):459-79. doi: 10.1108/14777261011070493.
This paper seeks to investigate conditions under which entrepreneurs emerge as agents of effective and sustainable change in UK National Health Service Trusts.
DESIGN/METHODOLOGY/APPROACH: The research synthesises literature on changing regulatory structures ("post-bureaucracy") and entrepreneurial behaviour to understand how individual identity construction is informed both by context and by individual attributes. Thematic analysis of interview data involving managers from 11 NHS Trusts, including detailed analysis of six transcripts, focuses on regulatory processes, the emergence of entrepreneurial behaviour and outcome variations in workplace innovation and improvement.
This study identifies co-existing modes of regulation, which interact with individual behaviour, generating strategies differentiated as entrepreneurial or conformist. Four ideal types are identified: organisational entrepreneurship, resisted or dissonant entrepreneurship, conformity, and symbolic entrepreneurship. Analysis reinforces those literature findings, which suggest that the interaction of regulatory structures and the identity work of individuals influence the emergence of entrepreneurial behaviour and the effectiveness of change.
The ability to achieve effective and sustainable outcomes varies considerably even between NHS Trusts faced with comparable challenges in implementing nationally prescribed targets. This variance is explained in terms of the organisation's ability to generate the structures, processes, individual competence and motivation which enable employees at all levels to act entrepreneurially with the ability and legitimacy to achieve strategic goals by working creatively in the spaces between formal organisational structures.
ORIGINALITY/VALUE: The study identifies specific conditions, which stimulate the emergence of entrepreneurs as agents of effective and sustainable change in the NHS, identifying factors that policymakers should consider when implementing change.
本文旨在探讨创业者如何成为英国国民保健制度信托机构中有效和可持续变革的推动者。
设计/方法/途径：本研究综合了关于变革监管结构（“后官僚主义”）和创业行为的文献，以了解个体身份构建如何受到背景和个体属性的共同影响。对来自 11 家 NHS 信托机构的管理人员的访谈数据进行了主题分析，包括对六份转录本的详细分析，重点关注监管流程、创业行为的出现以及工作场所创新和改进的结果变化。
本研究确定了共存的监管模式，这些模式与个体行为相互作用，产生了有区别的创业或遵从策略。确定了四种理想类型：组织创业、抵制或不和谐创业、遵从和象征性创业。分析结果强化了那些文献发现，即监管结构的相互作用和个体的身份工作影响创业行为的出现和变革的有效性。
即使在面临实施国家规定目标类似挑战的 NHS 信托机构之间，实现有效和可持续结果的能力也存在很大差异。这种差异可以用组织产生结构、流程、个人能力和动机的能力来解释，这些结构、流程、个人能力和动机使各级员工能够通过在正式组织结构之间的空间中创造性地工作，具有实现战略目标的能力和合法性，从而以创业的方式行事。
原创性/价值：本研究确定了 NHS 中激发创业者成为有效和可持续变革推动者的具体条件，为政策制定者在实施变革时应考虑的因素提供了参考。
