Change agents and policy entrepreneurs at the local level

This research study is of four county-level efforts (three funded by an external foundation change agent, the fourth indigenous) to develop locally-designed innovations to extend health care coverage to the uninsured. This research posits, tests and supports a relationship where external change agents will stimulate (and indeed rely on) the appearance of policy entrepreneurs when funding innovative change efforts at the local level. The findings, supported by the development of two formal decision models, show that external change agents can play an important role in encouraging policy innovation at the local level, that the pre-existing local market context is an important predictor of the success of innovative efforts, and that the appearance of policy entrepreneurs to lead externally-funded innovations increases the probability of the successful development and launch of desired innovations. Another key finding is that collective entrepreneurship, posited to occur when innovation is desired in a technically complex issue area, is key to the successful development and launch of innovations at the local level. Collective entrepreneur teams are groups of several persons who possess the differing components of a policy entrepreneur skills and assets, and appear in issue areas where complexity is so high that it is unlikely that one person possesses all of the necessary skills and assets to single-handedly act as a policy entrepreneur.; Perhaps the most useful finding of this research is that earlier theories of policy entrepreneurship are too simplistic, and fail to capture, define and explain the complexity that policy entrepreneurs and their collective teams face when pursuing innovation. By building on existing theories of policy subsystems and theories of punctuated policy change, this study posits and supports the idea that innovative policy changes will inevitably have to overcome a policy subsystem in order to develop and launch a desired innovation. The power of policy subsystems was found to differ across communities at the same point in time, thus leading to the conclusion that innovations that can succeed in some communities may not succeed in others, at the same point in time.; Two formal decision models of innovative change at the local level were developed and assessed, one of externally-initiated change, the other of internally-initiated change. In both models, it was found, and supported by the qualitative case studies, that two keys to the decision to pursue change were the ability to accurately assess the readiness of the community to support change, and the innovator's (external or indigenous) valuation of the best and worst outcomes. For a policy entrepreneur, it was also found that this person's ability to self-assess their own abilities, and match them to the innovative challenge, were additional components of the decision to pursue change.