Toward organizational pluralism: Institutional intrapreneurship in integrative medicine

A critical stage in change toward institutional pluralism occurs when incumbent organizations must begin to integrate diverse logics in their operations. The required institutional work inside organizations at that stage - institutional intrapreneurship - faces distinctive challenges. Incumbent logics are entrenched in organizational routines, status orders, policies and structures, which hampers change and triggers resistance. We use qualitative data from two integrative medicine programs inside large healthcare organizations to understand how institutional intrapreneurs work to integrate this new logic in these highly institutionalized organizations. We find that intrapreneurs use opportunistic tactics to create and strengthen organizational free spaces aligned with the new logic, and then leverage the capacity thus created to extend elements of the new logic into the broader organization. The study suggests that taking organizational context seriously can help explain the fate of early stage efforts towards institutional change.