Entrepreneurial Leadership Strategies for Catalyzing Innovation Performance.

Section 1: Foundation of the Study

Globalization and rapid technological advancement have pressured healthcare

leaders to catalyze innovation for economic growth, profitability, and improved patient

outcomes. However, significant hurdles in diffusing, adapting, and leading innovation

efforts have challenged healthcare leaders (Currie & Spyridonidis, 2019; Machon et al.,

2019). Effective innovation leadership can drastically improve organizational quality,

productivity, and efficiency (Avby & Kjellström, 2019; Avby et al., 2019; Dalton et al.,

2021). To catalyze healthcare innovation, leaders must successfully shape an

entrepreneurial climate and orientation, develop effective innovation management

practices, foster innovative work behavior, and promote creative and collaborative

internal and external partnerships (Afsar & Umrani, 2019; Avby et al., 2019; Bagheri &

Akbari, 2018; Kremer et al., 2019; Leonidou et al., 2020; Machon et al., 2019).

Entrepreneurial leadership is more likely to foster innovative behaviors in employees

than other leadership styles (Newman et al., 2018), though it has not been extensively

adopted within business management practices (Leitch & Volery, 2017). Thus, the

doctoral study research topic was entrepreneurial leadership strategies that catalyze

innovation performance.

Background of the Problem

Healthcare organizations’ survival and competitive advantage may depend on

leaders’ innovation capacity. The global healthcare environment is challenged with aging

populations, disease prevalence, rising clinical costs, limited resources, rapidly evolving

and disruptive technologies, and economic pressures (Currie & Spyridonidis, 2019; Lee

et al., 2019; Lombardi et al., 2018; Pesut, 2019). Healthcare leaders and the environment

are typically risk averse, evidence based, and compliance oriented, contrasting with an

innovation culture that embodies risk-taking, rapid change, and experimentation (Machon

et al., 2019). With competing operational needs, limited resources, and employee

challenges, leaders often consider employees’ time on strategy and innovation as

nonproductive (Machon et al., 2019), thus diminishing the potential for innovation

(Renkema et al., 2021). Innovation is pivotal to improving healthcare globally and

amplifying medical progress, and it is a top priority for business leaders. Despite

historical innovative drug discoveries, expiring patents, increased competition from

generic manufacturers, rising research and development (R&D) costs, and targeted novel

therapies have impacted healthcare companies’ market share and profitability (Califf &

Slavitt, 2019). A leader’s ability to innovate and focus on shaping an innovative and

performance-oriented culture requires various leadership styles to facilitate innovation.

Business leaders can drive economic growth, profitability, and optimized patient

outcomes through entrepreneurial leadership and innovation management.

Leaders must abdicate traditional leadership and adopt modern-day

entrepreneurial leadership strategies to conquer healthcare innovation challenges.

Entrepreneurial leadership is a specialized approach to realizing superior organizational

performance, innovation, and change through entrepreneurial strategies and high levels of

creativity, vision, and motivation (Nguyen et al., 2021; Purwati et al., 2021; Rehman et

al., 2021; Ricci et al., 2022). However, Leitch and Volery (2017) noted that many

entrepreneurial leadership concepts have yet to be extensively adopted within business

management practices. Therefore, the research goal was to explore leadership strategies

for catalyzing innovation using entrepreneurial leadership constructs, such as risk-taking,

experimentation, innovativeness and creativity, self-renewal, and agile resource

integration (Findsrud, 2020; Verma & Mehta, 2020). The background to the problem has

been provided, and the focus will now shift to the problem statement.

Problem and Purpose

The specific business problem is that some healthcare business leaders lack

entrepreneurial leadership strategies to catalyze innovation performance. Therefore, the

purpose of this qualitative multi-case study was to explore entrepreneurial leadership

strategies that some healthcare business leaders working in the pharmaceutical, medical

device, and consumer healthcare sectors in North America and Western Europe used to

catalyze innovation performance.

Population and Sampling

Population

The targeted population involved healthcare business leaders in North America

and Western Europe working in the pharmaceutical, medical device, and consumer

healthcare sectors who had successfully used entrepreneurial leadership strategies to

catalyze innovation. This population was appropriate for this study because healthcare

business leaders directly influence their organization's entrepreneurial orientation and

distinguish themselves from competitors by applying new knowledge and innovation (see

Dabić et al., 2021; Gifford & McKelvey, 2019; Shaher & Ali, 2020). Using individuals

within associated professional networks effectively diminishes access barriers to people

and data (Vuban & Eta, 2019). The sampled population interviewed involved six

healthcare business leaders who had demonstrated evidence of successfully applying

entrepreneurial leadership strategies to catalyze organizational innovation.

Sampling

I conducted a qualitative multi-case study to explore entrepreneurial leadership

strategies that some healthcare business leaders used to catalyze innovation performance;

therefore, a nonprobabilistic, purposive sampling method was appropriate for this study.

The process included an element of convenience sampling; however, the specific nature

of the criteria for involvement made this design purposive. The sampling strategy helped

in identifying suitable research participants. Matching interviewees with the research

objectives helps to improve a study’s rigor and the reliability of data and findings (S.

Campbell et al., 2020). The sampling strategy aligned with the research methodology,

aims, and objectives, contributing to research rigor.

The study involved multiple data sources, including six in-depth, semistructured

interviews and a review of participant-provided evidentiary documentation, such as

organizational business strategies and websites. Key eligibility criteria targeted healthcare

business leaders who were creative, who were strategic thinkers, and who had led or

significantly contributed toward strategic decisions within healthcare innovation

initiatives within the last 5 years. The specific eligibility criteria ensured that participants'

selection and use were nonprobabilistic, were purposive, were appropriate for the

research topic, and led to the collection of data on recent and relevant experience across

various entrepreneurial innovation conditions.

Nature of the Study

Qualitative methods were the basis for this study to explore entrepreneurial

leadership strategies that some healthcare leaders used to catalyze innovation

performance. Researchers use qualitative methodology to understand complex realities as

they contextualize a phenomenon's subjective and socially formed meanings, especially

from the subjects' perspective (Stake, 2005; Yin, 2018). Conversely, quantitative or

mixed methods allow for the objective and systematic collection of data and hypothesis

testing that may allow inferences and representation to broader populations (Bloomfield

& Fisher, 2019; Duckett, 2021). Qualitative research is increasingly being recognized as

a valuable methodology in the medical field for its meaningful research questions and

identification of suitable measures for future studies (Abramson et al., 2018). Due to the

study's exploratory nature and the fact that quantitative statistical data were not required

to answer the research question or test a hypothesis, qualitative research was more

suitable than quantitative or mixed-method approaches. In addition, the mixed

methodology approach would have been prohibitively extensive.

Qualitative research designs include phenomenological, grounded theory,

ethnographic, narrative inquiry, and case study. Phenomenological designs are suitable

for documenting participants' lived experiences (Pathiranage et al., 2020). Grounded

theory is suitable for discovering or constructing theory from data (Chun Tie et al., 2019).

Researchers immerse themselves in natural social settings within ethnographic designs to

understand cultural contexts (Pathiranage et al., 2020). Narrative designs are suitable for

capturing stories describing human events (Sonday et al., 2020). Phenomenological,

grounded theory, ethnographic, and narrative inquiry designs were unsuitable for the

study because lived experiences, life stories, and cultural elements would not be

emphasized or expected to contribute to the study. Within a qualitative multi-case study

design, researchers challenge existing theoretical assumptions and utilize several

evidence types and sources to explore complex phenomena from subjects' experiences

and perspectives in their natural settings (Stake, 2005; Yin, 2018). Therefore, a

qualitative multi-case study design was best suited for this study because it involves

exhaustive review and analysis of participants’ perspectives on a phenomenon.

Research Question

What entrepreneurial leadership strategies do some healthcare business leaders

use to catalyze innovation performance?

Interview Questions

1. How are you involved in leading innovation within your organization?

2. What entrepreneurial leadership strategies have you used to foster an

innovative or entrepreneurial orientation within your organization?

3. What challenges have you faced embedding an innovative or entrepreneurial

orientation?

4. What entrepreneurial leadership strategies have you used to manage and

implement innovation initiatives?

5. How do you judge the effectiveness of those entrepreneurial leadership

strategies?

6. How do you know when to apply specific entrepreneurial leadership

strategies?

7. What challenges have you faced in using those entrepreneurial leadership

strategies?

8. What have you done to meet those challenges effectively?

9. How do you measure innovation performance?

10. What additional information would you like to share about using

entrepreneurial leadership strategies to catalyze innovation performance?

Conceptual Framework

The conceptual framework of this study was entrepreneurial leadership.

Entrepreneurial leadership organically emerged as a new leadership concept from

entrepreneurship and leadership literature (Esmer & Dayi, 2017; Renko et al., 2015). No

author has claimed to be or been referred to as the original theorist; however, the concept

is well grounded and continues to evolve in the literature, making it worthwhile to add

constructs or insight to the body of knowledge. The concept of entrepreneurial leadership

is used to describe leaders' proficiency in influencing followers to achieve organizational

objectives through creative recognition and exploitation of entrepreneurial opportunities

for business growth (Pinelli et al., 2022; Renko et al., 2015). Key tenets, such as

opportunity recognition and exploitation, underlying the entrepreneurial leadership

concept are related to transformational leadership (Lopes Figueredo et al., 2022),

creativity-enhancing leadership (Makri & Scandura, 2010), and entrepreneurial

orientation (Lopes Figueredo et al., 2022; Lumpkin & Dess, 1996). The entrepreneurial

leadership concept holds that entrepreneurial leadership constructs offer a lens on how

leaders champion entrepreneurial behaviors and drive innovation performance within

organizations. Therefore, an organization's entrepreneurial orientation is likely to foster

entrepreneurial leaders who influence intrapreneurial attributes such as creativity, risk-

taking, self-efficacy, and opportunity recognition and exploitation within employees and

culture (Bagheri, 2017; Dabić et al., 2021; Pinelli et al., 2022; Renko et al., 2015; Shaher

& Ali, 2020). Thus, entrepreneurial leadership is an antecedent to establishing an

organizational and individual entrepreneurial orientation that leads to the development of

future leaders.

Operational Definitions

Entrepreneurial leadership: Leaders' proficiency in influencing followers in

achieving organizational objectives through creative recognition and exploitation of

entrepreneurial opportunities for business growth (Niazi et al., 2020; Renko et al., 2015).

Entrepreneurial orientation: Comprises a firm’s collective organizational

processes, methods, and approaches while performing entrepreneurially (Lumpkin &

Dess, 1996).

Innovation management: An organization’s ability to renew itself and enhance its

value through novel or transformed ideas (Fontana & Musa, 2017).

Innovation performance: The degree of success (efficacy) in relation to the efforts

spent (efficiency) while undertaking the innovation process (Rehman et al., 2021).

Innovation process: Comprises a firm’s collective organizational processes that

govern idea generation, selection, development, and diffusion (Fontana & Musa, 2017).

Innovative work behavior: Comprises the behaviors that promote the development

of new ideas, technology, techniques, and methods related to specific business goals

(Afsar & Umrani, 2019).

Social entrepreneurship: The creation of positive social change through

entrepreneurial activity, adoption of innovative approaches, collection of resources, and

development of networks aimed at creating or pursuing social value (Stirzaker et al.,

2021).

Assumptions, Limitations, and Delimitations

Assumptions

Philosophical assumptions involve researchers' beliefs surrounding problem

formulation, research strategy, data collection, and data analysis, and they comprise

epistemological, ontological, and axiological suppositions (Almasri & McDonald, 2021).

Assumptions are accepted issues, ideas, or positions and may be found across the

research process (Theofanidis & Fountouki, 2019). Researchers make assumptions about

human knowledge, realities experienced within the research process, and how their

values potentially affect the research process (Almasri & McDonald, 2021). This study

had two fundamental assumptions. First, it was assumed that leaders with distinct

entrepreneurship experiences could speak on what it takes to be entrepreneurial and

catalyze innovation. The second assumption was that entrepreneurial leaders would

truthfully and transparently answer research questions and share explicit success

strategies that may benefit other leaders. Asking probing questions to achieve the depth

and breadth of insight and meaning served as a mitigation strategy for this study.

Limitations

Research study limitations are restrictions out of the researcher's control and are

often linked to the chosen research design, statistical model, funding, or other factors

(Theofanidis & Fountouki, 2019). As this study was conceptual and exploratory,

limitations were inherent and integral to the research. Several limitations that potentially

affected the study design, results, and conclusions must be considered. Due to the

qualitative case study design and the insignificant number of participants required to

reach data saturation relative to the overall target population, the generalizability and

reproducibility of the findings may be limited or not achieved. Thus, future longitudinal

studies encompassing larger sample sizes or controlled conditions could provide better

insights into how entrepreneurial leaders catalyze innovation. However, the study design

included using multiple data sources to enhance the reliability, validity, and credibility of

the findings and conclusions. The interpretations and inferences made through thematic

analysis of participants' responses are a cause for caution (K. Campbell et al., 2021).

Reflexivity exercises comprising self-examination and notating biases and assumptions

throughout the research process are warranted to minimize researcher bias.

Understanding, cloaking, and uncloaking personal social locations and positionalities are

essential in the ethical treatment of participants and when analyzing transcripts (K.

Campbell et al., 2021; Thurairajah, 2019). The credibility of research findings can be

strengthened if researchers are reflexive about their methodology, are transparent about

their worldviews, and build ethically close relationships with participants while

remaining objective in data analysis.

Delimitations

Delimitations are deliberately imposed limitations established by the researcher

and within the researcher's control (Theofanidis & Fountouki, 2019). Forming

delimitations establishes boundaries that may better accomplish research goals and are

primarily coupled with the study's theoretical or conceptual framework, purpose, research

questions, variables, and sample (Theofanidis & Fountouki, 2019). Several delimitations

were established to safeguard a favorable study outcome.

First, although an extensive literature search was conducted, it was primarily

limited to current journal articles published after 2019. There remains a possibility that

meaningful and relevant literature sources were missed. Future research could broaden

the scope of the literature search to prevent unexpected omissions. Second, there is no

universal definition of entrepreneurial leadership, and the literature does not indicate that

researchers are moving toward consensus. While Renko et al.'s (2015) definition of

entrepreneurial leadership was used in this study, other definitions contain additional

constructs that may catalyze innovation and are worth exploring in future research. Third,

this study explored the effects of entrepreneurial leadership style on innovation. Other

leadership styles, such as transformational or creative leadership, may influence

innovation differently. Accordingly, future studies should investigate other leadership

styles that may independently or simultaneously influence innovation (Afsar & Masood,

2018; Bagheri, 2017; Mehmood et al., 2020; Newman et al., 2018). Furthermore, future

studies should compare the effect of entrepreneurial leadership with other leadership

styles, specifically in healthcare.

Fourth, the selection of samples was limited to three sectors: pharmaceutical,

medical device, and consumer, within the healthcare industry in the United States and

Western Europe. As various contexts may influence entrepreneurial leadership practices,

future research should leverage the insights from this study in other industries, sectors,

and business settings in a broader global context. Fifth, the study was analyzed through

the lens of business leaders who had successfully catalyzed innovation through

entrepreneurial leadership. Future research should include the perceptions of both

healthcare leaders and employees. The personal leadership characteristics of leaders and

employees may have different influencing effects; hence, future research may provide

better insight into how specific entrepreneurial leadership traits catalyze healthcare

innovation. While several delimitations existed within this doctoral study, other

researchers may expand on the findings and contribute to the literature.

Significance of the Study

Contribution to Business Practice

Healthcare business leaders work in a highly competitive environment where they

must seek novel solutions to catalyze and sustain organizational innovation, value

creation, performance, and profit. This study may be of significant value to business

practice as the findings provide healthcare business leaders insights into the

entrepreneurial leadership strategies that may help positively influence innovation

outcomes and contribute toward organizational competitive advantage. Innovation is an

effective corporate strategy that may lead to a competitive advantage through better

products, reputation, and market performance (M. Ali, 2021; Gallardo-Vázquez et al.,

2019). Therefore, this study’s findings on entrepreneurial leadership strategies may

provide valuable insight that informs corporate innovation strategy and business practice.

This study’s contributions to business practice or improvement involve

establishing successful entrepreneurial leadership strategies that may serve as guidelines

for modeling desirable organizational citizenship behavior and developing new

capabilities and competencies. Furthermore, establishing an entrepreneurial orientation

and culture can enable innovation and foster creative outputs by influencing employee

productivity (Ahmetoglu et al., 2018). Proficient business leaders who cultivate an

entrepreneurial climate can create value for the organization by promoting

experimentation, idea generation, opportunity recognition and exploitation, and concept

implementation (Bagheri, 2017; Fontana & Musa, 2017; Pinelli et al., 2022). Innovation

can be vital to growing and sustaining long-term profitability if organizational leaders

develop entrepreneurial leadership strategies, formulate robust innovation processes, and

capture innovation as a value driver within their strategic vision (Usman et al., 2021).

Business leaders can increase value creation, performance, and profit by adopting

entrepreneurial leadership strategies that foster innovation.

Implications for Social Change

In addition to achieving business success, organizations can contribute to society

through social change initiatives. Positive social change, such as social entrepreneurship,

focuses on actions intended to benefit society and its members rather than organizations

(Lumpkin et al., 2018). Beyond the organizational environment, the implications for

positive social change include fostering social entrepreneurship and innovation that may

spark technological advancement, influence economic growth and job creation, and

enrich societal well-being (Scuotto et al., 2022). Social entrepreneurship and innovation

may help alleviate poverty through higher disposable income, financial wealth, and

economic self-sufficiency (Lumpkin et al., 2018). Business leaders who learn about

successful entrepreneurial leadership strategies and practice social entrepreneurship may

foster social capital by creating social networks for community learning and involvement

in addressing healthcare challenges creatively and innovatively (Lumpkin et al., 2018;

Wahyuningtyas et al., 2018). Therefore, social change and social entrepreneurship have

benefits beyond organizational citizenship.

A Review of the Professional and Academic Literature

The proceeding literature review is structured into three components. The first

part focuses on entrepreneurial leadership theory, which comprises leadership theory and

entrepreneurship theory, and how each has converged to form an entrepreneurial

leadership conceptual model. Next, the topical foundation of organizational innovation is

laid out, emphasizing how business leaders manage innovation for performance,

including developing a fundamental understanding of healthcare innovation. Lastly, the

topic in relation to the conceptual model is discussed, specifically entrepreneurial

leadership constructs, such as orientation, culture, behavior, skills, and leadership

characteristics, and how they potentially catalyze innovation. In their bibliometric

analysis of entrepreneurial leadership research, Aparisi-Torrijo and Ribes-Giner (2022)

found that entrepreneurship, leadership, innovation, social entrepreneurship,

entrepreneurial leadership, entrepreneurial orientation, sustainability, transformational

leadership, entrepreneurs, and gender were the most frequent topics within the literature.

To provide a comprehensive critical analysis of the entrepreneurial leadership

literature, this doctoral study’s literature review framework was designed to be consistent

with the key topics found by Aparisi-Torrijo and Ribes-Giner (2022), other than gender,

which was not a primary factor for analysis. The literature review comprised 108

references, of which 95% were peer-reviewed journal articles and 87% were published

within 5 years of the expected graduation date. Walden University's library served as the

primary database source for obtaining scholarly work, and specific keywords were used

to source appropriate material for inclusion in the literature review. For example,

keywords included entrepreneurial leadership, pharmaceutical innovation,

entrepreneurial leadership and innovation, innovation work behavior, entrepreneurial

leadership theory, entrepreneurial orientation, and innovation performance.

Entrepreneurial Leadership Theory

Leadership and entrepreneurship have primarily been researched and defined

independently, though contemporary research has begun converging the two concepts

into entrepreneurial leadership theory. While leadership and entrepreneurial leadership

overlap in specific attributes and broad definitions, little consensus toward a universal

definition exists. Entrepreneurial leadership has been argued to be a distinct form of

leadership, emphasizing the need to manage the associated contextual challenges and

opportunities that may require unique entrepreneurial strategies to overcome (Harrison et

al., 2018). Numerous researchers have suggested a relationship between entrepreneurial

leadership, innovative behavior, and organizational performance (Dabić et al., 2021;

Shaher & Ali, 2020; Simić et al., 2020). Understanding the leadership styles, behaviors,

and competencies influencing creativity is vital in driving innovation performance

(Mehmood et al., 2020). Effective entrepreneurial leadership may promote an

entrepreneurial culture and orientation conducive to superior performance (Dabić et al.,

2021; Kör et al., 2021). Organizational performance and entrepreneurial leadership style,

competencies, and behaviors have various dimensions and may be influenced by many

mediating factors. Although emerging as a new leadership theory, entrepreneurial

leadership is a dynamic concept defined by various leadership influences within

entrepreneurial contexts.

Leadership

As leadership theory has strongly influenced entrepreneurial leadership theory, a

fundamental understanding of complementary and distinct leadership styles enables a

deeper appreciation of entrepreneurial leadership's effect on catalyzing innovation

performance. Leadership theories, such as entrepreneurial leadership, help explain the

traits and behaviors specific individuals use to influence the performance of others and

have led to the creation of multiple leadership styles with distinct and overlapping

characteristics. A particular leadership style may produce a drastically different outcome

than another and is highly dependent on situational context. Therefore, it is essential to

understand the makeup of the core leadership styles found in the literature, their effect on

entrepreneurship and innovation performance, and how they may have contributed to

entrepreneurial leadership theory. Leadership is the new driver for innovation and

comprises the ability of leaders to influence or motivate others to focus efforts on the

successful accomplishment of organizational objectives (Alharbi, 2021; Gutu, 2020).

Leadership influence encompasses various approaches, situations, skills, behaviors,

competencies, and qualities (Alharbi, 2021; Fries et al., 2021). The role and effect of

adaptive leadership, leader–member exchange (LMX), path–goal theory, servant

leadership, creative leadership, and transformational leadership on organizational

entrepreneurship and innovation are discussed in this section.

Adaptive Leadership. Individuals use adaptive leadership to tackle complex

challenges in agile ways and may lead to enhanced innovation performance. Adaptive

leadership is influential in organizational innovation, performance, growth, and survival

in fast-paced, uncertain, and hyper-competitive business environments (Busola

Oluwafemi et al., 2020; Mukaram et al., 2021; Yeo, 2021). Busola Oluwafemi et al.

(2020) uncovered that the combination of opening and closing (ambidextrous) leadership

behaviors predicted employees' explorative and exploitative innovation behaviors, while

adaptive or flexible leadership mediated the relationship. Furthermore, Mukaram et al.

(2021) confirmed a significant positive relationship between adaptive leadership and

organizational readiness for change. Yeo (2021) concluded that leaders should use their

vulnerability as a basis for inner strength through others' support, leverage collective

wisdom to accelerate decision-making, venture into innovation through experimentation,

and exercise personal instinct and objective judgment to think and act differently. Using

adaptive leadership may help entrepreneurial leaders encourage employees to explore,

experiment, and act creatively within innovative settings. Leaders’ adaptive

characteristics are essential for navigating complex and uncertain business environments

and are thus an essential facet of entrepreneurial leadership and innovation performance.

Leader–Member Exchange. High quality leader–member relationships may

enhance innovation performance and firm competitive advantage through the effective

development of innovative employee behavior, creativity, and talent management. Tingyi

Li et al. (2020) recognized that leaders' psychological capital has a significant positive

(direct and indirect) effect on employees' innovation behavior through high quality LMX.

However, Mascareño et al. (2020) contended that LMX did not directly affect employee

innovation, though employee creativity indirectly mediated the relationship. Furthermore,

Mulligan et al. (2021) explained that mindfulness and engagement served as mechanisms

of high quality LMX and subsequently positively facilitated innovation. Though the

literature supports a positive relationship between LMX and innovation, various LMX

constructs may have differing effects on innovation, underscoring the need for further

research. Entrepreneurial leaders may wish to foster employee innovativeness through

effective employee interactions to catalyze innovation performance.

Path–Goal Model of Leadership. The instrumental role of the leader in

supporting employees, resources, and information; helping them overcome deficiencies;

and improving performance in achieving individual and organizational goals can be

explained by path–goal leadership theory. Magombo-Bwanali (2019) defended that

participative path–goal leadership behavior is the primary leadership behavior associated

with team leaders and that supportive and achievement-oriented behavior significantly

influences subordinate performance. Saleem et al. (2020) argued that directive leadership

significantly affected performance, followed by supportive and achievement-oriented

leadership styles, though participative leadership was not considered a significant

predictor of performance. Furthermore, Singh and Rangnekar (2020) ascertained that

empowering leadership directly influenced employee proactivity; that empowering

leadership, employees' goal orientation, and job conditions are essential antecedents of

employee proactivity; and that goal orientation and job conditions concurrently partially

mediate the empowering leadership and employee proactivity relationship. In essence, a

leader’s role using path–goal leadership is to increase employees' motivation and job

satisfaction by adding value, removing hurdles, clarifying organizational goals, and

rewarding performance. Path–goal leadership may be insufficient to catalyze innovation

performance; however, constructs within the theory, such as hurdle removal, may be an

effective entrepreneurial leadership strategy that enables employees to be more

innovative, thus affecting innovation performance.

Servant Leadership. Servant leadership is a people-oriented leadership style that

significantly influences innovative employee behavior and, subsequently, innovation

performance, organization success, and competitive advantage. Iqbal et al. (2020)

discovered that servant leadership has a direct and positive relationship with employees'

innovative behavior and that psychological safety and thriving mediate the relationship.

Furthermore, F. Li et al. (2021) identified a positive relationship between servant

leadership and innovative employee service behavior, which was further mediated by

employee customer orientation. Lan et al. (2021) reported that servant leadership

indirectly influenced leaders' innovative behavior through their sense of accomplishment

and that leaders' extraversion strengthened the relationship and mediating effect. Whether

it involves influencing employees through leadership or increased self-motivation as a

leader, servant leadership can promote creative activities and innovativeness that lead to

business growth. With its positive effect on innovative employee behavior, servant

leadership may be a practical approach for entrepreneurial leaders to drive innovation

performance.

Creative Leadership. Effective leadership styles, such as creative leadership, are

an influential component of individual, team, and organizational creativity and innovation

vital to organizational survival. Zaman et al. (2020) determined that transformational

leadership constructs such as intellectual stimulation and inspirational motivation are

critical for innovation as they inspire creativity, unique problem-solving, and risk-taking

that leads to innovative behavior, value creation, and sustained competitive advantage.

Teng Li and Yue (2019) further identified a positive relationship between leaders'

creativity and team creativity, including a mediating effect from task complexity;

however, leader empowerment weakened the relationship. Qin et al. (2019) argued that

creative leadership is not without impediments and that a leader's creative mindset is

associated with state based moral disengagement that could limit leaders' self-regulation

capacity and potentially lead to abusive behavior, such as aggressiveness. Creative

leadership may influence and motivate employees to think and act innovatively,

overcome complex and challenging tasks or situations, and generate positive business

outcomes. Creative leadership empowers leaders to realize innovative solutions within

complex and rapidly evolving business contexts, such as entrepreneurship pursuits.

Transformational Leadership. Transformational leadership may be a practical

approach to organizational change and performance via innovative employee work

behavior. Creativity, new ideas, and innovations are significant factors in organizational

competitive advantage and can be enhanced through employee innovative work behavior

(Afsar & Umrani, 2019; Hadi et al., 2019). Hadi et al. (2019) determined that

transformational leaders influence employee motivation, thus enriching innovative work

behavior. Furthermore, the relationship between transformational leadership and

innovative work behavior is mediated by employees’ motivation to learn and moderated

by task complexity and innovation climate (Afsar & Umrani, 2019). Sivarat et al. (2021)

contended that employee creativity is emphasized by transformational leadership and

contingent rewards in exchange for their efforts in meeting innovation goals.

Transformational leadership significantly influences employee creativity and innovative

work behavior, supporting positive organizational innovation outcomes. While a valuable

tool for catalyzing innovation performance, transformational leadership may still be

insufficient within entrepreneurial climates.

Summary. As entrepreneurial leadership theory stems from leadership and

entrepreneurship theories, business leaders should develop, and practice leadership

strategies derived from several leadership styles to catalyze innovation performance in

entrepreneurial ways. Entrepreneurial leaders who can agilely adapt to complex and

rapidly changing conditions through adaptive leadership characteristics may foster

innovation performance by promoting innovative work behavior and preparing the

organization for change. With the right leadership traits, entrepreneurial leaders are well

positioned to foster high quality LMX that encourage innovativeness and positively

influence innovation outcomes. Through path–goal leadership, entrepreneurial leaders

must remove obstacles and provide the support, resources, information, and rewards

necessary to motivate employees to be creative, take risks, and increase their

discretionary effort.

Furthermore, entrepreneurial leaders may practice servant leadership and creative

leadership to cultivate discretionary effort and innovativeness and encourage out-of-the-

box thinking, risk-taking, and experimentation in an environment where employees feel

supported, willing to tackle challenges, and free to generate and implement new ideas. To

foster employee innovative work behavior and create an innovative organizational

culture, entrepreneurial leaders may leverage the influencing power of transformational

leadership to nurture a community oriented toward entrepreneurship. Leaders who can

develop and demonstrate entrepreneurial leadership traits and strategies congruent with

their environment may succeed more in catalyzing innovation, improving business

performance, and creating a competitive advantage.

Entrepreneurship

Like leadership theory, entrepreneurship theory is a significant part of

entrepreneurial leadership theory’s constitution. Entrepreneurial leadership was the

conceptual framework of this study; therefore, it is essential to understand

entrepreneurship constructs. Entrepreneurship is a prominent topic of inquiry in the

literature, though it lacks a universally aligned definition. In Clark and Harrison’s (2019)

literature review, the authors described various schools of thought and argued that a

holistic approach inclusive of multiple perspectives of entrepreneurship served the field

better than making compromises or concessions through integration. Fundamentally, the

entrepreneurial context, characteristics, strategies, and functions of the entrepreneur and

entrepreneurial process are essential for understanding entrepreneurial leadership and its

effect on innovation performance.

Entrepreneurial Context (Types). Firm performance can be improved through

innovation by employing various forms of entrepreneurship. Examples of

entrepreneurship that affect firm performance include corporate, opportunity-driven,

innovative, and digital entrepreneurship (A. Ali, Kelley, et al., 2020; Sahut et al., 2021).

Prince et al. (2021) reconceptualized entrepreneurship as the development and validation

of ideas and included such constructs as a firm start-up, uncertainty, innovation, value

creation, and opportunity recognition or creation. Ali, Kelley, et al. (2020) showed that

innovative and corporate entrepreneurship was high within economies with basic

institutional conditions and efficiently functioning markets. However, external contexts

that promote innovation had a negative relationship with opportunity-driven and

innovative entrepreneurship and a positive relationship with corporate entrepreneurship.

Sahut et al. (2021) discovered that corporate innovation is enhanced through digital

entrepreneurship and that digital platforms and crowdfunding create opportunities for

knowledge creation and exchange, better decision-making, and the promotion of

supportive networks. Entrepreneurship comes in many configurations and can influence

innovation and firm performance differently. Business leaders should focus on strategic

entrepreneurship practices within their specific context that support the achievement of

corporate objectives and create organizational value and wealth.

Corporate strategy is vital in navigating business leaders within complex

environmental contexts and establishing a competitive advantage. Benevolo et al. (2020)

and Rindova and Martins (2021) uncovered gaps in the extant entrepreneurship literature.

Rindova and Martins developed a framework that comprises three constructs: articulating

shaping intentions for changing an existing situation into a preferred one, designing

without final goals, and stakeholder dialogue and co-creation. The authors purported that

the three constructs could lead to value-creation and novel strategies. Benevolo et al.

(2020) designed an integrated framework to support global strategy creation, especially in

entrepreneurial firms seeking to exploit global opportunities. Fostering corporate

entrepreneurship by creating and implementing entrepreneurial strategies requires an

entrepreneurial mindset and creativity (Altahat & Alsafadi, 2021). Emphasizing

entrepreneurship within corporate strategies may increase competitiveness and

competitive advantage within highly complex environments. Corporate strategies that

comprise effective and efficient entrepreneurial innovation processes focused on

converting an idea into a product or service that delivers customer value may boost

organizational performance.

Entrepreneurial Process. Strategic entrepreneurship and innovation may lead to

opportunity recognition, enhanced risk-taking, greater flexibility, and improved

organizational performance. The dynamic external business environment warrants firms

to rapidly innovate, change and transform, rendering entrepreneurial action an essential

facet of any innovation ecosystem (Chebbi et al., 2020; Minafam, 2019; Tseng & Tseng,

2019). Minafam (2019) recognized that corporate entrepreneurial activities lead to higher

innovative product and process development rates. Tseng and Tseng (2019) established

six strategic approaches: the need to motivate innovative behavior, concentrate and

develop entrepreneurial capabilities, cultivate innovative-minded individuals, reward

corporate entrepreneurship, encourage big-picture thinking, and educate employees on

corporate entrepreneurship. Chebbi et al. (2020) contended that an internal marketing

strategy was needed to help drive internal stakeholder engagement, organizational

transformation, and adoption of a corporate entrepreneurship strategy. Through strategic

entrepreneurship, business leaders can achieve superior value by establishing an action-

oriented entrepreneurial and innovative climate that influences employee innovative work

behavior and engagement and leads to the development and adoption of dynamic

capabilities. Focusing on internal entrepreneurial activity through effective

entrepreneurial strategies and processes can promote innovative thinking, behavior, and

performance and is essential to catalyzing innovation performance.

The entrepreneurial process can be defined differently, though models share

similar external influencing factors and effects on firm performance. One model,

CROWAI, proposed by Carvalho (2022), comprises interconnected and permanently

looped entrepreneurial attributes: context, resources, objectives, will, action, and impact.

Carvalho’s attributes are essential when considering what entrepreneurial strategy or

leadership approach to implement, given the unique circumstances a business leader faces

and the effect or outcome they wish to achieve. Certain environmental conditions are

more conducive to entrepreneurship. For example, Guerrero et al. (2021) learned that

professional support, incubators/accelerators, and R&D investments are favorable, while

lack of funding sources, labor market conditions, and social norms are less favorable. The

development of incubators/accelerators may serve as a microcosmic ecosystem and can

be a powerful approach to innovation while agilely targeting and managing resources.

Altaf et al. (2019) reported that management support, work discretion, entrepreneurial

education, previous entrepreneurial experience, and time availability significantly and

positively impacted business performance and were moderated by an entrepreneurial

passion for inventing. Altaf et al. effectually tie in leaders, specifically leadership

constructs, as critical components of strategic entrepreneurship often overlooked in more

process-oriented models. There is no single approach to strategic entrepreneurship, as the

literature supports the significant positive effect that numerous entrepreneurial process

constructs have on firm performance. Though, the entrepreneur remains a central tenet of

strategic entrepreneurship.

Entrepreneur/Intrapreneur Characteristics. Entrepreneurial intentions,

knowledge, skills, and capacity play a significant role in entrepreneurs' success in

competitive and uncertain markets. Gieure et al. (2020) upheld that individuals are likely

to have an attitude and inclination to be entrepreneurial if they have the necessary skills,

knowledge, and capacity. Iwu et al. (2021) asserted that the content and design of

entrepreneurial education programs and the caliber of the lecturers influenced individuals'

entrepreneurial intentions. Furthermore, subjective norms influenced entrepreneurial

intentions and strongly predicted entrepreneurial behavior and action (Gieure et al.,

2020). Su et al. (2020) contended that entrepreneurs gain motivation through happiness

and satisfaction in their entrepreneurial pursuits. Positive emotions promote

entrepreneurial intention and, subsequently, the acquisition of resources and ability (Su et

al., 2020). Lastly, emotional value, like economic value, is a performance and

motivational driver within the entrepreneurial process (Su et al., 2020). Business leaders

focusing on entrepreneurship training and knowledge management, skill development,

and strategic resource management could significantly affect innovative work behavior

and foster financial, human, and social capital that capitalize on opportunities to catalyze

innovation and create wealth. In addition, business leaders should find ways to foster

entrepreneurial interest and competency development through formal training programs

and active engagement.

Managerial or leadership practices are critical in the development of

entrepreneurial competencies and for forming an entrepreneurial environment and

orientation that positively influences firm performance. Pesha et al. (2021) proposed two

methods to foster internal entrepreneurship; the first method is to develop a creative

environment that stimulates business improvement initiatives, and the second is to

leverage employee development programs to implement business projects. Furthermore,

Gandhi et al. (2021) proposed that leaders develop intrapreneurs through a tailored

incentive system, empowering them to source project resources, holding them

accountable for certain risks, connecting them to cross-departmental resources, and

establishing an innovation framework comprised of experimentation. Khan et al. (2021)

avowed that developing entrepreneurial competencies, culture, and orientation positively

influences firm performance. Leaders are pivotal components of strategic

entrepreneurship, as their leadership strategies and approach can yield different results. In

addition, leaders applying diverse and contextually based leadership traits with an

entrepreneurial orientation can enhance organizational innovation. Leaders could catalyze

innovation performance by fostering an entrepreneurial organizational culture and

promoting entrepreneurial competencies and innovative work behavior.

Entrepreneurs often work within complex and uncertain environments where

resources and key stakeholder relationships, such as mentoring relationships, are essential

to successful entrepreneurial outcomes. St-Jean and Tremblay (2020) acknowledged that

mentoring supports the development of entrepreneurial self-efficacy concerning

opportunity recognition for individuals with low learning goal orientation. Furthermore,

the effect of mentoring entrepreneurs decreases once the mentorship ends, emphasizing a

need for long-term support (St-Jean & Tremblay, 2020). Entrepreneurs with high learning

goal orientation also experience a slight decrease in self-efficacy with intense mentorship

(St-Jean & Tremblay, 2020). Entrepreneurs significantly gain from mentoring

relationships, with coachable entrepreneurs benefiting the most. Kuratko et al. (2021)

recognized that entrepreneurs' coachability positively correlated with goal progress,

product innovativeness, firm performance, investment decisions, and mentorship

expectations. The literature overwhelmingly supports the need for business leaders to

support the growth and development of budding entrepreneurs through training,

information sharing, coaching, and mentoring. Active and long-term leadership support,

tailored to the idiosyncratic needs of novice entrepreneurs, plays a pivotal role in their

development and success, and can significantly influence their attitude, behavior, and

goal attainment. Therefore, effective entrepreneurial leadership strategies, such as

coaching and mentoring, are necessary to positively affect innovative work behavior and

firm performance.

Strategic entrepreneurship processes, also called intrapreneurship within corporate

settings, coupled with adequate resource management and leadership support, can

positively influence organizational innovation. Intrapreneurs can enable and revitalize

organizational performance through innovation development and implementation if given

the necessary resources and conditions to develop and implement innovative ideas and

projects (Alpkan et al., 2010; Brigić & Alibegović, 2019; Usman et al., 2021). Brigić and

Alibegović (2019) noticed that intrapreneurship activities directly and positively

impacted product, process, and marketing innovations. Organizational and environmental

characteristics also positively influence intrapreneurship and, subsequently, growth and

profitability (Galván-Vela et al., 2021; Usman et al., 2021). Furthermore, management

support and risk-taking tolerance significantly influence innovation performance (Alpkan

et al., 2010). Though, performance based reward systems and offering employees free

time to innovate did not influence innovativeness (Alpkan et al., 2010). For

intrapreneurship to succeed, entrepreneurial leadership, entrepreneurship-trained

employees, and an entrepreneurial-oriented climate must be present. Strengthening these

intrapreneurial facets may promote innovative behavior and result in firm growth and

profitability. Business leaders should align the corporate strategy, business environment,

and resources to successfully implement innovation initiatives while supporting strategic

entrepreneurship and employee innovativeness.

Summary. As entrepreneurship takes on many forms, it is crucial to note that

capitalizing on opportunities and mitigating challenges requires contextually based

leadership strategies and approaches. Each strategy will share similar attributes, such as

considering the business environment, leadership style, the entrepreneur, and the

innovation process. The innovation or entrepreneurial process should factor in knowledge

development, skill improvement, and leadership support beyond standard task-oriented

procedural steps. Long-term coaching and mentoring are strategies that improve an

entrepreneur’s experience and output. Formal development programs can encourage

innovativeness and provide active leadership support.

Furthermore, a climate that supports opportunity recognition, idea generation,

risk-taking, experimentation, and knowledge sharing can further promote

entrepreneurship and value creation. Developing entrepreneurship capabilities, such as

incubators/accelerators, may enable business leaders to rapidly innovate, change, and

transform the organization, leading to firm growth and profitability. To catalyze

innovation and firm performance, a business leader must align the strategy, environment,

and resources; doing so in an entrepreneurial way may amplify the positive effects.

Entrepreneurial Leadership

The conceptual framework of this study is entrepreneurial leadership theory,

which is an amalgamation of leadership theory and entrepreneurship theory.

Entrepreneurship is increasingly becoming more popular as individuals pursue

opportunities for financial gain, personal development, and social change, even if they

work for an established firm (Renko, 2018). Understanding the relationship between

leadership and entrepreneurship is essential in relating to millennials and the future

workforce, developing markets and firms that lack structure or legitimacy, and

capitalizing on opportunities, market share, and competitive advantage (Renko, 2018).

While the definition of entrepreneurial leadership is nebulous, it is imperative to

understand it as a contextual phenomenon, company culture, leadership style, and an

entrepreneur's leadership characteristics.

Definition. Like the broad definition of leadership, authors use diverse definitions

of entrepreneurial leadership within the literature, resulting in a lack of consensual

meaning and universally integrated definition (Harrison et al., 2020; Ruttan, 2019).

Several authors have leaned toward transformational leadership characteristics, such as

influence (Yukl, 1999) and vision (Gupta et al., 2004), while others have described

innovation (Fontana & Musa, 2017) or risk-taking (Kuratko et al., 2021) as core tenets of

entrepreneurial leadership. Entrepreneurial leadership has been described relative to

Bass’ (1985) four theoretical constructs of transformational leadership: idealized

influence, inspirational motivation, intellectual stimulation, and individualized

consideration. To be successful entrepreneurial leaders are required to be charismatic role

models of entrepreneurial qualities, motivationally communicate high expectations and a

clear shared vision to inspire commitment and entrepreneurial behavior, challenge

followers to think creatively and innovatively, and shape a supportive climate for

opportunity recognition, exploitation, and implementation (Northouse, 2019). Renko et

al. (2015) attempted to bridge the gap by defining entrepreneurial leadership in its

simplest form, as leaders' ability to influence and direct followers' performance in

exploiting entrepreneurial opportunities while pursuing organizational goals. Rost

thoroughly analyzed leadership theories, origins, and word use and concluded that

definitions are contradictory, models discrepant, and research disconnected from

leadership's true nature (Rost & Amarant, 2005). Despite inconsistencies across the

literature, the broad definition of entrepreneurial leadership allows researchers and

practitioners to apply different lenses that focus on leaders' proficiencies and traits, thus

contributing to a deeper understanding of leadership's complexity.

Leadership Characteristics. Unlike other leadership styles, entrepreneurial

leadership characteristics are more advantageous in navigating an increasingly complex,

turbulent, and competitive business environment. Harrison et al. (2018) determined that

to be successful, entrepreneurial leaders should develop skills within the following

categories: technical, conceptual, interpersonal, and entrepreneurial. Bagheri (2017)

asserted that leaders who demonstrate entrepreneurial leadership principles model

entrepreneurial behavior and encourage employees toward new idea creation while

fostering an innovative culture. Additionally, Mehmood et al. (2020) confirmed that

entrepreneurial leaders, through their creative abilities, motivate, involve, and develop

creativity in followers, resulting in exploring and exploiting new entrepreneurial

opportunities. Furthermore, supported by Cai et al.’s (2019) study, Mehmood et al.

recognized that entrepreneurial leaders create psychologically safe situations in which

knowledge and idea-sharing between leaders and followers mediate the relationship

between entrepreneurial leadership and employee creativity. While these recent studies

support that entrepreneurial leadership characteristics are similar, in some cases distinct,

to other leadership styles, they also support the significant positive influence

entrepreneurial leadership has on followers, innovation, and organizational performance.

Many influencing factors not evaluated within these studies could affect entrepreneurial

leadership. While other mediating factors were not controlled for, it can be inferred from

the research that entrepreneurial leadership is an essential leadership style and plays a

more significant role in realizing economic value within highly turbulent and uncertain

environments.

Summary. Entrepreneurial leadership is a newer leadership paradigm derived

from leadership theory and entrepreneurship theory and is the conceptual framework of

this study. Currently, there lacks a universal definition of entrepreneurial leadership

within the literature; however, countless authors have examined entrepreneurial

leadership constructs, such as entrepreneurial orientation, opportunity recognition, risk-

taking, and innovative work behavior, and their influence on innovation performance.

While other leadership styles share similar leadership traits, skills, and behaviors,

entrepreneurial leadership is tailored toward influencing and motivating followers to

recognize and exploit new opportunities that create business and social value in complex

and dynamic environments. Entrepreneurial leadership constructs have been shown to

have a significant positive influence on innovation performance and are discussed within

the literature review's entrepreneurial leadership and innovation section.

Organizational Innovation

The healthcare industry does not typically foster an entrepreneurial climate;

therefore, the onus falls on healthcare leaders to catalyze organizational innovation using

entrepreneurial approaches. Leaders who can successfully shape an entrepreneurial

climate, embed effective innovation management practices, and promote creative and

collaborative partnerships could positively affect healthcare innovation (Kremer et al.,

2019; Machon et al., 2019). To achieve remarkable innovation performance, leaders must

first develop innovative work behaviors of employees by cultivating opportunities to

share knowledge, generate ideas, and collaborate within creative settings.

Healthcare Innovation

Healthcare and pharmaceutical innovation are critical to developing life-saving

drugs. However, leaders are faced with significant challenges in supporting innovation

diffusion, adaptation, and leadership efforts. Currie and Spyridonidis (2019) recognized

that shared leadership significantly impacted innovation diffusion and local adaptation.

Furthermore, Crespo-Gonzalez et al. (2020) noticed that the adaptation of innovation was

vital to the long-term sustainability of the firm; though, innovation adaptation could also

present a barrier due to required maintenance and loss of effectiveness over time. Machon

et al. (2019) observed that a leader's ability to adapt to environmental changes and

demonstrate a high degree of collaboration were essential to healthcare innovation. While

radical innovation can be challenging in highly regulated industries, opportunities exist at

the organizational level to foster entrepreneurial climates that promote innovativeness.

Entrepreneurial leadership and innovation management play instrumental roles in

healthcare innovation. Leadership characteristics that shape innovative organizational

capabilities are critical to innovation performance and sustainability.

Establishing innovation leadership as a core capability can support innovation

management and improve firm performance. Innovation leadership is vital for improving

quality, productivity, and efficiency, whether managing internal innovation processes or

the external pressure from healthcare reform (Dalton et al., 2021). Avby et al. (2019)

acknowledged three types of innovation: service, process, and organizational innovation

in healthcare systems, and that innovativeness was influenced by entrepreneurial

leadership practices, cross-team collaboration, robust performance metrics, and a

learning-oriented culture. Avby and Kjellström (2019) described that better innovators

are managers and teams who effectively manage development (exploration) and

production (exploitation) challenges. Dalton et al. (2021) retrospectively reviewed 953

leadership statements and concluded that health leadership was not clearly recognized

within health professional practice standards. If innovation leadership can be embedded

in the organization's fabric, leaders may be better positioned to direct the flow of

innovation toward new opportunity recognition and match the necessary resources to

exploit them. Although the importance of innovation leadership is well established within

the literature, there still exists a need for effective leadership frameworks to drive

healthcare innovation, reform, and improve patient outcomes. Entrepreneurial leadership

practices may help leaders develop individuals’ creativity, establish innovation

management processes, and promote a climate that enables exploring and exploiting

opportunities and challenges.

Innovation Management

Effective innovation management is essential for establishing an innovative

culture and processes that create new business value. Innovation is a significant factor in

a firm's ability to enter new markets, increase market share, and realize a competitive

advantage and corporate sustainability (Bocken & Geradts, 2020; Kremer et al., 2019).

Renkema et al. (2021) contended that human resource management could positively

influence employee-driven innovation, specifically, that innovation initiatives form

through the organizational route, the formalized-system route, and the project-initiative

route. Kremer et al. (2019) further suggested six best practices for managers to become

innovation leaders: develop appropriate group norms, design teams strategically, manage

external stakeholder interactions, show leadership support, display organizational

support, and effectively use performance management. Leaders need to understand how

to manage and sustain corporate innovation, promote a culture of creativity, and

understand how innovation transcends all aspects of the organization: strategy, structure,

processes, incentives, and people (Bocken & Geradts, 2020). An organization’s

entrepreneurial orientation is a significant influence on innovation and performance.

Understanding and applying effective innovation management strategies may

facilitate enhanced stakeholder engagement and the implementation of innovation using

cost-effective or lean processes that contribute to firm performance. Retkoceri and

Kurteshi (2019) opined that business leaders associate innovation with ideas and a

systematic management process that leads to new products and services. The authors also

reported that process innovation was the most common form of innovation, followed by

product and service innovation (Retkoceri & Kurteshi, 2019). Business model innovation

is often overlooked, even though it is essential in fostering an innovation culture

(Retkoceri & Kurteshi, 2019). Solaimani et al. (2019) explained that using lean methods

is a practical innovation approach, especially in coaching leadership, which enables the

hard and soft processes that lead to enhanced innovativeness. Furthermore, Leonidou et

al. (2020) identified that engaging various internal and external stakeholders through

collaborative partnerships can enhance innovation output and entrepreneurship

development. Effective innovation management practices are essential in facilitating an

innovation process that produces a favorable cost-benefit relationship and creates value.

Innovation Work Behavior

Innovative work behavior is essential to innovation performance as it enables

individuals to generate, promote, and implement new ideas. Knowledge management,

including information sharing, organizational learning, and diversity, are essential tenets

of innovation that drive organizational growth, performance, and sustainability through

employee innovative work behavior. Anser et al. (2020) described that functional

flexibility and knowledge sharing mediated the relationship between knowledge

management infrastructure capabilities and innovative work behavior. More specifically,

knowledge management infrastructure capabilities significantly predict functional

flexibility and knowledge sharing, positively affecting innovative work behavior (Anser

et al., 2020). Furthermore, knowledge sharing moderated knowledge management

infrastructure capabilities and functional flexibility (Anser et al., 2020). Battistelli et al.

(2019) ascertained that information sharing positively correlated with task-related and

interactional dimensions of work based learning. Furthermore, task-related learning

positively correlated with innovative behavior through challenging tasks (Battistelli et al.,

2019). Lastly, interactional learning had an indirect, positive relationship with innovative

behavior through organizational commitment and challenging tasks (Battistelli et al.,

2019). Leaders establishing a robust knowledge management system can foster a learning

and knowledge-sharing culture that promotes innovative work behavior leading to idea

generation and implementation. Consequently, innovation performance can be enhanced

through knowledge management and innovative work behavior.

An innovative climate can help engrain innovative work behavior within the

organization's fabric. Antecedents of innovative work behavior, such as employee

engagement, knowledge sharing, organizational climate and capabilities, and self-

leadership, positively contribute to desired innovation outcomes (Kör et al., 2021). Ali,

Farooq, et al. (2020) recognized that organizational climate for innovation and employee

engagement had a direct and indirect effect on innovative work behavior and that

employee engagement partially mediated the relationship between organizational climate

for innovation and innovative work behavior. Kör et al. (2021) contended that perceived

organizational innovativeness, self-leadership, and self-leadership strategies were

positively related to managers' innovative behavior. Furthermore, self-leadership

mediated the organizational innovativeness and innovative behavior relationship, while

risk-taking moderated the mediating effect (Kör et al., 2021). Bogilović et al. (2020)

confirmed that cognitive group diversity mediated the negative relationship between

visible dissimilarity and innovative work behavior. Furthermore,

innovative/entrepreneurial and team/clan climates moderated the relationship between

visible dissimilarity and cognitive group diversity, thus reducing the negative effect

visible dissimilarity had on innovative work behavior (Bogilović et al., 2020). Fostering

innovative work behavior, employee engagement, and self-leadership within an

entrepreneurial-oriented culture positively influences innovation performance. Innovation

must receive leadership support and be incentivized to encourage employee commitment

and the development of creative ideas.

Summary

Leadership is a crucial influencing factor in healthcare innovation, especially as

healthcare settings are often less entrepreneurial and risk averse. Entrepreneurial

leadership positively influences innovation performance when leaders establish an

entrepreneurial orientation and foster innovative work behavior (Bagheri et al., 2020;

Bocken & Geradts, 2020). Embedding appropriate innovation management practices is

vital to facilitating creative and collaborative internal and external partnerships and

diffusing and adapting innovative solutions across and within organizations.

Entrepreneurial and innovation leadership has been shown to improve quality,

productivity, and efficiency by exploring and exploiting new opportunities and

challenges (Avby & Kjellström, 2019). Through entrepreneurial leadership and

innovation management, healthcare companies can enter new markets, increase market

share, establish competitive advantage, create new business models, and develop new

products and services that meet the needs of a rapidly evolving healthcare landscape

(Bocken & Geradts, 2020). Thus, innovation performance can be catalyzed by a suitable

entrepreneurial climate, innovative work behaviors, and leadership practices.

Entrepreneurial Leadership and Innovation

Entrepreneurial leaders have an opportunity to shape the healthcare landscape.

Healthcare leaders may significantly influence innovation performance by developing

entrepreneurial characteristics and demonstrating entrepreneurial behaviors. Leaders who

model innovative behavior may encourage others to do the same and cultivate an

entrepreneurial-oriented organizational culture, form, and function. Overall,

entrepreneurial leadership as an innovation driver could lead to positive organizational

performance, growth, and competitive advantage.

Entrepreneurial Orientation

Organizations with an entrepreneurial orientation can convert opportunities and

challenges into organizational growth and profit. Organizational strategy, resources,

entrepreneurial traits, and entrepreneurial spirit significantly contribute to organizational

orientations that influence innovation performance, firm growth, and success. Abou-

Moghli (2018) noticed a significant positive relationship between innovative,

collaborative, and proactive entrepreneurs and business success, though surprisingly

discovered that innovativeness and risk-taking entrepreneurial attributes are not crucial.

Jeong et al. (2019) observed that leaders who establish an adaptive organizational culture

and people-centered management style influence firm entrepreneurial orientation and

performance. Song et al. (2019) further contributed that firm performance is positively

influenced by knowledge capabilities fostered through an entrepreneurial and interaction

orientation. Leaders must develop specific entrepreneurial attributes and promote an

entrepreneurial culture and orientation to catalyze and deliver positive innovation

outcomes. By orienting the organizational culture and processes toward entrepreneurship

and innovation, firms can grow and increase profitability.

An entrepreneurial orientation enables leaders to seek new opportunities and

affect change that improves organizational performance. The relationship between

entrepreneurial orientation and firm performance may be mediated by factors such as the

firm's learning orientation, innovation performance, differentiation strategy, and leaders'

leadership style. Innovation performance and differentiation strategy mediated the

relationship between entrepreneurial orientation and firm performance (Zehir et al.,

2015), while learning orientation partially mediated the relationship (Shaher & Ali,

2020). Entrepreneurship and innovation have many constructs, and by understanding the

various factors, business leaders could establish a suitable strategy and climate that

improves firm performance. An entrepreneurial orientation can stimulate learning,

knowledge sharing, idea generation and implementation, risk-taking, and

experimentation, all of which contribute toward innovation performance.

Entrepreneurial Culture

Leaders must establish an entrepreneurial culture and promote behaviors that

foster innovation to enhance organizational performance. In their analysis, Crespo et al.

(2022) determined that employee commitment, implementation of innovative ideas, and

team culture supported market competitiveness and organizational performance.

Furthermore, Crespo et al. determined that entrepreneurial environments would benefit

from new work culture systems focused on employee engagement and team based

workplace situations. Entrepreneurial team culture is especially significant to advancing

women’s workplace status (Santos & Neumeyer, 2022). Leaders practicing

entrepreneurial leadership may foster a team based learning culture oriented to

implementing best practices that catalyze innovation performance. Leaders who invest in

training and development and build a culture of sharing, creativity, and risk-taking can

foster an innovation climate (Chebbi et al., 2020). However, building an entrepreneurial

culture relies on leaders’ ability to shape innovative employee behavior, foster creativity,

and instill a resilient entrepreneurial spirit (Chebbi et al., 2020). Entrepreneurial

leadership may significantly affect organizational culture, which fosters an environment

conducive to creativity, innovativeness, risk-taking, and growth and development.

Leaders shaping an entrepreneurial climate and innovative work behaviors can improve

organizational performance.

Entrepreneurial Behavior

Leaders play a pivotal role in shaping employees' innovative work behavior

within innovation initiatives. Bagheri and Akbari (2018) determined that leaders'

entrepreneurial leadership methods strongly influence innovation work behavior and idea

evaluation, creation, realization, and promotion. Additionally, leaders' entrepreneurial

leadership encourages and supports employees in exploring and generating new ideas and

seizing implementation opportunities (Bagheri, 2017) through empowerment, autonomy,

and self-determination (Akbari et al., 2020). Employees who perceive a work

environment as innovative and have strong self-leadership can better cope with

complexity and ambiguity and feel empowered to generate new ideas and engage in

innovation (Kör et al., 2021). Kör et al. (2021) advocated using entrepreneurial leadership

to foster an innovative organizational culture to promote innovative employee behavior.

Newman et al. (2018) determined that leaders modeling entrepreneurial leadership

behaviors were likelier to stimulate innovative behaviors in employees with higher

creative self-efficacy than if they practiced other leadership styles. Recent studies support

that leaders practicing entrepreneurial leadership could significantly affect innovative

employee behavior. While the research did not control for other personal leadership and

employee factors or diverse business contexts, the research still showed that

entrepreneurial leadership plays a prominent role in employees' creative self-efficacy,

self-leadership, ideation, and opportunity recognition.

Entrepreneurial Skills

Innovation is a pivotal aspect of corporate entrepreneurship and requires unique

leadership skills to catalyze innovation performance. To run organizations successfully,

leaders must have relevant leadership and entrepreneurial attributes, skills, and

competencies to exploit opportunities and overcome challenges (Harrison et al., 2020;

Ordu, 2020). Entrepreneurial skills are essential to designing innovative strategies that

support exploiting new opportunities within dynamic environments. Like the definition of

entrepreneurial leadership, aligning on a determinant set of entrepreneurial skills remains

a challenge within the literature. Škare et al. (2022) found that entrepreneurship is

strongly related to creativity and leadership and, to a lesser degree, to communication.

Entrepreneurial leadership facilitates the generation of competitive advantage and is

supported by entrepreneurial leadership skills and behaviors, cultural values, and mindset

(Škare et al., 2022). In addition to risk-taking, creativity, autonomy, and proactiveness,

entrepreneurial leaders must be able to create and influence a strategic vision, be efficient

with their time and energy, market their value, make rapid decisions, quickly build trust,

and facilitate new ideas generation, experimentation, and solution development (Ordu,

2020). Furthermore, effective social skills enhance interpersonal connections and job

performance (Niazi et al., 2020). Niazi et al. (2020) found that managerial competency

positively influences entrepreneurial leadership, and that entrepreneurial leadership

positively influences job performance. Currently, limited studies include an examination

of specific entrepreneurial leadership skills across varying contexts, which would require

future research. However, there is a good foundation within the literature on the

moderating or mediating effects of entrepreneurial leadership influence on various

leadership, innovative behavior, and innovation performance relationships.

Negative Entrepreneurial Leadership Traits

The entrepreneurial leadership body of knowledge covers many favorable traits

that influence opportunity recognition, entrepreneurial orientation, and organizational

performance; however, little is discussed on negative traits or outcomes. Kraus et al.

(2020) examined the role of narcissism, Machiavellianism, and psychopathy on

opportunity recognition, entrepreneurial activity, orientation, leadership, and motives.

Kraus et al. affirmed that narcissism is related to high self-confidence, power, fame, and

recognition, leads to higher entrepreneurial risk-taking behaviors, and is commonly found

in leadership personalities. The inability to reflect on failures and recognize opportunities

resulted from narcissistic entrepreneurial leadership (Kraus et al., 2020; Liu et al., 2019).

While Machiavellianism can be considered manipulative, self-serving, and immoral,

coalition-forming and reputation-building traits benefited entrepreneurial leaders who

could foster new networks, extract information, and recognize opportunities (Kraus et al.,

2020). Psychopathy is related to status and prestige, egocentricity, domination,

impulsivity, and imprudent behavior (Kraus et al., 2020; Palmen et al., 2020, 2021).

Psychopathy was found to be beneficial for opportunity exploitation; however,

entrepreneurial leaders focused on business ideas that delivered them power and rewards

and less on social value (Kraus et al., 2020). Kraus et al.’s findings highlight the

importance of entrepreneurial leadership integrity. If entrepreneurial leaders can avoid

self-serving behaviors and emphasize social entrepreneurship and innovation, they could

foster idea generation, opportunity recognition and exploitation, an entrepreneurially

oriented climate, and catalyze innovation performance that produces positive business

and societal value.

Entrepreneurial Leadership and Innovation Performance

Globalization and rapid technological advancement have encouraged a greater

focus on new value creation, product innovation performance, and entrepreneurial

management of dynamic business environments (Pinelli et al., 2022; Rehman et al.,

2021). The role of leaders is increasingly being analyzed for its effect on organizational

vision and strategy, employee performance, and exploitation of innovation opportunities

(Miao et al., 2019). Bagheri et al. (2022) asserted that entrepreneurial leadership had a

positive relationship with innovative employee behavior within new ventures which

could contribute to organizational innovation strategies, activities, and performance.

Conversely, Rehman et al. (2021) argued that entrepreneurial leadership did not directly

affect innovation performance, though the literature did not support their findings. Miao

et al. (2019) detected that CEO’s entrepreneurial leadership was positively associated

with the top management team and individual employee performance, further noting that

psychological safety mechanisms mediated this relationship. Leaders play an

instrumental role in driving innovation through their influence over organizational

culture, business practices, and human resource management.

Research indicates that organizational performance is influenced by

entrepreneurial leadership. Competitive advantage and organizational sustainability can

be created through effective leadership; human capital, resource, and knowledge

management; and trust. Simić et al. (2020) insinuated that entrepreneurial leadership

strengthens human capital's effect on organizational performance, while Sarmawa et al.

(2020) established that ethical entrepreneurial leadership had a profound positive effect

on trust between employees and, subsequently, on organizational sustainability.

Furthermore, Soomro et al. (2019) noted that entrepreneurial leaders' vision for change

could influence followers' ability to create or exploit strategic organizational value. An

essential task for business leaders is the promotion of ideal entrepreneurial behaviors and

a culture conducive to superior value creation and performance realization.

Entrepreneurial leadership may achieve superior organizational performance that

influences future events and supports employee innovativeness. Organizations need

experienced entrepreneurial leaders who promote and foster innovative employee

behavior, leading to new customer value and sustainable organizational growth.

Developing talent within an organization is necessary, though insufficient, as leaders'

entrepreneurial proficiencies play a pivotal role in leveraging employees' abilities to

achieve superior performance (Simić et al., 2020). Dabić et al. (2021) concluded that

leaders' entrepreneurial leadership behaviors mediate the effect of employees' intellectual

agility on organizational innovativeness and performance through community building

and future orientation. Shaher and Ali (2020) indicated that an organization's

entrepreneurial orientation positively and significantly influences innovation

performance. While entrepreneurial leadership positively affected the innovation process,

Fontana and Musa (2017) determined that idea selection, development, and diffusion did

not necessarily lead to innovation performance. There are many direct and mediating

dimensions to innovation and organizational performance, with leaders' entrepreneurial

leadership predispositions, knowledge, skills, and abilities playing an influential factor.

Organizational Sustainability

The sustainability of an organization is a true measure of business success, and

the leader is the key to delivering it. Pauceanu et al. (2021) argued that it is not enough to

have entrepreneurship or leadership characteristics to achieve firm development and

sustainability objectives. In a competitive environment, it is essential to have both

entrepreneurial and leadership traits, such as entrepreneurial leadership, to innovate,

embrace risks, capitalize on opportunities, maximize organizational performance, and

thrive (Pauceanu et al., 2021; Sarmawa et al., 2020). Furthermore, entrepreneurial

leadership positively influences innovation performance; employee creativity,

innovativeness, engagement, motivation, and trust; job-embeddedness; and overall firm

performance; while decreasing employee turnover (Pauceanu et al., 2021; Sarmawa et al.,

2020). While entrepreneurial leadership's effect on organizational sustainability requires

more profound contextual research, the literature supports a positive relationship through

entrepreneurial leadership's direct influence on organizational innovation, including

influence on organizational orientation, culture, and human capital.

Social Entrepreneurship and Innovation

Social entrepreneurship and innovation can support organizational and societal

sustainability. Social entrepreneurship and innovation comprise the process of new idea

creation that confers social benefits and value to multiple stakeholders, such as

individuals, businesses, government institutions, and society as a whole (Bodolica et al.,

2021; Stirzaker et al., 2021). Leaders can enhance the organization’s bottom line through

innovative solutions while imparting positive social change. To effect positive social

change through social entrepreneurship, leaders should help cultivate credibility,

confidence, and endorse ideas; support the value proposition; and assist in securing

adequate resources for broad-scale idea implementation (Bodolica et al., 2021). Leaders

should establish corporate social responsibility strategies and entrepreneurial

development training programs that elicit authentic motivation from social

intra/entrepreneurs to engage in social entrepreneurship (Carvalho, 2022). Leaders

motivate others to think and act beyond business performance outcomes. Social

entrepreneurship and innovation provide a pathway to contribute ideas and innovative

solutions designed to add economic, social, ecological, or psychological value.

Summary

Leaders’ entrepreneurial leadership traits, skills, behaviors, and mindsets

drastically affect healthcare innovation performance. Leaders who demonstrate

entrepreneurial leadership abilities can foster an entrepreneurial orientation and culture

that promotes creativity, innovative work behavior, and the exploration and exploitation

of new opportunities. An entrepreneurial climate stimulates employee and team

commitment and engagement in innovation management and facilitates the

implementation of new ideas (Crespo et al., 2022; Santos & Neumeyer, 2022). Training

and development and leadership support are essential elements of nurturing

entrepreneurial leadership behavior as it leads to enhanced creativity, knowledge sharing,

and risk-taking (Bagheri, 2017; Chebbi et al., 2020). Empowerment, autonomy, and self-

determination enable employees’ innovative work behavior that encourages self-efficacy,

new idea generation, experimentation, and implementation (Akbari et al., 2020).

Entrepreneurial leadership skills are essential to developing creative strategies and

solutions that produce new business and customer value, market competitiveness,

competitive advantage, and organizational sustainability through employee

innovativeness and innovation performance (Pauceanu et al., 2021; Škare et al., 2022).

While there are several negative entrepreneurial leadership traits, such as narcissism,

authentic leaders who maintain high integrity, selflessness, and focus on the greater good

can positively influence innovation performance and contribute toward social

entrepreneurship. Within the literature, entrepreneurial leadership has been shown to

positively influence organizational innovation and help establish an entrepreneurial

orientation, culture, and innovative work behaviors that catalyze innovation performance.

Conclusion

As leadership and entrepreneurship theories converge, the universal definition of

entrepreneurial leadership may take form, and its influence and effect on organizational

performance, innovation, and leaders' proficiencies more precisely measured.

Entrepreneurial leadership's broad definition indicates that future studies will enrich the

body of knowledge and provide a deeper understanding of the concept within diverse

contexts. As the business environment becomes more complex, turbulent, and

competitive, leaders must enhance their skills to identify new opportunities, manage

uncertainty and failures, and exploit limited resources to achieve strategic value creation

(Harrison et al., 2020). Numerous authors' work supported the significant positive

relationship between entrepreneurial leadership and innovative employee behavior,

emphasizing entrepreneurial leadership's direct role in innovation initiatives (Bagheri,

2017; Dabić et al., 2021; Mehmood et al., 2020; Newman et al., 2018). This positive

relationship underscores the importance of developing, adopting, and practicing an

entrepreneurial leadership style in influencing followers within creative settings. Leaders'

ability to shape an entrepreneurial orientation and culture that supports innovation may

achieve superior organizational innovation and performance. Entrepreneurial leadership

is a unique style that promotes greater creativity and innovation geared toward superior

organizational success. Healthcare leaders who embrace entrepreneurial leadership could

help their organizations innovate, navigate complex business environments, establish new

competitive advantages, and experience greater profitability and growth. Future research

can contribute to entrepreneurial leadership theory by focusing on the introduction and

validity of additional instruments and how researchers and leaders can accurately

measure entrepreneurial leadership, considering current theoretical and practical

implications.

Transition

Entrepreneurial leadership theory is a new concept and has not been universally

defined or broadly applied within organizational contexts. Healthcare business leaders are

typically risk averse and often unsuccessful in embedding innovative work behaviors,

processes, and orientations that exploit entrepreneurial contexts. Therefore, the purpose

of this qualitative multi-case study was to explore entrepreneurial leadership strategies

that catalyze innovation performance. Healthcare business leaders who had successfully

implemented innovation initiatives using entrepreneurial leadership strategies,

specifically within the pharmaceutical, medical device, and consumer sectors, were the

target population for this study. The literature review included evidence of

entrepreneurial leadership characteristics that promote employee creativity,

innovativeness, and experimentation, leading to enhanced innovation performance within

complex business environments. The results of this study may contribute to professional

practice and positive social change by providing healthcare business leaders with

practical strategies for stimulating innovation, thereby creating additional jobs and

wealth.

Section 2 comprises the role of the researcher and participants, an outline of the

intended research methods and design, population and sampling parameters, ethical

research considerations, and an in-depth account of the data analysis process, including

data collection instruments and organization techniques, and analytical methods.

Research quality management through reliability and validity criteria was also covered in

Section 2. A presentation of the research findings and their application to professional

practice and social change is reported in Section 3. Furthermore, my recommendations

for action and further research were delineated.

Section 2: The Project

Section 2 comprises a restatement of the research problem to remind readers of

the focal topic, a description of the researcher’s role in the data collection process and

their relationship with the topic and participants, information on participant eligibility

criteria and strategies for participant access, and relevant ethical considerations.

Furthermore, the chosen research methods and design are described, including population

and sampling parameters. Lastly, a comprehensive review of the research process

surrounding data and research quality management is provided.

Purpose Statement

The specific business problem is that some healthcare business leaders lack

entrepreneurial leadership strategies to catalyze innovation performance. Therefore, the

purpose of this qualitative multi-case study was to explore entrepreneurial leadership

strategies that some healthcare business leaders working in the pharmaceutical, medical

device, and consumer healthcare sectors in North America and Western Europe used to

catalyze innovation performance.

Role of the Researcher

Data Collection Process

A well-defined data collection process is critical to quality research, and as the

researcher of this qualitative multi-case study, I served as the primary data collection

instrument. Qualitative researchers aim to evaluate phenomena in their natural settings by

uncovering the applied meaning attributed by research participants (Aspers & Corte,

2019). The role of qualitative researchers is to collect and study empirical artifacts, such

as case studies, personal experiences, real-world observations, and interview data

(Denzin & Lincoln, 2018). Qualitative research is less standardized than quantitative

research, making it essential for qualitative researchers to codify their practices

systematically (Aspers & Corte, 2019). Chowdhury and Shil (2021) suggested that case

researchers establish research site entry strategies using formal and informal gatekeepers,

proactively plan fieldwork, and be knowledgeable about data generation and collection

procedures and analytical techniques that enhance the validity, reliability, and

generalizability of the case study data. This doctoral study comprises a qualitative multi-

case study design.

As the researcher and primary data collection instrument, I appropriately selected

participants and collected data from multiple sources, such as semistructured interviews

and archival records. My role as the researcher started with defining the case or cases;

developing a theoretical perspective aligned with my research design; identifying,

collecting, and triangulating multiple data sources; and including opposing views to

address the research question comprehensively. Ubochi et al. (2021) used a purposive

sampling technique to explore the perceptions, meanings, and practices of

entrepreneurship among nurses. Similarly, Avby et al. (2019) used purposive sampling to

ensure that a variety of aspects, such as location, were included in their study to

determine what enables healthcare innovation. However, Avby et al. stated that purposive

sampling may have affected their results. Therefore, I selected participants based on a

purposive sampling technique with elements of convenience sampling, built trusting

relationships, and actively managed selection bias. Miller et al. (2020) found that

semistructured interviews were conducive to collecting data on the effect of using

iterative circles within innovation management practices. Likewise, Murray and

Palladino (2020) used semistructured interviews to investigate modern entrepreneurs'

human capital. Hence, I used semistructured interviews to determine successful

entrepreneurial leadership strategies that catalyze innovation performance.

Relationship With the Topic, Participants, or Research Area

The relationship between the researcher, the research area, and the participants is

essential to the topic under evaluation and the research outcome. While close

relationships may exist, the researcher must build trust while remaining objective,

maintaining adequate distance, and limiting the influence of their biases or positionality

(Thurairajah, 2019). Qualitative researchers must engage in continual reflexivity, internal

dialogue, and critical self-evaluation of their positionality and how it may influence their

research process and outcome through enhanced analysis and interpretation (Calabria,

2019). Research quality may be improved through reflexivity, thus lending credibility,

transparency, and ethical considerations to the research by establishing boundaries and

following basic guidelines.

As the researcher, I had experience and knowledge in and had led organizational

innovation initiatives. Accordingly, I was familiar with implementing strategies

surrounding organizational innovation. Inspired by the topic of innovation leadership, I

sought to gain a deeper understanding of entrepreneurial leadership strategies that may

catalyze innovation performance. Thus, a research question was formed surrounding this

topic as a basis for inquiry. Moreover, as the researcher, I had no preestablished

relationships with participants other than the potential of a limited professional

networking relationship developed from working within the healthcare industry. Each

participant was expected to provide truthful and unprejudiced responses about

implementing successful entrepreneurial leadership strategies to catalyze innovation

performance. I practiced continual reflexivity to mitigate potential bias based on my past

experiences with the research topic and limited relationships with participants.

Research Ethics

Ethical behavior is the linchpin of quality research, emphasizing the need to

protect research participants’ best interests. Protecting participants’ rights includes

ensuring respect for persons, beneficence, and justice, which capture the ethical values

inherent in quality research (National Commission for the Protection of Human Subjects

of Biomedical and Behavioral Research [NCPHSBBR], 1979; Schupmann & Moreno,

2020). It is the role of the researcher to treat participants autonomously, fairly, and

openly to make informed choices concerning the extent and risks of participation through

a robust informed consent process before engaging in research activity (NCPHSBBR,

1979; Schupmann & Moreno, 2020). Subjects inherently trust researchers; therefore, a

researcher’s role is to understand and communicate the nature and scope of the study’s

risks and benefits, ensure an acceptable benefit-to-risk ratio, and distribute risks equitably

(NCPHSBBR, 1979; Schupmann & Moreno, 2020). Fundamentally, respect for persons,

beneficence, and justice are research values and principles captured in the Belmont

Report and must be adhered to by researchers.

As the researcher, I mitigated bias, ethically treated participants, and collected and

reported data in alignment with the Belmont Report. Following the Belmont Report’s

guiding principles, I treated participants with respect through a robust informed consent

process, including assessing the risks and benefits of participation and ensuring fair

treatment throughout the research study. Furthermore, participants’ time and effort were

appreciated, their individual needs met, and their contributions recognized and connected

to the overall study outcome. Participants and company identifiers were masked using

pseudonyms, such as P1 or Company 1, to protect privacy. As a doctoral student

researcher, I completed the collaborative institutional training initiative (CITI Program)

certification (Record ID 42431199), which prepared me to follow ethical research

principles. I adhered to the Belmont Report’s tenets of respect for persons, beneficence,

and justice within this doctoral study.

My role as the researcher and primary data collection instrument was to mitigate

bias, including avoiding data interpretation through a personal lens. My use of a case

study interview protocol (see Appendix A) and semistructured interview format enabled

greater flexibility in the data collection process. Furthermore, the interview protocol and

semistructured format facilitated open dialogue, in which interpretations and

misunderstandings between me as the researcher and the participant were clarified or

expanded upon. External validity is contingent on well-defined cases and research

protocols that establish the rules to be followed (Quintão et al., 2020). Thus, by detaching

preformed personal perceptions and opinions regarding the topic and using an interview

protocol, I was able to mitigate personal bias. Quintão et al. (2020) suggested that the

protocol contain data collection techniques, such as interview recording, response coding,

and data analysis methods. Therefore, I defined in the protocol my process to

memorialize interviews via video and audio-recording, transcribe responses, and conduct

member checking to mitigate personal bias and ensure that the data truly reflect

participants’ views.

Participants

Participant Eligibility Criteria

Ensuring that the right participants are included in a study based on predefined

criteria is crucial to quality research. Eligibility criteria, inclusion, and exclusion are key

characteristics of the target population used to answer the research question and mitigate

a potentially unfavorable study outcome (Patino & Ferreira, 2018). The target population

of this study involved healthcare business leaders who had successfully used

entrepreneurial leadership strategies for catalyzing innovation. Furthermore, study

participants were creative, strategic thinkers who had contributed to innovation initiatives

within the last 5 years. Creative leadership was an essential component of the study to

explore how leaders tap into their innate entrepreneurial mindset and ability to lead

themselves and others in achieving organizational goals (Gheerawo et al., 2020).

Strategic management skills, innovation, and leadership capabilities enable leaders to

play a significant role in delivering entrepreneurial outcomes, such as job creation, R&D,

and organization competitiveness (Abou-Moghli, 2018). Thus, creativity, strategic

management, knowledge, and relevant experience were vital criteria for study eligibility

and evaluation.

Strategies for Establishing Participant Access and Relationships

Access to participants begins with institutional review board (IRB) approval of

the study proposal to ensure the ethical protection of participants. An investigator then

must seek, negotiate, obtain, and explain the research study to prospective participants

through a well-documented informed consent process (Vuban & Eta, 2019). Using

personal contacts and gatekeepers within the investigators’ network may be an effective

strategy for gaining access to research sites and participants (Vuban & Eta, 2019).

Providing incentives, such as research outcomes or the study report, may mitigate the

challenge of participant access within and across organizations. Additional access

strategies may include supporting organizational initiatives, securing administrative

permits well in advance, using participants’ preferred time and location for interviews,

and reassuring anonymity and confidentiality of participation (Vuban & Eta, 2019). The

proactiveness and flexibility of researchers can remove barriers or limit challenges to

participant access.

Following Vuban and Eta’s (2019) recommendations for negotiating access to

research sites and participants, I emailed and sought approval from senior business

leaders (gatekeepers) by explaining my research study and process, including participant

selection criteria, interview format, data collection and analysis, member checking

process, and the voluntary and confidential nature of the study. I requested access to

participants and pertinent archival records, documented all approvals, and engaged

recommended participants in the informed consent process. If additional participants had

been needed to reach data saturation, I would have identified and recruited, through

personal contacts, business leaders who met the eligibility criteria, such as successfully

using entrepreneurial leadership strategies to catalyze innovation performance.

Access to sites and participants may come with inherent challenges. The

researcher–participant relationship can be complex due to fundamental disparities in

personalities, power relations, needs, perceptions, biases, and other demographic factors

(Vuban & Eta, 2019). Researcher positionality may help gain access to participants,

shape the lens of the research, and bridge the gap between researcher and participant

through shared experiences (Calabria, 2019). Maintaining a steadfast distance between

the researcher and participant may limit the depth and breadth of data; therefore, a

semipermeable but objective relationship built on trust may uncover the participants’

truth (Thurairajah, 2019). Forming partnerships with participants through active

engagement in the research protocol, data collection and validation, and dissemination of

results may establish greater vested interest and compliance with the research process,

avoid power disparities, and open up access to participants’ lived realities (George et al.,

2020). The researcher–participant relationship may be positively influenced by trusted

partnerships and shared experiences that increase confidence in the researcher and

research outcomes. Greater trust and confidence in the relationship should lower access

barriers, increase participation, and lead to quality data.

To reduce access barriers and increase the likelihood of participation, I facilitated

the informed consent process using trust and rapport-building approaches without

jeopardizing my position as the researcher. Furthermore, following Calabria’s (2019)

recommendation to leverage the researcher’s positionality, I discussed shared experiences

surrounding the topic and relevant life experiences or circumstances. Thurairajah (2019)

determined that a semipermeable relationship is beneficial between the researcher and

participant; therefore, I established semirigid boundaries that fostered a trusting

relationship while objectively uncovering participants’ stories. To form and maintain

working relationships with participants, I followed George et al.’s (2020) process of

building rapport and trust early, guiding them through data collection, including

interviews and data analysis, and engaging them through member checking and

disseminating results. Having well-defined recruitment strategies for the identification

and inclusion of participants increased the likelihood of participation, supported the

attainment and verification of participant responses, and led to high quality research

outcomes.

Research Method and Design

Research Method

This doctoral study’s focal topic was entrepreneurial leadership strategies that

healthcare business leaders use to catalyze innovation performance. The chosen research

method for this study was a qualitative approach. While qualitative, quantitative, or

mixed methods research methods may be appropriate for use in a doctoral business study

(Stake, 2005), several authors have recognized the growing emphasis on qualitative

methods within the medical or healthcare industry (Rankl et al., 2021; Vindrola-Padros et

al., 2020), which is relevant to the business environment under evaluation. A qualitative

approach supports an in-depth exploration of the meanings’ healthcare workers attribute

to their surroundings and enables rich insight into their experiences (Rankl et al., 2021).

Therefore, using qualitative methods to conduct an in-depth inquiry into entrepreneurial

leadership strategies, their application to innovation management, their effect on

innovation performance, and business leaders’ individual experiences within healthcare

settings supported the methodological choice for this doctoral study. The nature of

qualitative methods, contrary to quantitative and mixed methods, allows for smaller

sample sizes, more profound and rapid inquiry into concepts and individual perspectives,

and the necessary flexibility to respond and adapt to research findings in real time

(Vindrola-Padros et al., 2020). As this doctoral study's qualitative multi-case study design

comprised a small sample size, a rapid and flexible inquiry to reach data saturation made

a qualitative approach preferential.

Quantitative and mixed methods research was not a suitable methodological

choice for this doctoral study. Quantitative research comprises hypothesis testing,

assumptions about relationships between variables, representative samples, and variables'

measurement and statistical testing (Bloomfield & Fisher, 2019). This study was not

hypothesis-directed nor did it begin with a theory, and it was not my intention to set out

to prove or disprove a theory. Mixed methods researchers focus on creating generalizable

outcomes from a qualitative approach using quantitative and qualitative methodologies

(Strijker et al., 2020). Strijker et al. (2020) recognized that within the literature, there are

many examples in which a mixed methods approach has been shown to provide greater

insight into real-world problems; however, the authors acknowledged that those studies

were not at the single-paper level and were better suited for larger projects. Quantitative

and mixed methods research would have added unnecessary structure and adversely

affected the true exploratory nature of this study. Therefore, quantitative and mixed

methods research were not appropriate for satisfying the research objectives of this

doctoral study.

Research Design

The chosen research design for this study was a qualitative multi-case study

approach and was selected over phenomenological, grounded theory, ethnographic, and

narrative inquiry research designs as more suitable for meeting the research objectives.

Case studies have roots in the medical, legal, and psychological research fields

(Chowdhury & Shil, 2021). Evaluating multiple cases enables a researcher to identify a

phenomenon's holistic and meaningful attributes within specific contexts (Chowdhury &

Shil, 2021). A researcher using multi-case study strategies investigates specific case

subjects, such as persons, groups, organizations, processes, or events (Yin, 2018). A

phenomenon is explored in real-life settings (Yin, 2018). Qualitative multi-case study

designs can lead to rich, empirical descriptions and theory development, allowing a

researcher to make analytical rather than statistical generalizations (Yin, 2018). Bounding

the cases, expressly participant and time boundaries are critical in determining the scope

of the data collection and what data are relevant to the phenomenon or external to the

cases (Yin, 2018). Adequately defining the case boundaries is crucial for doctoral

students to ensure an appropriate time horizon, research focus, and minimal cost

associated with conducting their research. The doctoral study was a qualitative multi-case

study.

Alternative qualitative designs include phenomenological, grounded theory,

ethnographic, and narrative inquiry. Phenomenological research designs are used to

capture the participants' lived experiences of the phenomenon (Pathiranage et al., 2020;

Renjith et al., 2021). Like case study research, phenomenological researchers seek to

identify meaning through rich descriptions. However, phenomenological research is

focused on capturing textural and structural descriptions of what and how the

phenomenon was experienced (Renjith et al., 2021). Participants' lived experiences were

not a part of the scientific inquiry or the study's unit of analysis. Therefore, a

phenomenological research design was not suitable for this study.

The primary purpose of a grounded theory researcher is to construct a theory in

the context of the social process under evaluation using data generated from the study

(Chun Tie et al., 2019; Renjith et al., 2021). Grounded theory is often used to explore the

participant's process, action, or interaction with the phenomenon (Pathiranage et al.,

2020). Theory generation and development are not a part of the research objectives of

this study; therefore, grounded theory was not selected as a suitable research design.

Ethnographic research is rooted in anthropology and helps researchers understand

participants' cultural-specific knowledge and behavior within their natural settings

(Ghirotto et al., 2020; Pathiranage et al., 2020; Renjith et al., 2021). Ethnographic

research is often conducted by directly observing events unfolding and may or may not

include interviewing participants (Ghirotto et al., 2020). Observing participants' social

actions and interactions within a given context is not a part of the design for this study;

therefore, ethnographic research was not a suitable design methodology for this study.

Narrative research is a valuable method for exploring an individual's life and

capturing and revealing personal stories of their lived experiences (S. J. Murray & Tuqiri,

2020; Renjith et al., 2021; Sonday et al., 2020). Storytelling is the predominant form of

communicating participants' lived experiences (Renjith et al., 2021). While participants

may incidentally share stories to validate actual experiences within their interview

responses, a narrative inquiry was not the intended research strategy for this study.

Data saturation is a critical element of research quality and is associated with

sampling strategies and size. Data saturation is considered the pinnacle of data collection

and can be reached once no new information is received from participants (Alam, 2021;

Morse, 1995). For this doctoral study, I interviewed healthcare business leaders until no

new information contributed to the database, no additional themes were generated, and

additional data did not contribute value to answering the research question. Data from

multiple sources, such as organizational business strategies and websites, and six

business leader interviews, was collected and analyzed to reach saturation. Additional

interviews would have been conducted until data saturation was reached. The qualitative

multi-case study design and use of multiple data sources within this study enabled the

collection of quality evidence and the need for fewer participants.

Population and Sampling

Sampling Method

The targeted population involved healthcare business leaders in North America

and Western Europe working in the pharmaceutical, medical device, and consumer

healthcare sectors who successfully implemented entrepreneurial leadership strategies to

catalyze innovation performance. The sampled population from whom data were

collected involved six healthcare business leaders who had demonstrated evidence of

successfully applying entrepreneurial leadership strategies to catalyze organizational

innovation. The following key eligibility criteria were used within the study: healthcare

business leaders who (a) have been successful in implementing entrepreneurial leadership

strategies to catalyze innovation performance, (b) are creative, strategic thinkers, and (c)

have led or significantly contributed toward strategic decisions within healthcare

innovation initiatives within the last 5 years.

A nonprobabilistic, purposive sampling method was selected for this study. The

process included an element of convenience sampling; however, the specific nature of the

criteria for involvement made this design purposive. Campbell et al. (2020) contended

that purposive sampling better matches the sample to the research aim and objectives. As

I sought to recruit healthcare business leaders who had successfully implemented

entrepreneurial leadership strategies to catalyze innovation performance, in alignment

with Campbell et al.’s contention, a nonprobabilistic, purposive sampling method was

appropriate for the study as it aligned the sample with the research objectives.

Furthermore, depth of understanding is increased through a small and purposively

selected sample of participants that may provide meaningful insight while efficiently

using limited research resources (S. Campbell et al., 2020; Denzin & Lincoln, 2018).

Purposive sampling supports the study rigor and trustworthiness of the data (S. Campbell

et al., 2020). Purposive sampling was selected as it aligned my research methodology,

aims, and objectives, thus contributing to the research rigor of the doctoral study.

Data Saturation and Sample Size

In qualitative research, the sample size is often justified based on the principle of

data saturation. Data saturation is defined as data adequacy and is reached once no new

information is received from participants, and a full range of ideas has been proffered

(Alam, 2021; Morse, 1995). The higher quality of data provided by the participants; the

fewer participants are needed for the study (Gill, 2020). Furthermore, data saturation may

be reached more rapidly through data triangulation of multiple data sources (Denzin &

Lincoln, 2018; Fusch et al., 2018). A researcher determines the data's adequacy and

comprehensiveness of the results as patterns and themes emerge from rich, detailed

descriptions of the phenomenon under evaluation (Morse, 1995). As a first step, the

presence and frequency of themes are identified; however additional data may be

required to reach data saturation to understand better the issue's depth, breadth, and

nuance and its applied meaning (Hennink et al., 2019). This study involved multiple data

sources to generate higher quality data through fewer participants, including six in-depth,

semistructured interviews and a review of participant-provided evidentiary

documentation, such as organizational business strategies and websites. Therefore,

targeting six case studies (two for each healthcare sector) was anticipated and justified to

reach data saturation. If saturation did not occur after collecting data and interviewing six

participants, the data collection process would have continued with the recruitment and

interviewing of additional participants until saturation was achieved.

Interview Setting

This qualitative multi-case study involved six semistructured interviews

conducted virtually via Microsoft Teams or Zoom. The rise of conference calling tools

has provided qualitative researchers with cost-effective and convenient alternatives to in-

person interviews (Gray et al., 2020). Gray et al. (2020) determined that remote

interviews via conference calling tools were convenient and easy to use, enhanced

personal connections, allowed for greater accessibility over various devices, and saved

participants’ travel time. The virtual nature of the interviews gives participants more

control over the time and location that is most convenient for them; therefore, interviews

for this study were scheduled according to participant preferences. The advent of

technology has enabled more economical, diverse, and geographically dispersed research.

Ethical Research

Ethical research practices are critical to quality research outcomes and the

protection of participants. This study's ethical oversight included university and IRB

approvals (# 09-22-22-1058822), doctoral committee oversight, and a well-documented

informed consent process. Researchers must obtain informed consent from potential

participants before conducting research (Jacquier et al., 2021). Informed consent is a

means to ensure that participant autonomy is respected, and that each participant has

received adequate information about the study (Jacquier et al., 2021; Sandu, 2020).

Furthermore, by helping potential participants grasp and willfully agree to the details of

the study, the researcher demonstrates respect for persons and abides by ethical research

standards (NCPHSBBR, 1979; VandeVusse et al., 2022). Before proceeding with this

research study, I obtained Walden University committee and IRB approvals and then

fully consented participants. Having adequate research ethics oversight contributed to

research rigor and helped protect participants from undue harm.

Challenges still exist even though the informed consent process is well-

established in research. Several authors have highlighted concerns in the literature

surrounding informed consent in qualitative research (Douglas et al., 2021; VandeVusse

et al., 2022). For example, participants may be reluctant to provide consent knowing their

responses will be shared, rendering data sharing highly selective (Jacobs et al., 2021;

VandeVusse et al., 2022). Furthermore, the study's validity may be questioned if

participants are self-conscious about responding to sensitive topics (MacLean et al.,

2019; VandeVusse et al., 2022). Additionally, Douglas et al. (2021) observed that many

participants signed consent forms without actually reading them. VandeVusse et al.

(2022) suggested that researchers assess participants' willingness to share their data, their

understanding of data sharing, and their motivations for consenting or not consenting to

have their data shared. Having clear mitigation strategies and close researcher

involvement may alleviate participation concerns.

To mitigate these challenges, I sent the informed consent form to potential

participants via email for prereview, addressed questions or concerns through discussion,

and confirmed consent aspects at the interview's beginning. Participants were reminded

that highly sensitive information would not be collected, that responses are confidential

and masked using pseudonyms (such as P1 or Company 1), they had the opportunity to

review their responses, and the opportunity to withdraw their consent to participate at any

point via face-to-face, telephone, or written means and be removed from the study.

Furthermore, study participation would have been paused or terminated if any signs of

discomfort with the research were observed. Taking the time to ensure consent is

documented and well-understood enhanced research credibility and validity.

Researchers must ensure that high ethical research standards are adhered to

before, during, and after the conduct of a study (Denzin & Lincoln, 2018); therefore, I

completed the collaborative institutional training initiative (CITI Program) certification

(Record ID 42431199) as a doctoral student researcher. Furthermore, unwavering

adherence to the Belmont Report's ethical guidelines was followed. Specifically, I

respected participants' autonomy, protected them from harm while maximizing benefits,

and promoted equitable representation of the risks and benefits. I made participants aware

of all relevant study information, including risks and benefits, so they could make a

voluntary and fully informed decision to participate. Full disclosure of the doctoral

study's procedures and any benefits or risks to the participants was provided to Walden

University's IRB for approval before any participant recruitment, data collection, or

dataset access was conducted. I leveraged the restricted set of case study procedures,

agreements, and consent forms that already had procured IRB preapproval. After IRB

approval was confirmed and partner agreements were established, the participant contact

information was solicited, individual interviewees were given study details and an

informed consent form, interviews were scheduled, and supporting documentation was

collected. The final doctoral manuscript includes the Walden IRB approval number to

attest that Walden University's high ethical standards have been met.

Within this study, informed consent included details surrounding the study

purpose, relevant procedures, voluntary nature of participation, any risks or benefits, and

the researcher's contact information. Privacy is a vital aspect of the informed consent

process. Therefore, potential participants were made aware of the steps to protect their

confidentiality, including the masking of any identifiers with pseudonyms (such as P1,

P2) and how data is kept secure for at least 5 years, such as restricted access, password

protection, data encryption, use of codes in place of names, and data destruction. A

participant could withdraw consent anytime via face-to-face, telephone, or written means

and be removed from the study. There were no incentives for participation in this study,

though participants who completed the study may be provided a copy of the study

summary report.

Data Collection Instruments

As the researcher of this qualitative multi-case study, I served as the primary data

collection instrument. Yin (2018) suggested that a case study protocol comprises an

overview of the case study, data collection procedures, protocol questions, and a tentative

outline for the case study report. Although a protocol includes a set of substantive

questions used in data collection, it serves more than a conventional questionnaire or

instrument (Yin, 2018). Yin advocated that the protocol contains questions about each

case representing a line of inquiry and not just questions to be verbalized to the

interviewee. Designing protocol questions based on a line of inquiry adds flexibility and

adaptability and emphasizes the researcher as the primary data collection instrument of

case study research. Thus, I served as the primary data collection instrument for this

doctoral study based on Yin's proposition.

The data collection for this doctoral study involved multiple data sources

following a formal case study interview protocol (see Appendix A). The interview

protocol guided me in gathering evidence, data analysis, and case study reporting, thus

ensuring better research quality. Yin (2018) described reliability and validity in simple

terms: reliability refers to replication and consistency, while validity refers to the

suitability of the research measures used, the analytical accuracy of the results, and the

generalizability of the study's findings. In the context of qualitative research data

analysis, dependability, bias, cultural differences, transferability, and credibility are

potential areas of data quality issues (Yin, 2018). The six primary sources of evidence

that ensure methodological rigor are documentation, archival records, interviews, direct

observations, participant observation, and physical artifacts (Varela et al., 2021; Yin,

2018). The data collected for this study included multiple data sources, including six in-

depth, semistructured interviews and a review of participant-provided evidentiary

documentation, such as business strategies and websites.

A robust and well-documented research process is imperative to research quality.

It is vital for students to comprehensively and transparently describe their research

process, analysis, and conclusions to ensure study rigor (Shufutinsky, 2020).

Standardizing the data collection and analysis process may enable other researchers to

reveal similar information (Yin, 2018). Reliability and validity are enhanced if other

researchers can replicate the study, even in theory. It is essential for students conducting

qualitative research to use multiple data sources or repeated measures of a phenomenon

to establish the truth of their doctoral research study findings (Varela et al., 2021). A

valid study demonstrates what truly exists and could be as simple as accurately gaining

knowledge and understanding of the nature of a phenomenon (Cypress, 2017). The

validity of a qualitative study's findings is related to the meticulous recording,

transcription, repeated verification, and interpretation of the data (Cypress, 2017).

Students are expected to maintain the highest levels of research rigor as other seasoned

researchers. Therefore, students need to understand and be prepared to conduct quality

research.

To ensure research rigor, students should focus on the reliability and validity of

their research process and data. To increase reliability and validity within their doctoral

study, students should ensure that the research question is well-defined and substantiated,

the study design is appropriate for the research question, appropriate application of

purposeful sampling strategies, and that multiple data sources are collected and managed

systematically and accurately analyzed (Varela et al., 2021; Yin, 2018). The triangulation

of multiple data sources leads to data saturation (Fusch et al., 2018) and results in the

presentation of the corroborated experiences of a shared phenomenon (Denzin & Lincoln,

2018), thus enhancing reliability. Students should also ensure adequate exposure to the

phenomenon to build rapport with participants to collect and deeply understand multiple

perspectives and reduce potential bias (Elgabry & Camilleri, 2021). Additional

techniques, such as member checking, reflection or field notes, transcription review, and

peer examination of the data, help clarify researcher interpretations and add depth to the

data (Caretta & Pérez, 2019), thus enhancing data quality. Using a case study protocol

and database and maintaining a chain of evidence significantly contribute to establishing

reliability (Varela et al., 2021; Yin, 2018). To establish construct, internal, and external

validity, Yin (2018) proposed several tactics, such as using multiple sources of evidence,

pattern matching, and using theory or replication logic within case study research.

There are many techniques to the data collection process that can support research

reliability and validity. Based on the recommendations by numerous authors (Caretta &

Pérez, 2019; Elgabry & Camilleri, 2021; Varela et al., 2021), the following steps were

followed to enhance research reliability and validity. I defined and aligned the study’s

research methodology to the research question and developed meticulous sampling and

recruitment strategies. I built rapport and trust with participants early in recruitment to aid

data collection from semistructured interviews. I followed an interview protocol (see

Appendix A) to ensure consistent research practices across participants. Multiple data

sources were triangulated, for example, public company information, such as corporate

websites, was reviewed, and participants were asked to share archival and current

documentation as evidence to support innovation performance beyond interview data.

Furthermore, participants were allowed to review and comment on a written summary of

my interpretations of the research data through the member-checking process.

Data Collection Technique

The data collection techniques used in this study included data collected from

multiple sources, such as semistructured interviews, archival and current records, and

company websites. The triangulation of multiple data sources offered more profound

insight into healthcare leaders' entrepreneurial leadership strategies to catalyze innovation

performance. Furthermore, the triangulation of multiple data sources enhanced reliability

and construct validity, helped mitigate bias, and supported data saturation. The member-

checking process helped me as the researcher corroborate interviewer interpretations and

added to research rigor.

Data Collection Process

Within research, each author may use various data collection techniques that

support their unique research design and goals. DeJonckheere and Vaughn (2019)

identified 11 steps in the qualitative research process necessary to successfully conduct

semistructured interviews in healthcare settings. DeJonckheere and Vaughn advocated

that the researcher (a) determine the purpose and scope of the study, (b) identify

participants, (c) consider ethical issues, (d) plan logistical aspects, (e) develop the

interview guide, (f) establish trust and rapport, (g) conduct the interview, (h) take memos

and reflect, (i) analyze the data, (j) demonstrate the trustworthiness of the research, and

(k) present findings in a paper or report. DeJonckheere and Vaughn’s 11-step process is

robust and was followed in this doctoral study. In addition, as preliminary steps, Walden

University and IRB approvals were obtained before any study conduct, and participants

consented through a documented informed consent process and form. A pilot study was

not intended to be conducted nor applicable to this doctoral study.

Semistructured Interviews

This doctoral study involved video and audio-recorded semistructured interviews

conducted via videoconferencing software, such as Zoom or Microsoft Teams.

Semistructured in-depth interviews are commonly used within qualitative research,

guided by an adaptable interview protocol, and augmented by probing and follow-up

questions (DeJonckheere & Vaughn, 2019). An advantage of semistructured interviews is

that they facilitate the collection of open-ended data and enable the researcher to explore

participants’ thoughts, feelings, and beliefs (DeJonckheere & Vaughn, 2019).

Furthermore, semistructured interviews are flexible in structure, iterative, and permit

advanced scheduling (DeJonckheere & Vaughn, 2019). A disadvantage of semistructured

interviews is that novice researchers and those with few resources must develop a robust

data collection strategy and the skills necessary to execute it effectively (DeJonckheere &

Vaughn, 2019). Novice researchers must be prepared to navigate challenging

interviewing situations, including disengaged or emotional participants, especially if

sensitive or personal topics arise (DeJonckheere & Vaughn, 2019). As I had previous

interviewing experience as a researcher, conducting semistructured interviews was an

appropriate data collection technique for this study. Using a semistructured interview

approach enabled the flexibility to adapt my data collection techniques to accommodate

participants and ensure high quality research outcomes.

The subsequent steps were followed in conducting this study’s semistructured

interviews. A convenient time for the participant was set up in advance. At the beginning

of the interview, a brief overview of the study was provided, consent was confirmed, and

the interview format and agenda were reviewed. A friendly, nonjudgmental attitude,

conversational tone, and active listening approach was adopted to mitigate any potential

power differential between the researcher and participant. An interview protocol (see

Appendix A) was utilized to keep interview questions consistent and aligned with the

scientific inquiry and research question. Probing and follow-up questions were used to

clarify, explore, and elaborate on participants’ responses. Additional notes and

observations were captured using a notepad or OneNote digitally.

Member Checking

Member checking serves as an essential verification tool to support research

validity. Member checking is the process the researcher undertakes to solicit feedback

from the participant on the researcher’s interpretation of the data and is often considered

the gold standard of qualitative research (Lincoln & Guba, 1985; Motulsky, 2021).

Member checking allows participants to review, expand, or comment on the researcher’s

interpretative summary of interview data or research results to improve accuracy and

transferability and ensure alignment with their views (Brear, 2019; Busetto et al., 2020).

Member checking may reveal researcher bias, errors, or misrepresentations; enable

further investigation of emerging themes or interpretations; and empowers participants to

shape the prioritization of issues or insights (Brear, 2019). While considered the gold

standard for verifying validity and trustworthiness, researchers should consider member

checking as one of many available tools, factor in participant experiences with the

process, and adopt a more reflexive approach instead (Candela, 2019; Motulsky, 2021).

The member checking of researcher interpretations is a vital facet of research quality for

this study.

Within this doctoral study, I conducted member checking using Marshall and

Rossman’s (2016) approach of reviewing and interpreting interview data, synthesizing

responses for each interview question, providing participants the synthesized summaries,

confirming the accuracy of my interpretations, and collecting more data until no new

information was collected. Member checking was conducted via phone discussion to

support the validity of this study’s research. A 30-minute recorded virtual conference call

was set up at the participant’s convenience to review and confirm my interpretations of

the data and make relevant revisions.

Documentation Review

Within this doctoral study, an assessment of archival and current records, such as

presentations, reports, dashboards, and processes or procedures, provided insight for

scientific inquiry. Documentation is critical for recording strategy, objective setting,

progress measurement, and outcome evaluation within healthcare (Martin et al., 2020).

Furthermore, good documentation practices can shape leadership decisions, though

Martin et al. (2020) advised that documentation should be objective and free of implicit

or explicit superfluous attitudes and biases. Archival records shed light on the historical

activity of organizations, individuals, and events and can be used to establish an

evidentiary foundation. Documentation review was essential for triangulating multiple

data sources to reach data saturation.

Through the recruitment process, I asked business leaders to consent to participate

in the study and provide relevant source data that may contribute toward addressing the

research question. Documentation was reviewed and analyzed for how leaders

successfully used entrepreneurial leadership strategies to catalyze innovation

performance. Including documentation review in the data collection and analysis process

offered a historical and prospective outlook into how leaders set strategy and objectives,

evaluate and measure progress and outcomes, and capture lessons learned that shape

future direction. Additionally, through documentation review, I corroborated interviewee

responses to establish truth in the data set or raised questions that may have required

further substantiation. Disadvantages of documentation review included the volume,

confidential nature, and lack of context inherent in the records. Moreover, static

documents served as snapshots that created gaps in the overall picture and required

onerous and in-depth exploration. Requests for supporting documentation may have

posed a challenge if leaders did not have easy access to documents or were reluctant to

provide them due to the sensitivity of the information.

Company Websites

Company websites contain a wealth of information and can be a beneficial source

of data to support this doctoral study. Company websites are used to disseminate

information to various stakeholders, such as healthcare workers, patients, shareholders,

and the community. An advantage to including company website data is that global

public information on corporate vision, mission, values, culture, history, innovation

programs, and financial performance can be collected across the pharmaceutical, medical

device, and consumer healthcare sectors. Furthermore, public data can be analyzed and

benchmarked against industry, sector, and other healthcare organizational data.

Company websites for each participant in the study were reviewed, and

information pertinent to organizational entrepreneurship and innovation was assessed for

inclusion in data analysis. The sheer volume of information and ease of navigation of

company websites could have posed a disadvantage as it may have required substantial

time and participant guidance to assess relevance to the study. Another disadvantage was

that company website information is public and, although trustworthy, needs to be

corroborated to generate reliable and valid insights and conclusions. Like internal

documentation review, company website information was essential to triangulating

multiple data sources to reach data saturation.

Data Organization Technique

Suitable data organization techniques can support the efficient and effective

collection of data. Yin (2018) proposed six sources of case study evidence: documents,

archival records, interviews, direct observations, participant observation, and physical

artifacts. Furthermore, Yin advocated four prevailing principles essential to data

collection: using multiple data sources, creating a case study database, maintaining a

chain of evidence, and exercising care with social media or other electronic sources of

evidence. Therefore, suitable data organization techniques are critical to high quality case

study research and one of the first steps in qualitative analysis (Yin, 2018). Effective data

organization techniques contributed to the reliability and validity of the research study.

Interviews are one of the most valuable sources of case study evidence. Audio

recordings of interviews provide a more accurate representation of the interview versus

taking notes (Gray et al., 2020). Accordingly, interviews within this doctoral study were

conducted and recorded using Zoom or Microsoft Teams conferencing tools. Zoom and

Microsoft Teams safely captured and secured interviews and supported the automatic

transcription of interview recordings, making it a valuable tool for systematically

organizing interview data. Furthermore, digital memos, logs, and reflective journals were

created to facilitate study conduct. I used Microsoft OneNote to track scheduled

interviews and capture additional interviewer questions, annotations, and meaningful

interpretations for data analysis, my synthesis of individual interviews, and personal

reflections on the research process to support real-time modifications. As outlined in the

interview protocol and informed consent form, participants were asked to consent to the

recording and secure storing of interview data and other documents, such as digital notes.

Research databases are an essential tool for efficiently collecting and managing

data. Organizing and documenting the data collected in a comprehensive database is a

fundamental principle of case study research and may be subject to secondary analysis

(Yin, 2018). The database within this doctoral study contained the full array of compiled

data, kept separate, and maintained in a well-organized and retrievable form. The data

retention protocol used in this study is to securely store all research documentation for at

least 5 years. Thus, electronic data, such as interview recordings, digital notes, and the

research database, is preserved in an orderly filing system using structured nomenclature,

stored in personal, restricted, and dedicated OneDrive folders, backed up and password-

protected on a flash drive, and secured safely for 5 years.

Data Analysis

This doctoral study involved the triangulation of multiple data sources to mitigate

bias, enhance reliability and construct validity, and reach data saturation. Fusch et al.

(2018) emphasized the importance of triangulation to support research reliability and

validity, enabling a researcher to saturate the data. As initially conceived by Denzin in

1970 and 1978, there are four types of triangulation: data, investigator, theory, and

methodological (Denzin & Lincoln, 2018; Fusch et al., 2018). Methodological

triangulation involves using multiple methods to obtain a more comprehensive and in-

depth understanding of the phenomenon (Abdalla et al., 2018; Fusch et al., 2018). Thus, I

used methodological triangulation by collecting data using multiple data collection

methods, such as semistructured interviews, and review of organizational business

strategies and websites. The interpretation process occurred as the data was collected

from multiple sources.

Researchers widely use thematic analysis to analyze qualitative data. The

thematic analysis process involves theme generation and coding and is a widely

recognized case study data analysis method. The first step is the transcription of audio

interview recordings and then cross-checking transcripts with researcher field notes

(Rashid et al., 2019). The interviewee's transcription verification or member checking is

conducted for accuracy (Yin, 2018). Once the transcripts are verified as representative,

the transcribed narratives are coded, and concepts are developed (Deterding & Waters,

2021). Concepts are then combined into categories based on collected evidence sources

(Rashid et al., 2019). The thematic analysis processes proposed by numerous authors

(Deterding & Waters, 2021; Rashid et al., 2019) are robust approaches suitable for

interpreting this doctoral study’s qualitative data. I started data analysis by generating

transcripts of the audio-recorded interviews. In addition, interview data were synthesized,

and researcher interpretations were verified through member checking. Subsequently, I

coded the narratives and formed concepts and themes that addressed the research

question. Using methodological triangulation with thematic analysis helped thoroughly

evaluate the study data and address the research question.

Following a systematic methodology, such as thematic analysis, adds

transparency to the data analysis process and can enhance research quality. A four-step

approach: prepare, exploration, specification, and integration (PESI), can be used for data

interpretation (Rashid et al., 2019). First, the researcher familiarizes themselves with the

evidence and carefully organizes, sorts, and builds an interpretation frame (Rashid et al.,

2019). This data processing step includes indexing the interview transcripts, checking

field notes, organizing and examining documents, and consulting the literature review

(Rashid et al., 2019). Second, initial or key codes are developed and transformed into

concepts (Rashid et al., 2019). Third, associations between concepts are amalgamated

into categories or themes based on discernible patterns, the conceptual framework under

evaluation, and an understanding of contemporary literature (Rashid et al., 2019). Fourth,

cross-case patterns are identified and interpreted between cases (Rashid et al., 2019). The

PESI approach is a robust methodology and was used for data interpretation within this

doctoral study.

Computer-assisted qualitative data analysis (CAQDAS) tools, such as NVivo, can

simplify data analysis. Case study data can be analyzed in various ways, including

examining, categorizing, tabulating, testing, or recombining evidence (Yin, 2018). While

CAQDAS tools may facilitate data analysis, researchers still need an analytic strategy to

define relevant codes and interpret observed patterns (Denzin & Lincoln, 2018; Yin,

2018). Yin (2018) suggested using the following five techniques for analyzing case

studies: pattern matching, explanation building, time-series analysis, logic models, and

cross-case synthesis. NVivo was the CAQDAS tool used in this doctoral study to store,

organize, analyze, and represent qualitative data. NVivo software helps in the thematic

analysis of the data, explicitly transcribing interviews; constructing code, themes, and

categories; and may be used in data analysis to understand the research inquiry better

(Alam, 2021; Deterding & Waters, 2021). NVivo offers greater flexibility in the

categorization of large amounts of rich text, improves the quality of results, reduces time

and effort in data analysis, aids in the identification of trends and themes through the

cross-examination of information, and supports data visualization for an adequate

representation of relationships between concepts (Alam, 2021). Furthermore, NVivo

supports the trustworthiness and transparency of the data analysis process (O’Kane et al.,

2021). Finally, key themes derived in this study were correlated to the literature on

leadership, entrepreneurship, innovation management, and the conceptual framework of

entrepreneurial leadership. A review of new studies within the body of knowledge

discovered since the time of proposal writing and germane to addressing the research

question was added to the final doctoral study. As the doctoral study researcher, I trained

on NVivo before data analysis to ensure an adequate examination, categorization,

tabulation, recombination, and presentation of the evidence to support addressing the

research question. A thorough analysis and correlation of study findings to contemporary

research supported an in-depth scientific inquiry and satisfied the goal of this study.

Reliability and Validity

The concepts of reliability and validity are fundamental tenets of all research and

are essential for establishing the trustworthiness of qualitative research (Rose & Johnson,

2020). Reliability and validity cannot be declared based on the study’s conclusions; they

must be built into the research process (Chowdhury & Shil, 2021). Furthermore, the

verification process is a continuous assessment of validity and reliability throughout all

research phases (N. Singh et al., 2021). A common criticism of case study research is low

validity and reliability; however, this can be mitigated by adopting a theoretical stance

(Quintão et al., 2020). Yin (2018) affirmed that high quality case study research must

have construct validity, internal validity, external validity, and reliability. Though,

dependability, credibility, transferability, and confirmability replace the commonly

accepted criteria of reliability and internal and external validity (FitzPatrick, 2019). The

relevancy and application of the contemporary research lexicon are further elaborated in

the following sections on reliability and validity.

Reliability

The concept of reliability in qualitative research is problematic because reliability

is assumed to be demonstrated when repeated measures of a phenomenon produce the

same results using objective methods (Rose & Johnson, 2020). Reliability is often

synonymously likened to replicability, repeatability, and stability (Cypress, 2017).

However, these views take a positivist or postpositivist lens often applied in quantitative

research, while qualitative research is based on a constructivist paradigm that is better

suited for naturalistic inquiry (Rose & Johnson, 2020). Thus, reliability within qualitative

research should focus on the consistency of transparent research practices, analysis, and

conclusions that factor in the limitations of the research (Quintão et al., 2020). The

ultimate goal is to minimize research errors and biases to strengthen reliability.

Dependability

Dependability is associated with reliability as it comprises steps necessary to

improve the consistency of methods and processes during data collection and analysis (N.

Singh et al., 2021). Written procedures or an audit trail enhance dependability (N. Singh

et al., 2021). This study incorporated a research protocol and case database. A protocol

establishes the research practices, while the case database contains the collected data

(Quintão et al., 2020). Several techniques may be used to enhance the reliability and

dependability of the study cases, such as recording the interviews, coding the responses,

member checking, and using analytical data analysis methods (Quintão et al., 2020).

Furthermore, analytical rigor can be enhanced by training qualitative researchers

conducting the interviews and coding the data (N. Singh et al., 2021). To ensure the

reliability of the study data, I, as this study’s sole researcher, have completed the CITI

Program (Record ID 42431199) and NVIVO training courses.

Furthermore, a trail of emergent research steps, theme identification, analysis, and

memos were kept, authenticating the decisions, methods, and analysis presented in the

study. Lastly, I conducted member checking using Marshall and Rossman’s (2016)

approach of reviewing and interpreting interview data, synthesizing responses for each

interview question, providing participants the synthesized summaries, confirming the

accuracy of my interpretations, and collecting more data until no new information is

collected. Member checking was used to achieve methodological rigor and reliability

based on a mutual analytical understanding between participants and myself as the study

researcher.

Validity

The reliability of the data collected contributes toward internal validity, whereas

external validity is concerned with the generalizability of the data across persons,

settings, and times (Chowdhury & Shil, 2021). In the case of study research, validity can

be difficult to establish; however, triangulation can resolve challenges, especially within

the method triangulation that can increase researcher confidence (Chowdhury & Shil,

2021; Rose & Johnson, 2020). The critical aspect of internal validity is to ensure that the

researcher can construct a plausible causal argument that supports the results (Quintão et

al., 2020). On the contrary, external validity depends on the research protocol and defined

cases and is more concerned with analytical generalization over statistical generalization

(Quintão et al., 2020). To ensure external validity, case study selection should be

justified, case study contexts presented, and patterns identified that allow readers to

generalize the results (Quintão et al., 2020). In the following sections, validity is

presented as credibility, transferability, and confirmability to align with commonly used

terms in qualitative research. In addition, the effect of data saturation on research rigor is

described.

Credibility

Credibility is associated with internal validity and refers to the extent to which the

research findings are believable or probable (N. Singh et al., 2021). Verification

strategies include the appropriateness of the research methods; prolonged participant

engagement; member checking; peer scrutiny; source, method, and investigator

triangulation; reflective commentary; and deviant case analysis (N. Singh et al., 2021).

To enhance credibility, this study comprised a research protocol with appropriate

research methods, allowed participants to review interview transcripts to verify the

adequacy and accuracy of responses and their applied meaning or interpretations, and

triangulated data methods. Interviewee transcript review allows the researcher to share

and check the accuracy of interview transcripts with participants and ensure they are

representative of their experience (Rowlands, 2021). Alternatively, member checking is a

distinct process the researcher undertakes to solicit feedback from the participant on the

researcher’s interpretation of the data and is often considered the gold standard of

qualitative research (Lincoln & Guba, 1985; Motulsky, 2021). Member checking is the

most significant contributor to credibility as it allows researchers and participants to

recapitulate, refine, review, and expound on the findings during data analysis (DeCino &

Waalkes, 2019). Furthermore, member checking contributes toward data saturation and

the fidelity of the data and analysis.

Transferability

Transferability is associated with external validity and refers to the

generalizability of the findings (Langtree et al., 2019). In qualitative research, a

researcher enhances the degree to which results are transferable to other contexts or

settings through thick or dense background descriptions (N. Singh et al., 2021). This

study comprised thick descriptions of participants, the research process, and any contexts

of behaviors and experiences that may be meaningful to others. Thick descriptions enable

the reader to make transferability judgments that apply to their circumstances (Langtree

et al., 2019). Several other techniques may enhance transferability, such as triangulation

of sites or contexts and nominated, purposive, or theoretical sampling (N. Singh et al.,

2021). Triangulation and purposive sampling were used in this study.

Confirmability

Confirmability is concerned with establishing that the data and the researcher’s

interpretations of the findings result from the data and are verifiable by other researchers

(Moorley & Cathala, 2019). Confirmability is similar to objectivity or neutrality in

quantitative research and is used to corroborate that the findings are unyielding to the

researcher’s characteristics, biases, or assumptions (Moorley & Cathala, 2019). Like

dependability, an audit trail can enhance confirmability. This study contained a complete

set of notes on decisions, reflections, sampling, the emergence of the findings, and

information about data management. Practicing self-reflexivity, managing positionality,

and minimizing research biases strengthened the credibility and confirmability of the

study.

Data Saturation

Data saturation is the most commonly used method to increase research rigor and

judge data adequacy for a purposive sample (Hennink et al., 2019; Morse, 1995). When

using a structured approach, such as semistructured interviews, data is analyzed at the

end of the data collection phase; therefore, an adequate sample is needed to ensure data

saturation is reached and data can be replicated (Gill, 2020). Beyond replication, data

saturation helps establish connections between similar concepts and processes across

various situations, experiences, contexts, and events, thus developing congruence with

the data set at a conceptual level (Denzin & Lincoln, 2018). At some point within the data

collection process, no new information is presented, issues begin to be repeated, and any

further data collection becomes redundant (Hennink et al., 2019). This study included a

similar method used by Hennink et al. (2019), in that code saturation and meaning

saturation were evaluated. Code saturation was achieved when no new information was

presented, and the codebook was stabilized. While meaning saturation was achieved

when I, as the researcher, fully understood the data and no further insights or nuances

were realized. Evaluating code and meaning saturation led to this study's breadth and

depth of high quality data.

Transition and Summary

Some healthcare business leaders lack entrepreneurial leadership strategies to

catalyze innovation performance. Therefore, the purpose of this qualitative multi-case

study was to explore entrepreneurial leadership strategies that some healthcare business

leaders working in the pharmaceutical, medical device, and consumer healthcare sectors

in North America and Western Europe used to catalyze innovation performance. As the

primary data collection instrument, I defined the case or cases; developed a theoretical

perspective aligned with my research design; and identified, collected, and triangulated

multiple data sources to address the research question comprehensively and enhance

credibility, transferability, and confirmability. A limited relationship existed between me

and the topic and me and the participants based on work experience in innovation and

networking exposure. Research ethics training was completed to ensure that I conducted

research in alignment with tenets of the Belmont report and that a robust informed

consent process was applied to protect participants.

A qualitative multi-case study approach was selected to explore specific cases,

and purposive sampling was used to recruit participants who had successfully

implemented entrepreneurial leadership strategies to catalyze innovation. I used a case

study protocol comprising an overview of the case study, data collection procedures, and

protocol questions to minimize researcher bias and ensure consistency across the research

process. The methodological triangulation of multiple data sources; such as

semistructured interviews, organizational business strategies and websites; was

performed to mitigate bias, enhance reliability and construct validity, and reach data

saturation. I conducted thematic analysis, including providing opportunities for transcript

review and member checking, and correlated key themes with contemporary literature

from the time of proposal writing.

Section 3 comprises the presentation of the doctoral study findings, any

application to professional practice and social change, and recommendations for action

and further research. The doctoral study concludes with prominent take-home messages

regarding the value of the research.

Section 3: Application to Professional Practice and Implications for Change

Introduction

The purpose of this qualitative multi-case study was to explore entrepreneurial

leadership strategies that some healthcare business leaders working in the

pharmaceutical, medical device, and consumer healthcare sectors in North America and

Western Europe used to catalyze innovation performance. Data were collected from six

participants using semistructured interviews and a review of organizational strategy

documents and websites to achieve methodological data triangulation, with no new

information emerging to reach data saturation. Six key themes relevant to healthcare

innovation emerged from the data: innovation management, innovation strategy,

innovation performance, innovation leadership, innovation and change, and innovation

orientation. From the six themes, eight subthemes emerged relevant to healthcare

business leaders' entrepreneurial leadership strategies to catalyze innovation performance.

Presentation of the Findings

The overarching research question for this doctoral study was the following: What

entrepreneurial leadership strategies do some healthcare business leaders use to catalyze

innovation performance? Semistructured interviews of six business leaders were

performed, and upon data saturation, a thematic analysis was conducted that resulted in

six themes and eight subthemes (see Table 1). The review of organizational strategy

documents and websites corroborated the emergent themes from interview data. The

presentation of the findings section was structured by theme, including subtheme context,

and discretely tied to the entrepreneurial leadership conceptual framework and

contemporary literature.

Table 1

Key Innovation Themes, Subthemes, and Frequencies

Theme

Subtheme

Frequency

Percentage

Innovation management

Innovation process

Idea management

Customer orientation

348

Innovation strategy

Business strategy

Strategic analysis

Project & risk management

247

Innovation performance

199

Innovation leadership

Leadership proficiency

Leadership style

164

Innovation and change

144

Innovation orientation

Total

1,185

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Theme 1: Innovation Management

Entrepreneurial leadership and innovation management play instrumental roles in

healthcare innovation. Effective innovation management fosters an innovative culture and

processes that generate new business value. P6 urged entrepreneurial leaders to work

with an appropriate sense of urgency:

The longer it takes to develop a product and get it in front of patients and

consumers, the higher the markets’ expectations are because we're all innovating

and trying to move forward in these key areas of health and innovation. And so, if

it takes you too long, or you don't start, and ignore a differentiated position, by the

time you get to market, you may not be meeting a consumer or patient need.

An entrepreneurial leader’s role is to establish effective innovation management

processes, innovative behavior, and an entrepreneurial climate conducive to the rapid

development and implementation of innovative solutions. For example, based on

Company 4’s website, the organization used its breadth, scale, and experience to

reimagine the way healthcare is delivered and help people live longer healthier lives. The

research findings on innovation management confirm Kremer et al.’s and Machon et al.’s

(see Kremer et al., 2019; Machon et al., 2019) position that leaders who can successfully

shape an entrepreneurial climate, embed effective innovation management practices, and

promote creative and collaborative partnerships could positively affect healthcare

innovation. Healthcare leaders must innovate with speed and agility to create new

business value, build dynamic capabilities and partnerships, and deliver healthcare

solutions within a competitive healthcare environment. Innovation management is a

fundamental aspect of innovation performance and was discussed using three key

subthemes: innovation process (f = 229), idea management (f = 68), and customer

orientation (f = 51).

Innovation Process

Emerging from the data was a consensus that no one-size-fits-all innovation

models exist. Instead, innovation initiatives are case-dependent, and the strategic

innovation framework used should be balanced between a structured and flexible

approach. Across innovation's early, mid, and late stages, entrepreneurial leadership

activities (see Table 2) are essential to successfully guide employees through innovation

development and value delivery.

Table 2

Innovation Process Codes and Frequencies

Code

Frequency

Subtheme

percentage

Analysis & reflection

Innovation processes

Asking critical questions

Experimental design

Impact analysis

Implementation challenges

Continuous improvement

Business case

Project scaling

Novel approach

Innovation importance

Design thinking

Feasibility

Total

229

A key concern of study participants was keeping pace with rapidly evolving

customer and market needs. All six business leaders confirmed that acting with speed and

agility is essential. P1 noted that making innovative solutions “as real as possible, as fast

as possible” was crucial to healthcare innovation success. The overarching objective of

innovation, as proposed by P2, is to create, develop, and deliver “the right solution,

designed and implemented the right way, to create maximum value for patients, for sites,

for ourselves.” Ideating, experimenting, and developing innovation solutions with speed

and agility confirms Prince et al.’s (2021) conceptualization of entrepreneurship as the

development and validation of ideas, recognition, and creation of opportunities that

generate value. Leaders who begin with the right analytical processes and act quickly

may help their business keep pace with the rapidly evolving market and consumer needs

and create value for customers sooner. While speed and agility are essential to

innovation, designing the right solution takes a fundamental understanding of the

problem or opportunity.

Delivering value begins with defining the problem through analytical exercises

that generate a comprehensive set of assumptions, hypotheses, critical questions,

knowledge gaps, and needs that inform the experimental design and eventual project

business case. Within P2’s strategy documentation, the evaluation of ideas was noted as a

critical first step leading to qualitative opportunity assessment and a business case.

Design thinking methodology was advocated, by P4 and P5, as a practical approach to

empathize, define, ideate, prototype, test, and implement innovative projects. P5 stressed

the criticality of analysis and reflection across the innovation lifecycle. While defining

the business problem upfront and conducting postmortem lessons learned was commonly

practiced, according to P5, spending more time in early-stage “premortem analysis” to

calibrate to evolving market and customer needs and reflect on innovation performance

more frequently to proactively and strategically pivot was needed. Robust early-stage

innovation management processes, such as adequately defining the problem or

opportunity, may facilitate or hinder innovation performance. Innovation success also

hinges on developing and implementing innovative solutions, not just generating ideas.

While many employees enjoy the ideation phase of innovative projects, study

participants emphasized the dire need to deliver solutions. As noted on their website,

Company 5 delivers life-enhancing, first-to-market innovation by combining the power

of science with meaningful human insights and digital-first thinking. According to P1,

very few people come to entrepreneurial roles that are hardcore deliverers that

don't like to cultivate, so usually, that's not the issue. On the other side, you have

people who continually want to innovate and don't know when to stop.

The inability to effectively charter projects and shepherd employees through the

innovation management process can lead to a perpetual state of creation at the sacrifice of

delivering value. Innovation cannot be forced but must come from creative, analytical,

and transparent processes.

Candid and transparent communication is the backbone of effective decision-

making and vital to the success of rapid innovation projects. P3 cautioned business

leaders not to “force-fit” or “wedge-in” solutions from the “inside-out,” urging them

instead to be courageous in saying that the “solution sucks, it’s never going to work,”

appreciate feedback offered, and “work like hell to change it.” Effective communication

and strategy reanalysis is key to innovation performance. P5 often requested employees

to escalate development and implementation issues expeditiously if they were “banging

their head against the wall for longer than the week.” Furthermore, P5 found that “almost

all the people were scared to say I couldn't get this done; when it was nothing to do with

their fault, or their abilities, or the competencies, whatsoever.” Fear of failure may

hamper innovation progress, emphasizing the importance for employees to raise concerns

and leaders to build a culture where failure is acceptable. Innovation performance begins

with engaging employees in the transparent cultivation and management of ideas.

Idea Management

Adopting a practical approach to cultivating ideas may foster an entrepreneurial

or innovative climate, increase employee engagement, and enhance innovation

performance. Emerging from the data was significance surrounding efficient idea

management practices, especially for problem-solving and recognizing and exploiting

opportunities (see Table 3).

Table 3

Idea Management Codes and Frequencies

Code

Frequency

Subtheme

percentage

Opportunity recognition

Problem-solving

Idea management

Total

Idea management is a vital step in producing value through the innovation

process. Within the strategy documentation provided by P2, idea profiles were noted as

the basis for effective decision-making, and it was indicated that opportunity assessment

requires a high-level of collaboration between idea owners and other business partners.

According to P3, holding ideation sessions using whiteboards helped facilitate

“provocative conversations,” scenario planning, and the formation of strategic roadmaps.

Entrepreneurial leaders who effectively led idea management practices enabled

employees to identify, raise, critically challenge, and backlog ideas. Leaders who exhibit

entrepreneurial leadership principles and behaviors tend to encourage employees toward

new idea creation while fostering an innovative culture (Bagheri, 2017). P1 found that

constructing “killer questions” during early-stage innovation allowed leaders to

differentiate between critical and trivial insights that would potentially solve the business

problem or opportunity. P1’s strategy documentation included tools to facilitate the idea

management process, encourage innovation teams to ask the right questions at the right

time, and help structure and challenge their thinking to aid decision-making and

communication. Having well-defined processes for managing how ideas are generated,

prioritized, and backlogged can support progress during later innovation stages. A crucial

element of idea management is the inclusion of ideas from various stakeholders, such as

internal business leaders, external partners, and customers.

The collection of ideas from and involvement of diverse thought leadership was

deemed an essential element of idea generation. As described by P1 and P2, thought

leadership often came from senior leadership advisory within innovation or risk-

assessment councils. Consulting senior leadership, for example, through quarterly

planning sessions or stage gates, also ensured that innovation team outputs linked to the

overarching organizational strategy. Beyond the innovation project team or senior

leadership advisory, P6 found that crowdsourcing ideas and implementing innovation

challenges were valuable means to increase the breadth and depth of idea management.

Upon review of various crowdsourcing platforms (websites), organizations 1 and 7

published innovation challenges that allowed innovators to submit ideas through an idea

portal that led to partnerships and funding to bring to market products that will improve

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people's lives. Company 1’s innovation performance document verified that 78

challenges were launched, and $13.3M+ in grant funding was offered to innovators.

Crowdsourcing ideas and innovation challenges established connections between

innovators with potential solutions to unmet needs and helped advance scientific

breakthroughs in healthcare. Developing an innovation strategy and customer-oriented

processes, such as crowdsourcing, is vital to innovation performance.

Customer Orientation

Customer centricity (f = 27) and user experience (f = 24) are critical components

in any organizational strategy delivering business and customer value. Company 3’s

strategic focus, as noted in P1’s strategy documentation, was aspiring to deliver more

ambitious patient-centric innovation to create value and win in a rapidly evolving market.

For P2, exposing and calibrating the innovation portfolio every 6 to 12 months with

internal and external audiences and environments is critical to ensuring a balanced

portfolio. P2 suggested that internal audiences look for connections to the broader

portfolio, question the strategic focus and space appropriateness, and assess if their

problems would be solved. Furthermore, P2 indicated that external audiences gauge

whether the company is “working on yesteryear stuff” and how congruent it is with

evolving market and customer needs. Thus, P3 advised that entrepreneurial leaders be

“hyper-connected to the customer” and develop the ability to “really dig into and

understand what it is they value, and what are the problems they're looking to solve.”

Being hyper-focused on the customer to deliver value extends F. Li et al.’s (2021) finding

that an employee customer-orientation mediates the effect leadership has on employee

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behavior. Leaders influencing an employee's customer service orientation may positively

influence innovation performance and deliver enhanced customer value.

Understanding evolving customer needs and engaging customers through the

innovation lifecycle may enhance innovation performance. P3 believed that a central

focus of an entrepreneurial leadership strategy should be “what’s in it for me

[customer]?” and “how is this [innovation] landing with the customer?” Thus, the

customer's voice is critical in informing innovation strategies. However, P3 highlighted

that it is not always what the customer is saying; “it’s what they’re not saying, it’s what’s

missing in the process, they didn’t tell us.” P3 suggested that entrepreneurial leaders keep

their finger on the pulse and listen to and stay connected with the “undercurrent feedback

along the [innovation management] process.” As suggested by P5, having a customer

orientation embedded in the innovation management process helps to ensure that “the

purpose of the innovation remains at the forefront and is designed and produced in a way

that will be innovative and useful to someone in the marketplace.” Producing an

innovative healthcare solution that customers do not use fails to generate value and

wastes precious organizational resources. Thus, involving the patient or customer

throughout the innovation lifecycle is essential for developing the right solution for the

right person at the right time.

Ties to Contemporary Literature

Innovation management is essential for conceptualizing, developing, diffusing,

and adopting innovative solutions. A systematic, planned, and controlled innovation

management process can help healthcare business leaders materialize ideas into

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innovation (Sharma et al., 2022). Furthermore, embracing agile philosophies and

techniques can support leaders' ability to be adaptive, be flexible, and rapidly act to

respond to external market, economic, and social risks (Sharma et al., 2022). The findings

of the doctoral study on innovation management were consistent with Sharma et al.'s

study (see Sharma et al., 2022), which indicated that organizations would benefit from

structured but flexible innovation management processes that enable rapid development

and implementation of innovative ideas. The implementation of innovation projects was a

common subject amongst participants and included as a critical aspect within

participants’ innovation strategy documents. Business leaders often used an experimental

design in their innovation initiatives, which was consistent with van Beest et al.’s

findings (see van Beest et al., 2022) that health innovations are successfully implemented

when the potential solution is explored in real life. For example, through prototyping,

knowledge gained through the process aids in the constant adaptation of the potential

solution, and changes are made for the solution to be adopted. Effectively chartering

innovation projects through an innovation management process may catalyze innovation

performance. The study findings substantiate Bocken and Geradts’s (2020) notion that

leaders need to understand how to manage and sustain innovation and how it transcends

all aspects of the organization: strategy, structure, processes, incentives, and people.

Innovation management begins with idea generation facilitated through structured

processes and is boosted by innovative approaches, such as crowdsourcing.

Another finding of the doctoral study was the advantage of using crowdsourcing

ideas to drive innovation. The doctoral study findings on crowdsourcing confirmed Sarić

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et al.’s (2022) notion that crowdsourcing fueled the involvement of key stakeholders

within the innovation process to better design and develop products and services that met

their needs. Doctoral study participants spoke to the criticality of involving customers

throughout the innovation lifecycle, from concept through implementation. Furthermore,

a customer orientation was deemed impactful to innovation performance. Liu et al.

(2022) found that a customer orientation can promote incremental innovation, though an

effect on radical innovation was unclear. Getting too close to the customer may influence

radical innovation and limit organizations to incremental innovation (Liu et al., 2022).

Contrary to Liu et al.’s view, participants in the doctoral study were able to implement

transformative, innovative solutions based on a deep relationship with customers and a

fundamental understanding of their needs. The study findings fortify Kremer et al.’s

(2019) position that innovation leaders should develop appropriate group norms, design

teams strategically, manage external stakeholder interactions, show leadership support,

display organizational support, and effectively use performance management. Business

leaders must develop suitable relationships with stakeholders given the strategic intent,

context, and needs of the innovative solution and end users. An innovation management

framework that clearly defines how ideas are amassed and transformed into viable

solutions tied to customer needs may enhance innovation performance.

Association With the Conceptual Framework

The conceptual framework of this doctoral study was entrepreneurial leadership.

Innovation is critical to organizational competitiveness and survival, underlying the

importance of effective innovation management processes. A leader’s role is to foster an

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innovative climate, motivate innovative work behavior, and embed organizational

processes that exploit entrepreneurial opportunities. Entrepreneurial leaders have distinct

qualities and a prominent role that enable them to shape conditions that influence

innovation management, such as identifying new trends, reducing uncertainty and

complexity, and developing creative talent (Cucino et al., 2021). Entrepreneurial

leadership was found to significantly influence employees’ innovative work behavior and

foster an innovative culture and climate in which employees can confidently explore,

share, and apply ideas and concepts (Malibari & Bajaba, 2022). Furthermore,

entrepreneurial leaders influencing innovative work behavior can shape a customer

orientation that better serves evolving customer demands, increases customer satisfaction

and loyalty, and improves company performance (Hoang et al., 2022; Karatepe et al.,

2020). Business leaders who effectively apply entrepreneurial leadership strategies can

profoundly affect innovation management processes and talent that lead to positive

organizational outcomes. Improved organizational performance positions companies to

be more competitive and contribute more toward the innovation ecosystem. Thus,

innovation management, specifically the innovation process, idea management, and

customer orientation themes, are influenced by entrepreneurial leadership and tie into the

conceptual framework.

Theme 2: Innovation Strategy

Innovation strategy is vital to business leaders as a strategic tool to assess the

healthcare landscape, set goals and objectives, evaluate performance, make informed

decisions to stay the course or pivot, and navigate a complex healthcare environment. In

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Company 2’s strategy document, P4 ensured that the strategic plan contained an

innovation roadmap that delineated a clear path to achieve value-add outcomes by

bringing the organization the best-in-class capabilities. Additionally, as stated on

Company 2’s website, the organization’s strategic intent was to couple its strong internal

capabilities with the most compelling external science to transform how diseases are

thought of being treated, cured, prevented, and intercepted in the future. This study’s

findings on innovation strategy supported Benevolo et al.’s (see Benevolo et al., 2020)

research on how strategic frameworks can support global strategy creation, especially in

entrepreneurial firms seeking to exploit global opportunities. Furthermore, the research

findings confirmed Bagheri et al.’s (see Bagheri et al., 2022) assertion that

entrepreneurial leadership positively affected innovative employee behavior and could

contribute to organizational innovation strategies, activities, and performance.

Entrepreneurial leaders can align the organizational strategy, business environment, and

resources to successfully execute innovation initiatives while promoting strategic

entrepreneurship and employee innovativeness. Innovation strategy is a vital component

of healthcare innovation and a key driver of innovation performance and was discussed

using three key subthemes: business strategy (f = 116), strategic analysis (f = 96), and

project and risk management (f = 35).

Business Strategy

Innovation strategy is a significant component of business strategy. At the core of

an entrepreneurial and innovative healthcare organization is “the pursuit of the highest

value opportunities to address unmet needs using best-in-class solutions,” as expressed

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within P2’s organizational strategy documentation. Furthermore, P4’s ambition was to

“bring best practices, capture feedback, and create an environment for continual growth

in the [healthcare innovation] space.” A common objective between healthcare business

leaders is their goal to define opportunities, foster internal and external business

partnerships, understand the market and consumer trends and unmet needs, and assess the

competitive landscape to bring cutting-edge innovation to patients and customers.

Emerging from the study data were seven fundamental factors that influence a business

innovation strategy (see Table 4).

Table 4

Business Strategy Codes and Frequencies

Code

Frequency

Subtheme

percentage

Strategic focus

Unmet need

Strategic road map

Strategic framework

Organizational growth

Competitive advantage

Strategy

Total

116

For many entrepreneurial leaders, confusion arises regarding the best innovation

approach. P1 inferred that there is no best innovation strategy, model, or process, as they

“all follow a similar road map: uncover unmet needs; evaluate against current strategy,

technology, and capabilities; risk reduction; business case, and so forth.” Furthermore, P1

advised picking a suitable fit-for-purpose model and getting the entire stakeholder set

aligned to follow that specific process. According to P3, to catalyze innovation

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performance, entrepreneurial leaders must “acknowledge and accept where they are, yet

not allow themselves to get comfortable and stay in the space but think beyond.” P3

insinuated that avoiding complacency is “what separates those companies that are going

to take us into the future.” To deliver healthcare innovation, leaders must have a

fundamental understanding of the innovation management process but not be too

restrictive on the exact model they use, as a rapidly evolving environment compels

constant reanalysis and strategic pivoting. To catalyze innovation performance,

innovation strategies should delineate the chosen process while innovation leaders seek

business partner alignment on the strategic approach to solving the business problem or

opportunity and delivering unmet needs.

A leader’s ability is indispensable to innovation strategy formation and

implementation. To succeed, entrepreneurial leaders must be technical, conceptual,

interpersonal, and entrepreneurial (Harrison et al., 2018). P4 confirmed Harrison et al.’s

(see Harrison et al., 2018) sentiments on leadership competencies. According to P4,

entrepreneurial leaders who are strategic visionaries, lead by example, and are apt at

influencing others, can quickly build confidence and trust in the innovation strategy to get

key stakeholders on board. Furthermore, P4 leans toward differentiation strategies that

shake-up the status quo, improve poor or subpar performance, or target areas where

people have business problems to solve yet act risk averse. Similarly, P5 sought out “new

growth opportunities that are outside traditional need states by thinking critically and

examining internal and external innovation drivers, such as consumer, market, and

technical feasibility perspectives.” Even empowered with entrepreneurial leadership

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strategies, P5 conceded that “getting the organization to buy into working differently

from an entrepreneurship or an innovation perspective is hard.” Consequently, P5 attested

that influencing key business partners to do things differently with “high levels of risk,

high levels of uncertainty, and a high potential for failure is hard.” An effective business

strategy is only as good as the leader’s ability to influence others to follow. Strategically

communicating strategy in terms of consumer and market direction, competitive

positioning, and organizational growth potential may sway decision-makers to invest in

innovation. While influence is critical for strategy adoption, a business strategy must be

founded on solid strategic analysis.

Strategic Analysis

The external marketplace and consumer needs are constantly evolving, and

healthcare is becoming more complex and competitive, underscoring the need to innovate

unrelentingly. Where one-off innovation may transform a start-up into a multimillion-

dollar business based on a single idea, it often does not work for large multinational firms

with extensive portfolios of products or solutions. P2 advocated the following:

A need for continuous input from several sources on where we can make inroads

doing things differently, take advantage of opportunities we find elsewhere that

we want to internalize, and find transformative solutions to sticky business

problems. Problems that don't resolve through a continuous improvement or

iterative approach but may benefit from radical change.

Thus, strategic analysis by entrepreneurial leaders is an essential aspect of innovation

management and requires an in-depth understanding of the internal and external business

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environment; the organization’s design, including capabilities, competencies, and

technologies; and areas of opportunity for transformative growth. This study’s findings

on strategic analysis extend Altahat and Alsafadi’s (see Altahat & Alsafadi, 2021) view

that an entrepreneurial mindset and creativity are required to create strategies that

promote corporate entrepreneurship. Strategic analysis is fundamental to creating

innovative strategies that entrepreneurial leaders use to deliver healthcare solutions.

Table 5 contains the underlying factors that emerged from the data surrounding strategic

analysis.

Table 5

Strategic Analysis Codes and Frequencies

Code

Frequency

Subtheme

percentage

External analysis

Leveraging technology

Organizational design

Complex environment

Breakthrough/disruptive innovation

Business transformation

Total

The healthcare environment is very complex and, by its very nature, poses

challenges for disruptive or radical innovation. P4 described the healthcare environment

as heavily regulated, quality-focused, and process driven, in which entrepreneurial

strategies may carry substantial risk and mistakes could have a significant effect on the

well-being of others. Over the next 3 years, P3 anticipates an increased number of

hospital mergers, closing of medical practices, and increased patient care demands, and is

not sure Company 4 is “set up to meet or exceed the patient experience necessary to get

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us where we need to go and allow for products being created or innovated to meet that

end user where they are.” Nevertheless, P3 believed there still exists an opportunity to

disrupt and innovate:

Against significant headwinds within a fragile healthcare industry, by striking a

delicate balance between real innovation that is a delighter but not too disruptive

that it spooks them [customers] into taking a step back, instead by meeting them

where they are, holding their hand, and walking them into the sunset.

Strategically analyzing the evolving healthcare landscape is vital to innovation strategy

and performance. Leaders must develop the right capabilities and competencies to match

rapidly changing market and customer needs and develop external partnerships where

internal capabilities are deficient.

Innovation through external partnerships can be a strategic and cost-efficient way

to generate business value and deliver unmet needs. In Company 5, P6 worked with

various business partners to “express healthcare challenges.” P6 affirmed that to “deliver

on our purpose and develop the most transformational technologies and solutions to

patients and consumers, we have to partner and collaborate externally.” According to P6,

“there is no shortage of solutions, ideas, and technologies out there,” making it essential

for business leaders to “scientifically and strategically assess, focus, and prioritize efforts

in the right spaces.” A key strategy in catalyzing innovation performance is constantly

assessing the business landscape and innovation ecosystem for opportunities to partner

externally. Company 5 used a venture investment or corporate venture capital function

that identified innovative solutions to business or customer needs and provided equity to

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companies for their growth and an eventual return on investment (ROI). As acclaimed in

Company 5’s strategy document, they are the oldest corporate healthcare venture capital

firm with nearly 50 years of experience and 156+ active companies in their portfolio. As

an additional benefit, business leaders provided mentorship or sat on the board of

directors as advisors to help cultivate innovation development. While a financial return is

an essential indicator of innovation performance, P6 advocated that the most significant

benefit is the development of strategically valuable solutions that advance the healthcare

innovation ecosystem and bring new therapies or technologies that meet patient and

consumer unmet needs. Fostering strategic external partnerships requires meaningful

customer focus, though once the relationship is established provides an opportunity to

catalyze innovation by exploiting the capabilities and competencies of multiple partners.

An internal or external innovation strategy may bring different inherent risks, though

fundamental disciplines of project and risk management remain vital to the effectiveness

of innovation strategy.

Project and Risk Management

Risk management plays a pivotal role in shaping an innovation strategy, fostering

a climate of risk-taking, and evaluating the risk-benefit of implementation. Project

management practices effectively enable the delivery of value of innovation to customers.

The frequencies of project and risk management practices were captured in Table 6, and

although small, the values denote project management and risk management disciplines

as facilitative capabilities that drive innovation.

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Table 6

Project and Risk Management Codes and Frequencies

Code

Frequency

Subtheme

percentage

Risk management

Project management

Risk-benefit analysis

Total

Effective risk management and project management are vital to strategy formation

and implementation and can influence innovation performance. According to P2, “The

essence of innovation is to create value or avoid costs, and you want to contain the cost

from experimentation to the lowest possible value.” P2 suggested that entrepreneurial

leaders within strategic innovation functions could help innovation teams define the value

of projects, gauge risk, and form an innovation strategy that includes proof of concepts

and rapid iteration experimental design, to avoid unnecessary failures and cost over time.

Furthermore, P4 suggested that teams “understand where they can apply risk or not and

create mitigation plans where things could go wrong.” The practical strategies provided

in this study’s findings extend Zaman et al.’s view (see Zaman et al., 2020) of a leader’s

role in inspiring creativity, unique problem-solving, and risk-taking. Leaders who

materialize risk-based strategies and foster a risk-tolerant culture can influence innovative

behavior, value creation, and sustained competitive advantage. Applying risk strategies,

such as portfolio de-risking, are critical to catalyzing innovation performance.

Using a risk-based leadership lens could affect the constitution of an

organization’s innovation portfolio. According to Company 1’s website, examples of

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risks and uncertainties included product research and development challenges, the

uncertainty of commercial success, manufacturing difficulties and delays, competition,

changes in purchasers’ behavior and spending patterns, government reform, and changes

to laws and regulations. A practical approach used by P5 is to balance risk across the

portfolio and multiple objectives by using “different technical strategies,

commercialization, and market opportunities.” Diversifying and de-risking the innovation

portfolio can lead to business growth, even though some innovation projects may fail.

According to P6, within early-stage innovation, creating de-risking and learning plans are

crucial to innovation development, learning about new spaces, and downstream success.

Acknowledging and understanding the organization’s risk tolerance, de-risking the

portfolio, and establishing risk-based practices and culture are vital to innovation

performance. In addition to risk management, project management is vital in delivering

healthcare solutions.

Innovation requires a flexible yet structured approach within large healthcare

organizations. Innovation projects are often sanctioned through formal processes of

writing a project proposal or charter, establishing a business case, and seeking senior

management approval and funding. Within Company 3 and Company 8’s strategy

documentation, the proposal, charter, and stage gate processes provided the overall

innovation project context; however, it was noted that they were not consistently applied

due to limited tools and methodology. The use of stage gates was deemed instrumental in

progressing projects across the innovation management process. Stage gates effectively

allow innovation teams to use collected data to seek senior leadership advisory and

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support, obtain go-no-go decisions, pause or kill projects, and receive additional funding

for incremental stages of R&D. Formal processes, such as business case approval and

stage gates, allow senior leaders to assess progress, provide guidance, and adequately

fund innovation.

Effective project management may lead to delivering business and customer value

on time and within budget. While project management is a fundamental aspect of

innovation development and commercialization, P5 cautions that project managers are

“incentivized to stay on time and on budget and do not necessarily care about how it

[innovative solution] does in the market.” While time and budget limitations are a normal

part of R&D, P5 suggested that focus and effort be on creating desirable value for

customers as “it’s important to be right, not six weeks early.” Influencing and steering

stakeholders toward common goals is an essential aspect of a leader’s role and confirms

Dalton et al.’s (see Dalton et al., 2021) opinion that innovation leadership is vital for

improving quality, productivity, and efficiency while managing internal innovation

processes. While rapid innovation is essential within healthcare, business leaders should

know that delivering desirable products is critical to generating customer value.

Strategically analyzing risks and managing progress using project management

methodologies is fundamental to innovation performance.

Ties to Contemporary Literature

Robust innovation and business strategies are critical to firm performance. As

uncovered within the doctoral study, business leaders must think critically and examine

internal and external drivers of innovation to influence stakeholders to adopt new ways of

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working and develop and implement innovative solutions. The role of strategic analysis

purported by participants as essential to innovation performance supports Lai et al.'s

(2022) notion that knowledge is critical for firms' survival in highly complex business

environments, such as the healthcare industry. Furthermore, strategic alignment between

stakeholders is essential to catalyzing innovation, business performance, and competitive

advantages (Lai et al., 2022). Furthermore, an innovation strategy may lead to a

competitive advantage through better products, reputation, and market performance (M.

Ali, 2021; Gallardo-Vázquez et al., 2019), which is corroborated by the study findings.

An innovation strategy incorporating strategic analysis tied to evolving market and

customer needs enables business leaders to leverage innovation to create and capture new

value through innovation management.

According to doctoral study participants, the development and implementation of

innovative solutions were key factors of innovation performance. While project

management was an underlying theme based on study data, participants did not

communicate deep insight into innovation project management practices. Zaman et al.

(2022) demonstrated that project management innovation positively influenced project

success and was boosted through the moderating effect of project governance and high

performance work practices. Zaman et al.'s findings underscore a need for novel ways of

working within entrepreneurial and innovative climates and hold strategic value for

business leaders driving organizational innovation initiatives. Infusing innovative

approaches within project management methods, robust governance structures, and high

performing work practices may irrevocably influence innovation performance.

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Due to the nature and complexity of the healthcare environment, innovation

projects experience unexpected risks, high levels of uncertainty, and significant effect of

change. A consensus from doctoral study participants was that healthcare stakeholders

are typically risk averse, though risk management practices were crucial to evaluating

and de-risking innovation projects and portfolios. The doctoral study findings extend Feld

et al.'s (2022) impressions that healthcare risk management is vital to understanding risks

through analysis and deriving acceptable mitigations and preventable measures to lower

potential patient or consumer harm. Furthermore, the study findings are consistent with

Zaman et al.’s (2020) view that innovation project leaders need to inspire creativity,

unique problem-solving, and risk-taking to foster innovative behavior, value creation, and

sustained competitive advantage. Innovation project and risk management practices may

achieve a sustainable competitive advantage, deliver high project value, catalyze

continuous innovation performance, and protect users if strategically ensconced within

the innovation strategy.

Association With the Conceptual Framework

A highly competitive healthcare business environment beset with complexity may

benefit from leaders with an entrepreneurial mindset and honed entrepreneurial

leadership strategies that influence organizational performance. Ersarı and Naktiyok

(2022) found that an entrepreneurial mindset positively affected entrepreneurial

leadership and that entrepreneurial leadership positively affected business performance,

cost leadership, and differentiation strategies. Entrepreneurial leaders may exercise

greater discretion while strategically analyzing new opportunities, developing innovation

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capabilities, and significantly influencing organizational value-generating strategies and

performance (Nguyen et al., 2021). Entrepreneurial leaders who think strategically give

the company a competitive edge and help create value by developing rapid, more

efficient, higher quality, and adaptable innovative products (Farida et al., 2022). Leaders

with an entrepreneurial mindset that think strategically and create innovative strategies

may influence organizational performance within complex healthcare environments.

Entrepreneurial leaders are apt to take risks, especially in ambiguous and

uncertain environments, and can shape a risk-taking culture (Raby et al., 2023). Strategic

entrepreneurship and entrepreneurial leadership may significantly affect the healthcare

environment as leaders with entrepreneurial mindsets form risk-based strategies that

cultivate new ideas, advance innovation efforts, and generate business and customer

value. Entrepreneurial leaders who develop and implement effective strategies can

catalyze innovation performance and competitive advantage. Thus, innovation strategy,

precisely business strategy, strategic analysis, and project and risk management themes

are influenced by entrepreneurial leadership and tie into the conceptual framework.

Theme 3: Innovation Performance

Managing and measuring innovation value starts with defining what success looks

like and identifying key milestones that deliver an expected ROI. According to P1, the

best entrepreneurial leaders demonstrate value by cultivating innovation and delivering it

simultaneously. Furthermore, P2 proposed that greater value can be created if

entrepreneurial leaders “work on difficult problems that they [stakeholders] care about

and cannot resolve themselves or present solutions in a way they [stakeholders] haven't

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thought of themselves.” In addition, P4 asserted that internal stakeholders want to know

the ROI before engaging in or supporting innovation efforts. However, according to all

study participants, the ambiguity of innovation makes it challenging to define innovation

performance metrics precisely. Nine factors associated with innovation performance

emerged from the study data (see Table 7).

Table 7

Innovation Performance Codes and Frequencies

Code

Frequency

Subtheme

percentage

Value-add

Performance measurement

Productivity

Defining success

Benefit realization

Performance management

Resource utilization

Funding

Goals & objectives

Total

199

100

Extending beyond customary financial measures of innovation performance is a

challenge for healthcare leaders. Like traditional projects, metric-driven behavior

influences innovation performance. Though, P3 affirmed that “you can't really be

prescriptive in terms of exact measurement of an innovative idea.” Producing “what

metrics matter most in getting that wheel to catch can be the detriment” to entrepreneurial

leaders who cannot strike a balance between their creative and structured, performance-

driven selves. Traditional measures, such as the health of the innovation pipeline

(innovation throughput), the execution of strategy (milestone achievement), new product

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development, commercialization, scalability of projects, stakeholder adoption and impact,

and various financial metrics, are all effective measures of innovation performance. In

reviewing organizational documents, Company 3 used the number of patents applied for

as a measure of success, while Company 2 used innovation cycle times to determine

adequate progress. While traditional hard metrics are easily defined, innovation leaders

would benefit from demarcating alternate measures of innovation performance.

Qualitative measures may be more meaningful within earlier innovation stages.

Innovation performance within healthcare is complex and can be measured at

multiple levels. P2 noted that, like an onion, innovation may have “many layers of impact

at the process, system, individual, organizational, and industry levels.” Thus, it may be

more appropriate to gauge early-stage innovation using qualitative measures and

development and implementation stages using hard metrics. Nontraditional measures may

include engagement scores, adoption of new ways of working, stage gate approval

records, pausing or killing failing projects, sustained funding, and user experience.

Furthermore, nontraditional measures could include innovation outputs, such as

addressing assumptions, hypotheses, and critical questions; ideas generated; quality of

provocative conversations; scenarios planned and tested; overarching commitment to the

innovation process, and various tenets of an entrepreneurial climate, such as innovation

work behavior and risk-taking. This study’s findings extend Su et al.’s (see Su et al.,

2020) research that positive emotions promote entrepreneurial intention and that

emotional value, like economic value, can be a performance driver within the

entrepreneurial process. Appling supplementary nontraditional measures may provide

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leaders with a more accurate assessment of innovation performance, uncover bottlenecks

or hurdles, and lead to more strategic decision-making. Whether using qualitative or

quantitative measures of innovation performance, metrics must be established based on

meaningful expected outcomes and progress gauged periodically to drive innovation

strategy effectively.

Innovation performance measures must be reviewed periodically, linked to the

overall organizational strategic objectives, and used to pivot strategically. All participants

interviewed utilized periodic progress checks and quarterly planning and review sessions

in which they initially set goals and objectives and evaluated the success of the

innovation portfolio and individual projects. Dashboards were leveraged to create

transparency, provide access, overcommunicate, and report on innovation progress. P5

conceded that entrepreneurial leaders need to “provide assurances that they’re competent

enough not to waste money and learn and fail productively, so stakeholders don’t feel

like they’re burning money, (that) they’re actually spending and taking risks

appropriately.” To catalyze innovation performance, entrepreneurial leaders must keep

their fingers on the pulse. To keep abreast of and connected to the rapidly changing

healthcare environment, according to Company 1’s website, business leaders fund

innovation challenges to bring forward groundbreaking ideas or technologies that aim to

enhance scientific progress. P5 cautioned that if leaders are disconnected from strategy

and progress, they “may get to the end of the line where you ship something, but it

doesn't look anything like what you thought you were going to achieve in the first place.”

Thus, it is imperative to periodically validate assumptions and hypotheses, connect back

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to the original strategic intent and objectives, make necessary adjustments or pivot, and

refresh the innovation strategy toward future growth.

Ties to Contemporary Literature

The doctoral study findings provide practical implications that extend the body of

knowledge on innovation performance management and measurement. The literature

contains theoretical implications on innovation value. For example, Guo et al. (2022)

found that value proposition innovation initiates value creation and value capture

innovation that enhances organizational performance. How organizations create new

consumer relationships or markets, use their resources and process capabilities to create

new value, and how it develops revenue models or cost structures to capture value is

essential in understanding how to compete within complex and ambiguous innovative

healthcare environments. Trachuk and Linder (2022) noted that the use of financial and

nonfinancial measures of innovation performance are highly variable and depend on the

type of innovators, such as radical innovators, technological innovators, effective

producers, creators, and imitators. Trachuk and Linder also found that the most common

indicators of innovation performance are sales growth from new products, patents

implemented, and total R&D expenses per thousand dollars of revenue. According to

Avby et al. (2019), healthcare innovation is influenced by entrepreneurial leadership

practices, cross-team collaboration, robust performance metrics, and a learning-oriented

culture, and confirmed by the study findings. No solitary metric can capture the

complexity of innovation. Therefore, business leaders must understand the meaningful

indicators of innovation performance based on the innovation outcomes they strategically

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plan to achieve for the specific innovation project. This doctoral study contributed new

indicators of innovation performance, such as engagement scores, adoption of new ways

of working, and sustained funding.

Association With the Conceptual Framework

Measuring innovation performance is challenging and requires leaders to define

success and expected value upfront. Ricci et al. (2022) found leadership's positive and

significant effect on entrepreneurial capital and innovation performance. Similarly,

Farida et al. (2022) found that a strategic mindset and strategic leadership led to value

creation and better decision-making, resource management, and management of an

entrepreneurial culture. Entrepreneurial leadership constructs, such as creativity,

innovative work behavior, opportunity recognition and exploitation, are essential to

generating value within innovative environments. If business leaders can foster an

entrepreneurial orientation and influence employees to work more innovatively, they can

improve productivity, catalyze innovation performance, realize benefits, and generate an

ROI. Measuring innovation performance and value may be done in numerous ways. An

entrepreneurial leader must define the goals, objectives, metrics, and other performance

measures most suitable for the specific innovation based on what key stakeholders value

most. Entrepreneurial leadership has been shown to affect innovation performance

directly; thus, managing and measuring innovation value is tied to the conceptual

framework.

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Theme 4: Innovation Leadership

The conceptual framework of this study was entrepreneurial leadership. Leaders

who establish innovation leadership, specifically entrepreneurial leadership, as a core

organizational capability can support innovation strategy, management, and performance.

Leaders may possess numerous leadership traits, skills, behaviors, and mindsets

conducive to catalyzing innovation performance. P1, P3, and P4 noted that diversity of

thought was critical to healthcare innovation. The significance of leadership diversity was

corroborated by Company 1’s website, in which the CEO stated that “the best innovations

can only come if our people reflect the world's full diversity of individuals, opinions, and

approaches.” Leading various stakeholders in the formation and execution of innovation

strategy via robust innovation management processes may lead to rapidly creating and

delivering healthcare solutions that serve unmet needs. The study’s findings confirm

Dalton et al.’s (see Dalton et al., 2021) notion that innovation leadership may improve

quality, productivity, and efficiency, whether managing internal innovation processes or

the external pressures within healthcare. Entrepreneurial leaders must eliminate

impediments and provide the necessary support, resources, information, and rewards to

motivate employees to act creatively, take risks, and increase their discretionary effort.

Innovation leadership is a central aspect of healthcare innovation and a significant

influence on innovation performance and was discussed using two key subthemes:

leadership proficiency (f = 88) and leadership style (f = 76).

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Leadership Proficiency

Leadership proficiency may be the most significant healthcare innovation driver.

According to P1, the “biggest gauge of whether [innovation] strategy is effective is if it

can withstand new leaders.” Entrepreneurial leadership plays an influential role in

healthcare innovation. The ability of an entrepreneurial leader to influence the conditions

for innovation, for example, the innovation management process and organizational

climate, can be consequential to innovation performance. Emerging from the data were

six factors that affect entrepreneurial leadership proficiency (see Table 8).

Table 8

Leadership Proficiency Codes and Frequencies

Code

Frequency

Subtheme

percentage

Leadership ability

Entrepreneurial mindset

Creativity

Evidence-based management

Resilience

Perseverance through failure

Total

An entrepreneurial mindset is a fundamental principle of entrepreneurial

leadership. P1 hires and develops entrepreneurial thinkers with diverse skill sets that can

lead and deliver within ambiguous environments. P1 goes as far as to say the “most

successful entrepreneurial leaders balance innovating and delivering well with their

teams, hire people that do both of those things well, or specifically have two groups that

do each of it well.” P2 commented that proficient entrepreneurial leaders have a

curiosity-driven mindset, higher tolerance to risk, autonomy in decision-making, and grit

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and can establish new ways of working by fostering innovative work behavior. Diverse

thought leadership, strategic vision, and courage are essential traits of an entrepreneurial

leader, according to P3. However, P3 cautioned that some creative leaders could get stuck

in a perpetual state of creation at the sacrifice of delivering value. P3 revealed that “even

creative, big thinkers can fail to see what was so obvious to me from a structured

business side, which was, you have to show them [stakeholders] the return, you have to

show them why it [innovative solution] matters.” Leveraging the unique leadership skills

and behaviors of various business partners may enhance innovation performance by

balancing the creative and execution facets of innovation management. Excelling in

healthcare innovation begins with choosing the right people to lead, influence, and

deliver an innovative culture, community, and projects.

The innovation process and best practices are often a central focal point of

innovation. As stated in Company 2’s strategy document, the organization brings in best

practices, captures feedback, and creates an environment for continual growth in the

[innovation] space. According to P5, “people underestimate talent, especially in big

organizations, because people assume that a competent professional, is a competent

professional, is a competent professional and that people are interchangeable, especially

in more ambiguous higher risk roles.” Having the wrong leader in the role can be

detrimental to innovation performance, and due to the rapid pace of innovation can make

it hard to change without adversely impacting the team’s ability to learn and deliver. P4

recommended that “senior leaders be thoughtful in terms of whom they put in these roles

and what purpose they serve” and if it is suitable for the individual and the organization.

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Conversely, P6 stated that business leaders “cannot purely rely on the great minds within

our organization... that it doesn't matter how big and incredibly talented employees are,

you can't have everybody who's talented within the industry in the organization.” The

research findings support Simić et al.’s (see Simić et al., 2020) notion that developing

talent is necessary but insufficient and that qualified entrepreneurial leaders must

leverage employees’ abilities to deliver superior performance. Choosing a leader with

entrepreneurial leadership proficiencies is instrumental in creating an entrepreneurial

climate and developing innovative employee behavior. A leader that can leverage

external talent through creative means may enhance innovation performance.

Developing an external innovation network may catalyze innovation performance

and be a cost-efficient strategy within the healthcare innovation ecosystem. To deliver on

Company 5’s innovation strategy, P6 established highly collaborative partnerships with

external talent that bring new capabilities and competencies into the organization.

Emphasis was given on Company 1’s website to accelerating early-stage innovation

through strategic partnerships, as great ideas can come from anywhere, and it takes a

partnership to turn ideas into breakthroughs. Additionally, P6’s organization used

innovation incubators that “allow us to not just physically host companies in labs and

give them access to [internal] capabilities, but also have people be able to sit down with

those companies and mentor them.” The incubator process shaped an external innovation

ecosystem that fosters strategic collaborations, future growth potential, cross-pollination

of expertise, and, eventually, an ROI. Business leaders should nurture and encourage

internal entrepreneurial leadership and a mindset that fosters scientific and innovative

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behaviors, thinking, and resilient working methods. In addition, leaders should

incorporate external capabilities and competencies within the innovation strategy to

exploit opportunities in solving healthcare challenges.

Leadership Style

A leader’s approach to influencing talent and an innovative culture may determine

innovation performance. According to P1, the successful implementation of an

innovation strategy hinges on business leaders’ leadership style and people management

ability. Entrepreneurial leaders who can effectively engage (f = 33), empower (f = 7), and

recognize (f = 3) employees may significantly catalyze innovation performance.

Emerging from the data were seven factors that are relevant to leadership style (see Table

9). Employee engagement had the most substantial influence over innovation

performance, underscoring the importance for entrepreneurial leaders to design and

execute effective engagement strategies.

Table 9

Leadership Style Codes and Frequencies

Code

Frequency

Subtheme

percentage

Employee engagement

Leadership approach

People management

Communication

Employee empowerment

Active listening

Employee recognition

Total

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A distinct leadership style may yield a considerably different outcome than

another and is highly dependent on situational context. Understanding leadership styles,

behaviors, and competencies influencing creativity are essential in catalyzing innovation

performance (Mehmood et al., 2020). Micromanagement was deemed, by P1, to stifle

innovation performance by creating distrust in the team’s ability to deliver. Furthermore,

P2 stated that entrepreneurial leaders’ “patience and grit” are the most prominent

innovation challenges. P3 found a clash between leaders with “outlandish thinking”

versus “structured experience,” though blending the leadership traits could “push

healthcare innovation to new places.” In cases of differing leadership styles, P3 suggested

a “divide and conquer” approach to shepherd projects through innovation. However, a

symbiotic relationship between diverse leaders must be established to be successful. Like

transformational leadership, entrepreneurial leaders must influence their strategic vision

by getting stakeholders to believe and adopt the organizational vision and objectives.

Projecting confidence, building trust, and leading by example were leadership traits that

P4 believed to be essential to influencing others. While there are countless leadership

traits, proficient leaders who model entrepreneurial leadership characteristics may

significantly influence innovative behavior, culture, and performance. Employee

engagement is a crucial driver of innovation performance.

Inspiring passion and a sense of purpose are admirable qualities of entrepreneurial

leaders. As advocated by P1, “happy people make great products,” and engaged

employees reduce headcount turnover. Key stakeholders must be strategically engaged

and aligned to successfully develop and execute innovation strategies. To P1, “strategy

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alignment is just getting the right people in the room for the conversation, who are the

decision-makers who can make or break this.” Through coaching, P2 engaged

enthusiastic, resilient, and willing employees to push forward, stating that an

entrepreneurial leader’s role is to “help people do their job and allow people to contribute

with ideas that can be rewarded by adoption.” The research findings confirm Bagheri’s

(see Bagheri, 2017) notion that entrepreneurial leadership encourages and supports

employees in idea and opportunity recognition and implementation. Influencing

creativity, innovative work behavior, and discretionary effort may significantly enhance

innovation performance. Effective leadership also includes managing situations or

conflicts that may detract from achieving organizational objectives or hinder innovation

performance.

Stakeholder engagement, especially within project teams, is not always positive

and can lead to conflict. P5 acknowledged that the demands of rapid innovation can lead

to increased stress and that leaders should expect and embrace conflict, though leaders

must “make sure the team feels supported, they're not burning the candle at both ends,

and that they're not burned out.” Furthermore, P5 advocated that entrepreneurial leaders

be cognizant of employee well-being, specifically their mental health, to remain highly

engaged and functional. From P5’s perspective, the strongest engagement comes when

cross-functional partners are interconnected, empathize with each other’s role, and think

and speak about the project holistically. As described by P5, leaders can recognize a

highly engaged and functioning team when, for example, “you hear technical folks using

marketing justifications, and marketing folks asking the right questions about the

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technical program, and when they're presenting to the senior leadership, you almost don't

know who's playing what role on the team.” All participants’ strategy documents

contained an element of stakeholder engagement, albeit focused on adopting and

delivering healthcare solutions. The emphasis on stakeholder engagement within the

research findings confirms Mulligan et al.’s (see Mulligan et al., 2021) concept that

engagement is a leadership mechanism that positively facilitates innovation. To foster a

highly engaged innovation team and drive innovation performance, an entrepreneurial

leader must be highly engaged and foster interconnectedness between all stakeholders.

Ties to Contemporary Literature

Innovation leadership plays a crucial role in top-level and mid-level management

for inspiring employees to be creative and deliver on innovation goals. The findings

within the doctoral study are consistent with the body of knowledge on innovation

leadership. Ye et al. (2021) noted that employee innovative work behavior is the source

of organizational development, survival, and competitive advantage. The challenge lies

with leadership to foster an environment in which employees demonstrate innovative

behavior through the generation and implementation of new ideas. Furthermore,

leadership creativity, such as with entrepreneurially minded leaders, is critical to

navigating increasingly complex decision-making environments, such as healthcare, and

innovation performance that may lead to competitive advantage (Ye et al., 2021).

However, the doctoral study findings extend Ye et al.'s notions by cautioning

exceptionally creative leaders to develop a balance between hyper-creativity and

structured progress or leverage others that can drive the advancement of new ideas and

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demonstrate an ROI. Furthermore, the study findings were congruent with Ali, Farooq, et

al.’s (2020) results that leaders fostering an innovative organizational climate and high

employee engagement can positively affect employee innovative work behavior that

enhances business performance. To catalyze innovation performance, business leaders

need to be proficient in fostering an innovation orientation at the organizational and

individual levels and balance uninhibited creativity with progress.

Competent professionals are central to innovation success, and promoting

innovativeness is a vital strategy for enhancing organizational performance. Developing

leadership characteristics, behaviors, and styles conducive to influencing

entrepreneurship and innovation may support employee performance. For example,

organizational innovation and transformational leadership positively affect employee

creativity and performance (Nasir et al., 2022; Zaman et al., 2020). Furthermore,

employee creativity leads to increased performance through enhanced abilities,

knowledge, and experiences that enable employees to achieve organizational objectives

(Nasir et al., 2022). The doctoral study findings, such as diversity of thought and

provocative conversations, were consistent with participation and consideration

leadership styles studied by Saythongkeo et al. (2022), which facilitates open idea

exchanges; critical feedback; cross-functional questioning, disagreements, and

negotiation; and shared decision-making.

There is potentially no best leadership style to catalyze innovation, as each

leadership style may comprise beneficial traits that influence employee innovativeness.

However, the study findings are congruent with multiple authors such that leaders who

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demonstrate entrepreneurial leadership principles model entrepreneurial behavior and

encourage employees toward new idea creation while fostering an innovative culture

(Bagheri, 2017). Furthermore, effective entrepreneurial leadership strategies may

promote an entrepreneurial culture and orientation conducive to superior performance

(Dabić et al., 2021; Kör et al., 2021; Shaher & Ali, 2020). Entrepreneurial leadership, the

concept under study, is purported to be the most suitable leadership style to foster an

entrepreneurial orientation and employee innovative work behavior. Fundamentally,

leadership styles empower business leaders to create a vision and motivate employees to

achieve innovation strategies.

Association With the Conceptual Framework

Leadership proficiency and style are central to the entrepreneurial leadership

conceptual framework. Leaders' strategic role and ability to foster new ideas, exploit

opportunities, create value, and effectively mobilize resources are essential to catalyzing

innovation, generating business value, and creating competitive advantage (Haim

Faridian, 2023). Entrepreneurial leaders influence employees through social processes

and interactions, such as framing challenges and goals, absorbing uncertainty, path

clearing, building commitment, and forming shared understanding (Haim Faridian,

2023). An entrepreneurial leader's strategic vision is critical to creating value through

governance within the innovation process (Haim Faridian, 2023). Furthermore, Raby et

al. (2023) found that entrepreneurial decision-making skills were critical for resource

utilization, funding estimation, and relationship building. Entrepreneurial leadership

skills, such as creative forward-thinking, are essential to assess and respond to current or

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emerging problems in developing and commercializing innovative products (Raby et al.,

2023). A core role of an entrepreneurial leader is to influence employees' innovative work

behavior. Central to the success of entrepreneurial leadership is the leader's ability and

behavior which results in new opportunity recognition and value creation. Innovation

leadership, adopting entrepreneurial leadership proficiencies and style, is directly tied to

the conceptual framework.

Theme 5: Innovation and Change

Innovation and change, explicitly change management, is vital to creating and

delivering innovation value. According to Company 1’s website, the organizational goal

was to foster structural and systemic change by supporting the global startup community

and expediting whole-scale impact toward health equity. A comprehensive change

management approach is essential to get stakeholders on board, embrace the change

process, and eventually adopt innovative solutions. Table 10 contains factors that

emerged from the data associated with innovation and change.

Table 10

Innovation and Change Codes and Frequencies

Code

Frequency

Subtheme

percentage

Stakeholder management

Strategic communication

Adopting change

Change resistance

Speed of adoption

Barriers to change

Status quo

Ambiguity

Radical change

Total

144

100

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Engaging stakeholders early and often, such as internal business partners and

external customers, is critical in informing the innovation strategy, developing the right

solutions, and laying the foundation of the value of the respective change. Upon review

of organizational strategy documents, Company 2 used a change strategy blueprint that

provided “a vision for what good looks like and recommended strategies and guidelines

for ways of working and stakeholder engagement via a thorough current state

assessment.” Furthermore, it was noted within Company 2’s document that

comprehensive change strategies helped “define rules of engagement between decision-

making stakeholders and principles of communication with impacted internal and

external groups to enable progress toward change.” An effective strategy for facilitating

change is establishing and leveraging change networks of highly engaged change

champions. The prioritization of stakeholders, especially early adopters, supported by

change champions can drive up adoption rates and help others navigate ambiguity.

The innovation climate can be wrought with complexity, ambiguity, and

uncertainty. As described by P1, the healthcare climate could be considered a “blackhole

that many different groups connect to.” Open and transparent communication is critical

during change efforts. This study's emphasis on effective communication may disconfirm

Škare et al.’s (see Škare et al., 2022) finding that entrepreneurship is minimally linked to

communication. A challenge for P3 is working in larger company environments that are

often siloed or functionally compartmentalized, in which incoming insights or feedback

may inconsistently land with stakeholders. According to P3, the lack of solid

interconnectivity has led to new product development delays and weaker innovation

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launches. Not only is it essential that key stakeholders be a part of innovation

development, but it may also be critical that they engage in change efforts surrounding

innovation adoption. Engaging people in shaping the change reduces resistance and helps

them navigate through ambiguity, build trust, and better understand the ROI of

innovation efforts.

Resistance to change can be debilitating to innovation performance. When it

comes to driving innovation, several business leaders noted employee resistance to

change, especially in ambiguous environments and when bringing external innovation in-

house. P4 emphasized the importance of entrepreneurial leadership practices to “help

support people that usually operate within very structured process-driven environments to

thrive within innovative spaces.” To overcome change resistance, P2 suggested that

“instead of imposing innovation on people, you identify gaps, and you help people see

that there's no other way, and at the end of the day, the value created is in people's best

interest.” Furthermore, P2 identified a “self-fulfilling prophecy,” in that people resist

change when they are already successful at their jobs and recommended directly

addressing the “what’s in it for me? why should I care?” attitude by revealing the value

that change brings to people’s lives and jobs. A leader’s role in overcoming employee

resistance to change found within this study extends Mukaram et al.’s (see Mukaram et

al., 2021) and Soomro et al.’s (see Soomro et al., 2019) research that there exists a

significant positive relationship between leadership and organizational readiness for

change and that entrepreneurial leaders' vision for change could influence followers'

ability to create or exploit strategic organizational value. Leaders are pivotal in reducing

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resistance to change, shaping followers’ experiences, and driving the adoption of

healthcare innovation. Healthcare leaders still face the challenge of building employee

confidence in managing uncertainty within ambiguous environments.

Fear of uncertainty was revealed from the study data. According to P6,

employees are experiencing a “not invented here” syndrome, in which they are less

interested and likely to adopt innovative solutions that their organization did not invent.

In P6’s perception, the fear stems from employees’ belief that they “don't know how to

do it, don't have the skill set to do it, or are not the right people to do it.” The fear of

uncertainty found within this study confirms Gieure et al.’s (see Gieure et al., 2020)

findings that individuals are likely to have an attitude and inclination to be

entrepreneurial if they have the essential skills, knowledge, and capacity. Leaders must

reduce fear of uncertainty and adequately prepare their employees for innovation and

change through practical change management principles, training and knowledge

management, skill development, and strategic resource management. Fear of the

unknown may immobilize employees and lead to change resistance, adversely impacting

innovation performance.

Another challenge impacting innovation performance and leading to change

resistance uncovered in the study is the concept of “innovation fatigue.” Several

participants noted that employees are becoming tired of constant innovation. Innovation

fatigue may stem from the bastardization of the term innovation, often used broadly and

not reserved for the top prioritized or idiosyncratic projects with significant portfolio

impact and value. As noted by P4, “people don't want to be guinea pigs; they don't want

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to try new things constantly. A lot of people want something that's fully baked and

already done and ready [to go]; they don't want to take that risk.” The innovation process

may be another reason for innovation fatigue. Overburdening processes create frustration

and discount innovation's genuinely creative and agile spirit. As cautioned by P2,

innovation fatigue can also affect the organization’s “capacity to absorb change,”

consequentially “exhausting the organization,” leading to inadequate innovation

performance. Innovation fatigue can be a significant roadblock and adversely affect

healthcare innovation. Leaders must be mindful of the organization’s capacity to

innovate, absorb constant change, and strategically prioritize or rebalance the innovation

portfolio accordingly.

Ties to Contemporary Literature

Change is an integral part of innovation, and change management is a

fundamental discipline essential to the innovation management process and value

delivery. Effecting change, primarily breakthrough or radical, often requires transforming

organizational structures, processes, and practices. The most impactful detractor to

effecting change is getting people on board and adopting the change. Harrison et al.

(2022) affirmed that change readiness was a significant precursor to whether employees

accepted and adopted a change initiative. The study findings were congruent with

Mukaram et al.’s (2021) findings that leadership is vital to entrenching organizational

readiness for change. The significance of strategic communication and preparing

stakeholders to be change ready through active stakeholder management were uncovered

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in the doctoral study findings and provide valuable practical insight to inform the change

management practices of healthcare business leaders.

Given innovation's significant effect within the healthcare industry, overcoming

resistance to change is vital to creating and delivering innovative solutions. Kashan et al.

(2022) noted that organizational resistance to change is a significant obstacle to

implementing new ideas. Furthermore, existing innovation models do not necessarily

account for the role of individuals and how to engage them in the innovation

implementation process (Kashan et al., 2022). The use of change agents and networks

was a principal finding within the doctoral study on innovation and change and congruent

with Kashan et al.'s focus on people who are active agents within the innovation process.

Establishing a support system to overcome resistance to change may catalyze innovation

performance.

Leaders are instrumental in effecting change by eliminating or limiting barriers to

innovation. Five significant management barriers that hinder innovation performance are

management support, low motivation, resistance to change, risk avoidance behavior, and

financial resource (Adegbite & Govender, 2022). The doctoral study findings indicated

that leaders profoundly support, motivate, and inspire change through leadership

influence, funding, and fostering a climate of risk-based decision-making. The doctoral

study finding on the phenomenon of "innovation fatigue" adds to the body of knowledge

and contributes theoretical and practical implications to change management theory. To

successfully implement novel, innovative solutions, change management practices should

be holistically embedded within the innovation management process.

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Association With the Conceptual Framework

Organizations must change in lockstep with evolving customer and market needs

to be competitive. To achieve fundamental change and organizational transformation,

business leaders must implement novel methods, systems, ways of working, and

innovations (Kassa & Getnet Mirete, 2022). Kassa and Getnet Mirete (2022) found that

entrepreneurial training, attitude, and leadership significantly affected innovation.

Entrepreneurial leaders, like transformational leaders, are pivotal to launching dramatic

change and innovation. Furthermore, entrepreneurial leaders can reduce change

resistance and foster new ways of working by inspiring creativity and positive attitudes in

employees (Kassa & Getnet Mirete, 2022). To gain a competitive advantage, develop

new technologies, better respond to market changes, and catalyze innovation

performance, entrepreneurial leaders should foster an entrepreneurial orientation and

drive organizational change focused on customer preferences, quality, and technology

interfaces (Siriram, 2022). Within any change initiative, a leader's role is essential in

creating awareness, desire, and knowledge, upgrading employees' ability to adopt the

change, and positively reinforcing and embedding the change within the organizational

structure, processes, and culture. Proficient entrepreneurial leaders may leverage their

skills to reduce barriers and increase adoption amongst stakeholders. Innovation and

change, precisely the change management theme, is influenced by entrepreneurial

leadership and tied to the conceptual framework.

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Theme 6: Innovation Orientation

To catalyze innovation performance, fostering a culture of curiosity, learning,

creativity, and risk-taking is imperative. Instilling a sense of purpose and igniting

employee passion is essential to establishing an organizational innovation orientation

within the business structure and individuals. As espoused on its website, Company 1 has

created an innovation orientation that tackles some of the world’s toughest healthcare

challenges by ensuring that those directly affected by a [healthcare] problem be at the

forefront of designing its solution. Furthermore, an emphasis is placed within Company

3’s strategy documentation on pursuing the highest value opportunities to address unmet

needs using best-in-class solutions that are enabled by a patient-centric innovation

orientation. Emerging from the study data were seven factors that may influence an

innovation orientation (see Table 11).

Table 11

Innovation Orientation Codes and Frequencies

Code

Frequency

Subtheme

percentage

Organizational culture

Purpose-Passion

Learning

Positive reinforcement

Diversity

Storytelling

Social change

Total

100

An innovative entrepreneurial climate is often prone to high-risk and uncertainty.

However, in a structured and regulated healthcare environment where employees are

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often risk averse, P4 advised entrepreneurial leaders to influence an environment in

which employees “feel safe.” Furthermore, P4 recommended that entrepreneurial leaders

build risk tolerance by helping employees form risk-based decisions and learn from past

failures and successes. To cultivate psychological safety and commitment, P5 urged

entrepreneurial leaders to encourage employee participation by inspiring their passions

and stimulating a “willingness to try” by developing a “coaching culture of curiosity,

openness, transparency, and candor.” The research findings confirm St-Jean and

Tremblay’s (see St-Jean & Tremblay, 2020) discovery that mentoring produces employee

self-efficacy and Kuratko et al.’s (see Kuratko et al., 2021) findings that coachability is

correlated with goal progress, product innovativeness, and firm performance. Employee

engagement and participation are influential factors in establishing psychological safety,

reducing risk-aversion, and fostering an innovation orientation. Coaching and mentoring

innovation leaders may lead to higher engagement and positive performance outcomes.

The entrepreneurship environment may be drastically different from the corporate

environment, though parallels may be drawn. Participants who previously had startup

experience and now work in large healthcare organizations noted the profound difference

in organizational culture and governing systems between the two business environments.

P3 attested that leaders could strategically change direction with minimal approval in a

startup environment. Having an agile mindset and being able to pivot swiftly meant that

innovation teams could remain closer to evolving consumer needs, iterate quicker, and

adapt more markedly than within traditional corporate environments. While the

healthcare environment is less tolerant of unbridled creativity, P2 advised entrepreneurial

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leaders to “help individuals remain motivated, optimistic, and constructive in the face of

these challenges” and emphasized that employee “passion and grit” are vital to catalyze

innovation. According to P2, funding innovation and awarding entrepreneurial behavior

of individuals who create good for the [innovation] ecosystem will benefit the company

and others and spur a new wave of innovation at little cost. This study’s findings may

disconfirm Abou-Moghli’s (see Abou-Moghli, 2018) conclusion that innovativeness and

risk-taking entrepreneurial attributes are not crucial to business success. While notable

differences exist between entrepreneurship and corporate environments, entrepreneurial

leadership plays a significant role in catalyzing innovation performance in both contexts.

Ties to Contemporary Literature

Senior and mid-level leaders are imperative in developing employee

innovativeness and promoting an innovative climate. Lek et al. (2022) found that the top

management team's innovation orientation positively mediates the organizational learning

and innovation performance relationship. The doctoral study findings are consistent with

Lek et al.'s results that senior leaders oriented toward and committed to innovation can

leverage institutional support to foster an innovative or entrepreneurial climate that

promotes learning and catalyzes innovation performance. Orienting leaders toward

entrepreneurship may support the formation of innovation strategies and plans and the

implementation of innovation outputs such as novel ideas, technologies, and processes.

Furthermore, the knowledge, skills, and abilities of leaders oriented toward innovation

influence their strategic choices, thus impacting innovation performance and

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organizational learning culture (Lek et al., 2022). Leaders committed to innovation and

able to nurture a learning culture may catalyze innovation performance.

Leaders with an entrepreneurial orientation may be predisposed to other business

orientations that enhance healthcare innovation. Mohungo et al. (2022) found that an

entrepreneurship orientation significantly and positively influences a market orientation,

aesthetics innovation, and business performance. Similarly, Giri et al. (2022) found that

entrepreneurial orientation and culture positively and significantly affected business

performance and innovation. The doctoral study findings were consistent with Mohungo

et al.'s and Giri et al.'s results, as having an agile and entrepreneurial mindset helped

leaders foster an entrepreneurial and market orientation that brought their organizations

closer to consumer needs and effectively facilitated the development and

commercialization of innovative solutions that generated business value. The study

findings also supported Jeong et al.’s (2019) observations that leaders who establish an

adaptive organizational culture and people-centered management style influence firm

entrepreneurial orientation and performance. Fundamentally, proficient leaders with an

entrepreneurial or innovation orientation have the propensity to act more independently

and creatively, take calculated risks, make strategic decisions to explore and exploit new

opportunities tied to the market and consumer needs, and develop an organizational

culture and followers to do the same.

Association With the Conceptual Framework

Entrepreneurial leaders who foster an entrepreneurial orientation and culture can

help employees be creative, identify and exploit new opportunities, take calculated risks,

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and achieve personal development within an ambiguous environment. Passion is an

essential aspect of entrepreneurship, and entrepreneurial leaders who can instill a sense of

passion and connect employees' innovative work behavior to a common purpose may

have a positive influence on entrepreneurial intentions, motivations, persistence,

commitment, innovation performance, and business growth (Dhakal et al., 2022).

Learning is also essential to an entrepreneurial orientation and indispensable to leadership

development in forming entrepreneurial knowledge, skills, and abilities. Rugpath and

Mamabolo (2022) found that meaning-making, redefining the purpose, entrepreneurial

competencies, leading self, leading others, and functioning as a jack of all trades are

essential to positive learning outcomes. Proficient entrepreneurial leaders had an open

and agile mindset, self-efficacy, took calculated risks, and solved problems, thereby

accelerating their learning development, and promoting a learning orientation coupled

with an entrepreneurial orientation to improve entrepreneurship and business

performance (Rugpath & Mamabolo, 2022). Entrepreneurial leadership promotes an

environment where employees can feel safe to be innovative, contribute ideas, and

accomplish goals without feeling intimidated (Malibari & Bajaba, 2022). Entrepreneurial

leaders who instill employee passion, purpose, and learning may positively affect

employee innovative work behavior and shape an innovation climate that catalyzes

innovation performance by transforming opportunities and challenges into growth and

profit. Thus, innovation orientation and climate themes are influenced by entrepreneurial

leadership and tied to the conceptual framework.

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Applications to Professional Practice

Applications to professional practice involve empowering healthcare business

leaders with theoretical and practical implications for applying entrepreneurial leadership

strategies to catalyze innovation performance. The doctoral study research findings apply

to professional practice in the healthcare industry, specifically pharmaceutical, medical

device, and consumer healthcare sectors. The research findings inform healthcare

business leaders of the significant effect entrepreneurial leadership has on setting the

strategic vision and action plans; engaging and motivating stakeholders; developing

innovative solutions; implementing change; and creating, capturing, and measuring value.

Healthcare leaders may enhance business and innovation performance and acquire

competitive advantage by understanding the antecedents and drivers of innovation. The

research findings may also extend and enhance business practices within other industries.

Innovation Strategy, Management, and Performance

The healthcare industry encompasses numerous organizations vying for

customers, market share, and competitive positioning. To survive and remain

competitive, healthcare organizations must create partnerships, share specialized

knowledge, cut costs, and mitigate risks while rapidly developing innovative healthcare

solutions (Akay et al., 2022). Innovation within a highly complex and risk averse

healthcare environment has challenged business leaders (Dube et al., 2022). Within the

research findings is an emphasis on innovation strategies to adopt a market and customer

orientation, to create value above base business, and for leaders to construct a robust

innovation framework and roadmap that defines success. While noted in the research

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findings that there is no secret formula to innovation, leaders may successfully innovate

within a highly challenging healthcare environment by forming innovation strategies and

action plans that comprise well-defined goals and milestones tied to strategic

organizational objectives, distinct ROI, and a sense of purpose. To achieve innovation

success, leaders must establish a robust innovation process.

The innovation process is fundamental to delivering business and customer value.

Haring et al. (2022) found that an in-depth appreciation and understanding of healthcare

innovation processes were lacking and that challenges to overcome barriers were

common to all stakeholders. Therefore, implications surrounding the three core phases of

the innovation process, early, mid, and late stages, were accentuated within the research

findings. Within early-stage innovation, business leaders advocated that idea

management was imperative to promote idea generation, critical examination, and

prioritization of concepts. In addition, including multiple stakeholders within the idea

management process is essential to patient-centered care (Välimäki et al., 2022). An

experimental design that includes forming assumptions and hypotheses, opportunity

recognition and problem-solving, testing and piloting concepts, and a suitable funding

and governance structure to steer innovative projects was recognized as essential to

innovation development within mid-stages. Key findings from Moss et al.’s (2022) study

are that organizational commitment to and financial support of innovative pilots was

crucial and can be influenced by intrapreneurial champions. The creation, testing, and

financial support of ideas play an instrumental role in driving healthcare innovation.

Leaders must balance the creative development phases with implementation and

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measurement phases of innovation management to deliver healthcare solutions

effectively.

Effective implementation and measuring innovation performance were

instrumental to late-stage innovation. Numerous measures of innovation are used by

organizations and vary in complexity and effort in collecting and analyzing data (Trachuk

& Linder, 2022). While measuring the value of ideas was deemed challenging to business

leaders, the research findings supported by the literature (Trachuk & Linder, 2022)

bestowed several financial and nonfinancial measures that leaders could apply to

innovative projects. Using qualitative and quantitative measures beyond financial metrics

can enhance the management and oversight of healthcare innovation. Leaders who

understand innovation drivers within each stage of the innovation process can affect

professional practice by critically analyzing healthcare’s most challenging problems and

fully exploiting opportunities that deliver innovative healthcare solutions and enrich

business performance.

Innovation Leadership, Orientation, and Change

Entrepreneurial leadership’s effect on healthcare innovation was the focal topic of

the doctoral study. The research findings supported the central role that healthcare leaders

play in fostering an innovation orientation, highly collaborative stakeholder engagement,

and novel ways of working. Festa et al. (2021) advocated that pharmaceutical leaders

develop competitive strategies surrounding their strengths which are focused on

differentiation or niche orientation toward enhancing innovation. Furthermore, leaders

are instrumental in helping employees navigate ambiguity and champion change

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adoption. Lindsay (2022) found that it is essential to develop and support leaders in

strengthening their voice, confidence, influence, and capability in their leadership

practice and using creativity and action amid uncertainty and ambiguity. Leaders

prepared to manage ambiguous environments may better support employees through

uncertainty. Developing innovation strategies and fostering an entrepreneurial climate

that promotes innovative work behavior, such as creativity, may catalyze innovation

performance and adoption of healthcare solutions.

Employees that demonstrate innovative behaviors may help drive innovation in a

complex, challenging healthcare environment. Entrepreneurial leadership stimulates

employee self-initiated, innovative behavior within ambiguous and uncertain

environments and leads to the recognition and improvement of entrepreneurial

opportunities (Bilal et al., 2022). A pivotal aspect of leaders’ roles is to nurture ideal

organizational citizenship behavior that facilitates innovative work behavior and the

development and adoption of new capabilities and competencies. By leveraging the

insights and strategies of the doctoral study research, business leaders can affect

professional practice by inspiring employees to be more curious and creative, think

critically, take calculated risks, rapidly experiment, learn from failure, and shape an

entrepreneurial mindset that catalyzes innovation performance, heightens customer

satisfaction, and delivers business value.

Implications for Social Change

Beyond business success, organizations can contribute to society through social

change initiatives. Social entrepreneurship is a paradigm that enables leaders to derive

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answers to societal problems in education, environment, health, and human rights (Valle-

Mestre et al., 2022). While social entrepreneurship is still in its infancy, it is increasingly

recognized as impactful to a nation’s social, economic, cultural, and environmental

wealth (do Adro & Fernandes, 2022). This doctoral study’s research findings could

contribute to social entrepreneurship and innovation in several ways. Proficient business

leaders may generate interactive and collective learning, institutional change, and the

creation of entrepreneurial capabilities that lead to social innovation (Naranjo-Valencia et

al., 2022). Furthermore, entrepreneurial leaders may help discover societal opportunities

and explore answers to social problems that generate income or support global economic

and environmental sustainability (do Adro & Fernandes, 2022). Through this doctoral

study, healthcare business leaders are better informed on strategies that catalyze

innovation performance through effective innovation management processes, strategy

formation, and leadership practices that foster an innovation orientation and drive change

adoption. Business leaders may effect positive social change by developing new leaders.

Business leaders who produce innovative healthcare solutions could shape

economic and social survival strategies for rural communities and deprived nations

(Naranjo-Valencia et al., 2022). A key research finding was that coaching and mentorship

of individuals within innovative programs benefited individual growth and resulted in

enhanced innovation performance. Entrepreneurial leaders practicing social

entrepreneurship may coach and mentor external talent that can achieve societal goals,

provide insights to the organization, and potentially create job opportunities for

individuals seeking to enter the industry. Organizations that outperform competitors in

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social innovation may differentiate themselves and achieve competitive advantage and

long-term organizational sustainability (do Adro & Fernandes, 2022). Valle-Mestre et al.

(2022) noted that social innovations are created based on social dimensions and not on

organizations’ economic interests. With the in-depth insights and practical strategies to

foster organizational entrepreneurship and innovation provided in this doctoral study,

business leaders focused on positive social change could extend the same strategies

across external individuals, communities, organizations, institutions, cultures, or societies

to solve healthcare challenges.

Recommendations for Action

As found in this doctoral study, entrepreneurial leadership strategies are effective

in catalyzing innovation performance. Navigating complex and uncertain business

environments, such as within healthcare, is an essential facet of entrepreneurial

leadership and innovation performance. To conceive, develop, and implement healthcare

innovation using entrepreneurial leadership, business leaders should consider the

following recommendations:

1. Innovation Management: Choose an innovation framework that facilitates

idea generation, opportunity recognition, and problem-solving via

crowdsourcing and premortem analysis; experimental design comprising

hypothesis testing and prototyping via rapid iterations; senior leadership and

diverse thought leadership consultation via innovation councils; and constant

introspection to pivot strategically. Ensure a robust communication strategy is

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in place across the innovation lifecycle. Lastly, periodically calibrate the

innovation strategy and progress with internal and external stakeholders.

2. Innovation Strategy: Seek growth opportunities outside traditional need states

and beyond base business while leveling risk across the portfolio. Clearly

articulate goals, objectives, performance measures, and expected outcomes

tied to consumer and market direction, competitive positioning, and

organizational growth potential. Stay abreast of the rapidly evolving

healthcare landscape to identify and exploit opportunities, uncover unmet

needs, and inform the innovation strategy. Develop and invest in external

partnerships, especially where dynamic capabilities do not exist internally.

Embed project management and risk management principles throughout the

innovation strategy and process.

3. Innovation Performance: Clearly define customers’ needs and what success

looks like and identify key milestones that generate an ROI. Foster metric-

driven behavior, though discerning between early- and late-stage innovation

performance measures. Adopt more qualitative measures during early-stage

innovation and more quantitative ones during development and

implementation.

4. Innovation Leadership: Hire, develop, and retain leaders with an

entrepreneurial mindset who can lead and deliver within ambiguous

environments. Establish a training program to develop entrepreneurial

leadership traits needed to foster an entrepreneurial and innovative orientation

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and propagate innovative work behavior amongst employees. Analytically

identify suitable employees to lead innovation projects, avoid rotating key

leaders, and reward teams for positive performance and failures. Leverage an

entrepreneurial leadership style to engage, empower, recognize, and inspire

passion and a sense of purpose within employees. Lastly, establish a coaching

and mentorship program to develop employees on entrepreneurship principles

and practices.

5. Innovation and Change: Manage innovation change using a robust change

management framework, such as Prosci ADKAR. Establish and develop a

change network that leverages change agents and early adopters. Create a

strategic communication plan inclusive of key messages. Analytically

prioritize key stakeholders, break down silos, and fortify interconnectivity

between key business partners. Strategically optimize, prioritize, and

communicate innovation initiatives to lessen innovation fatigue, limit

resistance to change, and augment change readiness.

6. Innovation Orientation: Cultivate an entrepreneurial and innovative culture by

materializing psychological safety when dealing with high-risk and

uncertainty. Embed agile philosophies, as appropriate, to swiftly pivot in line

with rapidly evolving market and customer needs. Establish an organizational

risk tolerance, nurture risk-based decisions, and empower employees with

decision-making autonomy. Encourage employees’ creativity and willingness

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to try by inspiring passion, grit, and a sense of purpose tied to organizational

objectives.

Three approaches will be used to disseminate the doctoral study findings. First, a

high-level summary of the findings will be provided to business leaders who participated

in the study for consideration and potential adoption within business practice. Second, the

study will be published in Walden University’s ProQuest database for the benefit of

future scholars. Lastly, I will work with my doctoral study chair and second committee

member to adapt and publish the research within a reputable journal.

Recommendations for Further Research

The purpose of this qualitative multi-case study was to explore entrepreneurial

leadership strategies that some healthcare business leaders working in the

pharmaceutical, medical device, and consumer healthcare sectors in North America and

Western Europe used to catalyze innovation performance. Six business leaders from

independent organizations across three large multinational firms were interviewed to

answer the research question. Recommendations for further research include expanding

the breadth and depth of the research. Including diverse industries, sectors, firms, and

geographies and increasing the number of participants may add to the generalizability of

the research findings. Furthermore, interviewing employees that implement the

entrepreneurial leadership strategies of business leaders would add additional insight into

the approach and effect of the strategies. Longitudinal studies comprising larger sample

sizes or controlled conditions could provide better insights into how entrepreneurial

leaders catalyze innovation. Entrepreneurship and innovation were the primary foci of the

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research. While the doctoral study covered several leaders with past entrepreneurial

startup experience, further research should include interviews with leaders directly in the

entrepreneurial space instead of the corporate environment. Comparing and contrasting

corporate intrapreneurship versus entrepreneurship would enhance the value of insights.

The last recommendation for further research would be to quantitatively examine each

theme or subtheme and its relationship with entrepreneurial leadership and innovation.

Reflections

Approximately 10 years had elapsed since I started my MBA. The 3-year MBA

journey significantly shaped my academic and personal life and prepared me for realizing

my dream of achieving a doctorate. While being conferred as a doctor is a significant life

achievement, the doctoral journey has shaped my personal, academic, and career life. The

doctoral study process provided a valuable blend of scholarly and practical research. A

doctorate program demands time, focus, commitment, and energy. More importantly,

pursuing a doctorate requires an unrelenting spirit and a healthy appetite for learning.

Furthermore, I found that having a suitable support network, such as family,

friends, and colleagues, facilitated the journey and significantly contributed to a positive

outcome. The DBA journey was one of self-discovery that broadened my horizons and

enriched my intellectual faculties. The research study deepened my strategic mindset on

various organizational constructs and emboldened me to pursue my future goals of

starting a leadership consulting business focused on entrepreneurship and innovation and

giving back to the community through professorship.

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Having close to 20 years of experience in healthcare, specifically, the

pharmaceutical sector, brings a wealth of knowledge and experience. The potential for

preconceived personal biases to creep into the research was present during the study

design and conduct stages. However, practicing constant reflexivity, comprising self-

examining biases and assumptions, helped minimize or avoid researcher bias.

Interviewing participants within a close network could introduce participant bias in which

the participant may respond in a way they perceive as matching up to the desired results

of the researcher. Participant biases were minimized by asking participants clarifying or

probing questions, requesting examples, and conducting member checking, ensuring a

proper understanding and interpretation of the data. Rapport was built early with

participants, and a comfortable virtual setting was used to conduct interviews, limiting

researcher influence, and allowing participants to speak candidly about their

organizations and personal experiences.

Conclusion

Globalization, rapid technological advancement, and significant hurdles in

diffusing, adapting, and leading innovation efforts have challenged healthcare leaders.

Healthcare business leaders are compelled to catalyze innovation performance through

effective entrepreneurial leadership strategies that enhance economic growth and

profitability and deliver improved patient and customer outcomes. As found within this

research study, improving healthcare innovation outcomes takes cutting-edge strategies,

agile processes, effective leadership practices, holistic change systems, an entrepreneurial

climate, and a community of talented, passionate, and purpose-driven employees. While

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not extensively adopted within business practices, healthcare leaders are encouraged to

embrace entrepreneurial leadership to create organizational strategies that lead to

differentiation, profit, and competitive advantage. Beyond improved business

performance, proficient entrepreneurial leaders may return value to society through social

entrepreneurship and innovation.

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