Chapter 7 The Entrepreneurial Process in Health Care: The Nashville Phenomenon

Abstract

In this paper, we argue that the opportunities created from the recent transformational change in the health care industry have provided the environment for entrepreneurship to thrive. As a result, new and innovative organizational forms have flourished particularly when embedded in communities of entrepreneurial activity where networks of experience, access, and social/work relationships exist. The major purpose of this paper is to initiate a theoretical dialogue in which entrepreneurship is introduced as a field of research that can be used to explain how and why health care organizations have emerged and changed into their present forms. First, we present the basic elements for understanding the process of entrepreneurship and how entrepreneurial activity is important to the innovation of new organizational forms. Second, we relate this to the field of health care by focusing on the three stages in the entrepreneurial model: creation, discovery, and exploitation of entrepreneurial opportunities. Third, we argue that the degree of entrepreneurial activity within a given community is the outcome of a dynamic process involving social networks along with positive economic and legal activities that reduce transaction costs and encourage entrepreneurship. To demonstrate this, we focus on the area known as the “health care business capital” in the U.S. – Nashville, Tennessee – and describe the entrepreneurial activity in that city beginning in the 1960s and relate this to the existing theory. We believe this research represents a juxtaposition of the practical and theoretical, so critical in understanding entrepreneurial activity and new organizational forms in health care.