Question: This research compared the underpinning logic of social enterprise in two domestic health systems where resources differ: England and Tanzania. It draws from previous research on the institutional logic of health system reform in Europe (Bevan & Robinson, 2005, Evans, 2005), USA (Scott et al, 2000) and Canada (Reay & Hinings, 2005) where change over time was framed in terms of the introduction of or power struggles between competing logics. For example, in the USA Scott et al (2000) describe how the introduction of the health market competed with an existing professional and state logic in the 1990s.
Social enterprises have emerged in an institutional environment where the meaning of the term is politically contested over time (Teasdale, 2012) and geography (Nicholls, 2010). Thornton et al (2012) have proposed that a new logic, ‘community’, exists which distinguishes community orientated organisations, such as social enterprises, from others.
This research examines the logic of a new institutional order, ‘community’, from the perspective of social enterprises in two health systems: England and Tanzania. Taking the institutional perspective of the health system, do social enterprises have a distinct role in achieving national health priorities? How does the institutional design of a health system influence social entrepreneurs’ opportunities?
Method: A case study design methodology was used, drawing on institutional logic meta-theory [Thornton et al, 2012, Scott, 2013] to guide data collection and analysis. Between 2013 and 2015, 20 policy actors in England were interviewed and 17 in Tanzania. Primary data were collected using in depth interviews with policy makers, policy influencers and policy implementers. Data were collected from published literature, websites and the media. The researcher also drew on personal experience of working as a social enterprise consultant between 2006 and 2015.
Results: Three common characteristics of social enterprise were evident across both countries: their organizational purpose was expressed through a social mission, they used their profits to further their purpose and their teams demonstrated a social entrepreneurial outlook when engaging with the health market. Social enterprises’ social missions were able to be aligned with health priorities and one or more of the social determinants of health. Social entrepreneurs responded to, and their strategies and care models were contingent on, the state and market design of the health system. Three domains of institutional design were important in shaping social entrepreneurs’ strategies including capacity within the health system to implement social entrepreneurial ambitions, incorporating social impact as a policy tool for effecting system change and consistency across intra-government systems. Taken from the perspective of these three domains, institutional developments to support the emergence of social enterprises were not consistently applied in either country.
Discussion: Policy actors with a focus on addressing the social determinants of health and health system reform have an opportunity to invest in social entrepreneurs to achieve their policy goals. Yet, there is very little comparative research in this field, the exception being a comparison of England and South Korea by Park and Wilding (2013). This dynamic between social entrepreneurs and policy actors can be used to develop an institutional environment which supports the emergence of an underpinning logic of social enterprise. A diagnostic tool which draws on the three domains of institutional design can be developed further to guide the breadth of system change required, promote comparative research and learning for all policy actors.
References:
Bevan, G. & Robinson, R. 2005. The Interplay Between Economic And Political Logics: Path Dependency In Health Care In England. Journal of Health Politics, Policy and Law, 30.
Evans, R. G. 2005. Fellow Travelers On a Contested Path: Power, Purpose, And The Evolution Of European Health Care Systems. Journal of Health Politics, Policy And Law, 30.
Nicholls, A. 2010. The Legitimacy of Social Entrepreneurship: Reflexive Isomorphism In A Pre-Paradigmatic Field. Entrepreneurship Theory and Practice, 611-633.
Park, C. & Wilding, M. 2013. Social Enterprise Policy Design: Constructing Social Enterprise In The UK And Korea. International Journal of Social Welfare 2013, 22, 236-247.
Reay, T. & Hinings, C. R. B. 2005. The Recomposition Of An Organizational Field: Health Care In Alberta. Organization Studies, 26, 351-384.
Scott, W. R., Ruef, M., Mendel, P. J. & Caronna, C. A. 2000. Institutional Change And Healthcare Organizations: From Professional Dominance To Managed Care, University Of Chicago Press.
Scott, W. R. 2013. Institutions And Organisations: Ideas, Interests And Identities, Sage.
Teasdale, S. 2012. What's In A Name? Making Sense Of Social Enterprise Discourses. Public Policy And Administration, 27.
Thornton, P. H., Ocasio, W. & Lounsbury, M. 2012. The Institutional Logics Perspective: A New Approach To Culture, Structure, And Process Oxford University Press.
6. Institutionalization, scaling up and public policies
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