Institutional entrepreneurship and institutional change: a comparative study of emerging and mature cases

The notion of institutional entrepreneurship emerged to explain how actors change the institutions in which they are embedded. However, the introduction of institutional entrepreneurship into institutions creates a promising tension between actors as strategic agents – institutional entrepreneurs – and the powerful influence of institutional forces on actors. For the notion of institutional entrepreneurship to hold, it is necessary to address how institutionally embedded actors bring about institutional change. This thesis examines how institutional entrepreneurs bring about institutional change and explains success in entrepreneurial efforts. Drawing on two in-depth case studies, the researcher examined which combinations of contextual elements constitute institutional entrepreneurship – in terms of deviation from existing institutional arrangements and institutionalisation of innovation – and which factors explain success or failure in institutional entrepreneurship. The cases provide comparative and contrasting perspectives on the process of institutional entrepreneurship. The first case focused on the entrepreneurial process in the emerging organisational field of positive psychology in Kuwait and led by actors outside the target institution for change. In contrast, the second case represented the mature organisational field of business incubation in Kuwait and led by actors inside the target institution. The researcher conducted semi-structured interviews with institutional entrepreneurs and their collaborators in each case and collected documents to augment and validate the data in the interviews. The research shows that the differences in the characteristics of emerging and mature fields and positions of institutional entrepreneurs shape the entrepreneurial process and the form of change in fields. The findings suggest that outsider-driven institutional entrepreneurship in emerging fields requires multiple forces from within and outside the field working for the institutional change. As outsiders who lack centrality in the target institution, the institutional entrepreneurs connect with macro-level forces and draw on related mature fields and their associated institutions to bring about their innovation. The situation is rather different in insider-driven institutional entrepreneurship in mature fields. The evidence shows that the institutional entrepreneurs target field-level forces. As insiders to the target institution, the institutional entrepreneurs leverage their social position and draw strategically on the established institutional logic and its associated set of practices to realise their innovation

Outsider-driven institutional entrepreneurship: the case of the emerging field of positive psychology education

The phenomenon of outsider-driven institutional entrepreneurship may appear both paradoxical and opaque. We examine outsider-driven institutional entrepreneurship by drawing on an in-depth qualitative case study of the emerging field of positive psychology education. We investigate how institutional entrepreneurs, located outside Kuwait’s Ministry of Education, enabled actors inside the Ministry both to deviate from existing institutional arrangements and to institutionalize new practices. Our findings illustrate that outsider-driven institutional entrepreneurship in emerging fields starts with ‘normalization’, that is, the production of claims, arguments, and evidence, about the effectiveness of the newly proposed practices. Our study contributes to the literature on outsider-driven institutional entrepreneurship in emerging fields by identifying a set of critical activities associated with deviation from prevailing institutional arrangements, and the institutionalization of innovation

A Comparison of Two Nights of Ambulatory Sleep Testing in Arrhythmia Patients

Introduction. Obstructive sleep apnea (OSA) is common and usually underdetected in patients with cardiac arrhythmia. Ambulatory sleep testing may provide an alternative method for detection of OSA under realistic conditions compared to in-laboratory polysomnography. We aimed to (1) determine the sleep architecture in arrhythmia patients; (2) detect differences in sleep parameters between patients with and without OSA; and (3) compare the results of two consecutive nights of unattended ambulatory sleep testing. Methods. Consecutive patients with unknown OSA status were recruited from arrhythmia clinics. Patients underwent two consecutive nights of self-applied in-home sleep testing replete with electroencephalogram (EEG) recording. Results. One hundred patients were recruited. The mean age was years (70% males). OSA (AHI ≥ 5/h) was detected in 85% of patients. In the total sample, the sleep efficiency was reduced, and sleep onset latency was longer compared to a reference population of the same age. In patients with OSA, the sleep efficiency and the percentage of slow wave sleep were reduced; however, the arousal and periodic limb movement indices were increased compared to patients without OSA. The two nights of the ambulatory sleep testing showed consistent results with an excellent test-retest reliability for the AHI (ICC = 0.813). REM latency was shorter during the second night of sleep recording (). There were no other significant differences in the sleep architecture, respiratory indices, and other sleep parameters between the first and the second night of the ambulatory sleep recording. Conclusions. There is no significant difference in the respiratory parameters obtained during two consecutive nights of ambulatory sleep testing. Ambulatory studies incorporating EEG may provide a reliable, convenient, and economically efficient method for sleep assessment and there appears to be no significant night-to-night variability.Peer Reviewe