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We examine how interactions between peripheral and central actors facilitate innovation efforts in innovation ecosystems through an exploratory, qualitative case study of a new type of central leader and its surrounding SMEs in the healthcare context. Our study makes a threefold contribution: we identify and describe an understudied type of ecosystem leader (a faciliatory ecosystem leader); we propose a framework describing the interactions between the central leader and peripheral actors; and we identify the presence and intertwining of emotions that arise from these interactions. We show how interactions between the ecosystem leader and SMEs that have varying levels of fit in the ecosystem can influence innovation ecosystems to better meet the innovation needs of SMEs. Our study extends the current knowledge on peripheral actors in innovation ecosystems and their role in ecosystem change. We draw attention to the potential benefits of retaining ecosystem members with poor fit and identify internal pressures for ecosystem change. Finally, our study identifies opportunities for future research on the impact and management of heterogeneous peripheral actors in innovation ecosystems. [ABSTRACT FROM AUTHOR]

In this paper, we investigate how actors in the addictions field have been battling over the introduction of the harm reduction logic - principles of addiction services that aim to reduce the adverse effects of drug use while individuals with addictions continue to use drugs. In particular, we give attention to how emotions have played a role in this continuing battle. Through an inductive process, we identified highly emotional dimensions of the harm reduction logic, and focused our analysis on the emotion-based mechanisms employed by proponents and opponents of the harm reduction logic. We observed that during different time periods, principles of harm reduction were alternately strengthened or diminished. Our findings highlight the difficulties in introducing novel approaches to critical health concerns, such as addictions that have significant social implications. Theoretically, we contribute to the literature on institutional logics by focusing on the emotion-based aspect of certain logics, and by explaining how actors can strategically use emotions to strengthen or weaken particular approaches to healthcare concerns. [ABSTRACT FROM AUTHOR]

We develop a typology of interstitial spaces showing that these arise at different points of between-ness, and that in different interstitial spaces new practices are generated from between different elements. In contrast to established models that suggest interstitial spaces occur rather naturally at the interface of fields, we show empirically that interstitial spaces are created at field overlap, at the interface of fields, and around new world views. Our empirical setting sits at the interface of an addiction treatment field. Our in-depth study of this setting allowed us to uncover the different interstitial space created by actors to encourage the genesis of new practice. We contribute to the literature by identifying where different interstitial spaces are created, the point of origin of new practices in different interstitial spaces, and the different micro-interactions that occur in these spaces. Our findings illuminate the agentic creation of interstitial spaces formed to encourage new practice. [ABSTRACT FROM AUTHOR]

Calls for change to fundamentally transform health care fields are increasing. Health care fields are highly institutionalized, meaning that actors in these fields face a paradox of embedded agency. If behavior and action conforms to institutional pressures, when and how and which actors can step away from pressures to pursue and implement change? In this paper, we conduct a review of the empirical literature on institutional change in health care fields to examine when, who, and how intentional change is pursued. Our review of the literature uncovers six themes around intentionally pursuing change. The themes that emerged suggest that changes and actions that fit health care fields' constellations of logics are better suited to changing long standing arrangements and practices. The review also shows that change involves a variety of actors some that leverage preferred social positions and some that used nuanced change action to overcome other's embeddedness in health care fields. [ABSTRACT FROM AUTHOR]

In this paper I develop an action oriented model of practice innovation. Building from an in-depth health care case study, I show how managerial action encourages collective creativity or the recombining of existing ideas into something new, and the deinstitutionalization of practice to make space for these new ideas. In contrast to established models that suggest that innovation in professional practice is spontaneous or involves the adopting of already know innovations, I show that and how managers can work with professionals to develop practice innovations. I contribute to literature on health care innovation by drawing attention to the disrupting work that can be used by managers developing practice innovation. My model describes three kinds of work: complexifying work, adapting work, and course shifting work, and show how each is implicated in the development of innovative professional practice. [ABSTRACT FROM AUTHOR]

Leadership in health care contexts involves the practice of constructing, maintaining and erasing boundaries. In this study, we focus on leading through and across boundaries in four interprofessional health care teams operating in the area of mental health services. We give special consideration to the specific contexts of these teams, and address the boundaries that are constructed and managed in interactions. Our qualitative study revealed that leadership is exercised by different members and at different levels of the teams, and that it involved managing the boundaries between a) roles of different members of the leadership constellation, b) leadership and clinical roles, c) formal leaders and other members of the team, d) different professions, e) personal life experiences and professional work, and f) the team and what members consider to be the environment. Leadership work involving the demarcation, erasure and contestation of boundaries is addressed. We consider the implications of our findings to the practice of leadership in health care contexts and beyond. [ABSTRACT FROM AUTHOR]