The emergence of health technology organizations among institutional healthcare and economic actors

Abstract

Few studies have considered the creation of health technology organizations where the entrepreneurs seize opportunities, create their entrepreneurial organization and provide it with legitimacy, and examined the triggers, constraints and pressures involved in this process. To study the emergence of such firms, we performed semistructured interviews with 20 entrepreneurs and strategic partners involved in the development and commercialization of health technologies. For each stage of the firm emergence process, we identified triggers and enablers, as well as barriers and constraints encountered by entrepreneurs, and pressures originating from institutional actors. We found that each stage of startup emergence had triggers where the entrepreneur faced a conflicting situation in the form of boundary misalignment, competing technologies, poor performances, and resource asymmetry. Each topic is examined in the light of neo-institutional theory and finally replaced within a larger process in which the entrepreneur addresses market and healthcare system needs and interacts with other actors. In each stage, we identified a predominant institutional process taking place, whether it was decoupling, organizational field influence or legitimation seeking. The present study aimed at understanding the process by which an opportunity is seized, an organization is created and an institution as big as a healthcare system is approached. The results may help entrepreneurs and decisionmakers understand the strategies engaged following pressures from the healthcare organization. Likewise, it could increase investors’ awareness of the emergence process of health tech businesses and stimulate mutual understanding between entrepreneurs, and economic and healthcare actors.

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Acknowledgements

I thank the anonymous reviewers for their careful reading of our manuscript and their many insightful comments, as these comments led to an improvement of the manuscript.

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Correspondence to M. Beaulieu.

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Appendix 1. Interview Questionnaire

Appendix 1. Interview Questionnaire

How can innovative health firms satisfy economic and health system actors by socially constructing themselves in its organizational field?

Preliminary questions

  1. 1.

    What is your position in the organization?

  2. 2.

    What is your training (studies, specialties)?

  3. 3.

    How long have you worked for this organization?

  4. 4.

    What is your involvement in the evaluation or use of innovations in health?

  5. 5.

    In your opinion, what are the key issues affecting the financing, development, evaluation or use of innovations in health?

Part 1 – Market Actions

The companies that market new technologies attempt to directly or indirectly influence the choice of adoption of their product. Which of the following market actions do you think might influence the acquisition of your technology, and why? As an example, you receive information about competitive actions such as (see Table 5).

Table 5 Competitive actions
  1. 6.

    Do you find that regulatory agencies (e.g., Health Canada) and / or professional associations (e.g. College of Physicians, American Heart Association) have too much say in the process of adoption and diffusion of innovation?

  2. 7.

    Do you think that too many stakeholders (a lot of decision levels, physicians, third-party payers, managers, shareholders) are involved in the innovation diffusion process? Do you think some actors impedes the process, the health system and/or the sustainability of innovation?

Part 2 – Institutional logic

  1. 8.

    What methods do you use to identify and define opportunities and needs from the healthcare system?

  2. 9.

    How do you combine your value proposition to the dynamics of a universal healthcare system? For example, do you need to develop specific business models or think “outside the box”?

  3. 10.

    On what basis did you develop your practice and your business so that it responds to health needs while being successful and profitable?

  4. 11.

    How do you explain and justify your value proposition to investors and decision makers knowing the desires of these actors can vary and even contradict each other?

  5. 12.

    How do you connect to your business logic to competitive actions oriented towards external actors?

  6. 13.

    How do you connect to your business logic to social intentions oriented external actors?

Part 3 – Disruptive innovations, startups and media coverage

  1. 14.

    Do you evaluate your relationships with other actors when your technology is a disruptive innovation (e.g. innovations which can be refocused and adapted to existing markets, or targeted for new markets, can these technologies change the rules of the market) compared to an incremental innovation? For example, in our research, a health innovation was considered “disruptive” because it consisted of risk management software for childbirth and was aimed at the obstetrician market (who had never previously used such a tool).

  2. 15.

    Similarly, do you think the response is different for emerging companies, compared with established companies with proven records?

  3. 16.

    Do you think the other actors are influenced by the media coverage of your innovation, whether by journalist interpretation or the scale of media coverage?

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Beaulieu, M., Lehoux, P. The emergence of health technology organizations among institutional healthcare and economic actors. Int Entrep Manag J 15, 1115–1151 (2019). https://doi.org/10.1007/s11365-018-0551-2

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Keywords

  • Innovation in health
  • Institutional entrepreneurship
  • Opportunities
  • Neo-institutional theory
  • Health technologies
  • Competitive actions
  • Social construction