High-skilled immigration enhances regional entrepreneurship.

Immigrants are highly entrepreneurial. But, what is the broader relationship between high-skilled immigration and regional entrepreneurship activity beyond the ventures that immigrants establish themselves? Using administrative data on newly awarded H-1B visas in the United States, we document a positive relationship between high-skilled immigration and regional entrepreneurship. A doubling of immigrants to a metropolitan statistical area is followed by a 6% increase in entrepreneurship within three years. In contrast, continuing H-1Bs and the arrival of unskilled immigrants (H-2B visas) do not increase regional entrepreneurship. Focusing on Indian immigrants (representing about 70% of all H-1B visas), we find the effect is stronger in metropolitan statistical areas with a larger local Indian population, but not other nationalities, suggesting that presence of conationals facilitates the relationship between high-skilled immigration and regional entrepreneurship. We present this and other evidence as consistent with a knowledge transfer mechanism.

Founder personality and entrepreneurial outcomes: A large-scale field study of technology startups.

Technology startups play an essential role in the economy-with seven of the ten largest companies rooted in technology, and venture capital investments totaling approximately $300B annually. Yet, important startup outcomes (e.g., whether a startup raises venture capital or gets acquired) remain difficult to forecast-particularly during the early stages of venture formation. Here, we examine the impact of an essential, yet underexplored, factor that can be observed from the moment of startup creation: founder personality. We predict psychological traits from digital footprints to explore how founder personality is associated with critical startup milestones. Observing 10,541 founder-startup dyads, we provide large-scale, ecologically valid evidence that founder personality is associated with outcomes across all phases of a venture's life (i.e., from raising the earliest funding round to exiting via acquisition or initial public offering). We find that openness and agreeableness are positively related to the likelihood of raising an initial round of funding (but unrelated to all subsequent conditional outcomes). Neuroticism is negatively related to all outcomes, highlighting the importance of founders' resilience. Finally, conscientiousness is positively related to early-stage investment, but negatively related to exit conditional on funding. While prior work has painted conscientiousness as a major benefactor of performance, our findings highlight a potential boundary condition: The fast-moving world of technology startups affords founders with lower or moderate levels of conscientiousness a competitive advantage when it comes to monetizing their business via acquisition or IPO.

Early-life exposure to hardship increased risk tolerance and entrepreneurship in adulthood with gender differences.

Many entrepreneurs credit their success to early hardship. Here, we exploit geographical differences in the intensity of China's Great Famine to investigate the effect of hardship during formative years on individual personality and engagement in business entrepreneurship. To exclude factors that might confound the relation between famine intensity and entrepreneurship, we model famine intensity by random weather shocks. We find robust evidence that individuals who experienced more hardship were subsequently more likely to become entrepreneurs (defined broadly as self-employed or business owners). Importantly, the increase in entrepreneurship was at least partly due to conditioning rather than selection. Regarding the behavioral mechanism, hardship was associated with greater risk tolerance among men and women but increased business ownership only among men. The gender differences were possibly due to the intricate relationship between a Chinese social norm­men focus more on market work, while women focus more on domestic work­and interspousal risk pooling associated with occupational choices. Scientifically, these findings contribute to a long-standing debate on whether entrepreneurship is due to nature or nurture, particularly how hardship conditions people to be entrepreneurial. The findings also highlight the importance of gender differences in shaping the effect of early-life experience on life cycle outcomes.

Does patent pledge reduce pollution and carbon emissions? Evidence from China.

The existing literature has extensively examined the impact of green innovations, such as patents, on pollution and carbon emissions. However, there has been comparatively less emphasis on the debt financing of green innovation by using patents as collateral. This oversight may have implications for the realization of pollution and carbon emissions reduction goals. Using a natural experiment based on the patent pledge pilot policy in China, this study investigates the impact of patent pledge on pollution and carbon emissions. We find that a significant reduction in the emissions of sulfur dioxide and carbon dioxide attributable to the patent pledge pilot policy, particularly in cities with lower initial green patent rates, and these results still hold after an array of robustness checks. We show that the encouragement of green innovation and the stimulation of environmental entrepreneurship are the mechanisms underlying these emission reduction effects. Furthermore, our analysis indicates that the impact of patent pledges on emission reduction is more pronounced in cities characterized by higher levels of government-reported environmental concern, public engagement in environmentally related searches, pollution information transparency indices, and green development evaluation indices.

Perceptions of HIV self-testing promotion in black barbershop businesses: implications for equitable engagement of black-owned small businesses for public health programs.

BACKGROUND: HIV self-testing (HIVST) offers an innovative and promising approach to increasing HIV testing among Black men in the United States, a population disproportionately affected by HIV. However, engaging Black men in traditional HIV prevention programs has been challenging due to stigma, medical mistrust, and limited access to preventive health services. This formative qualitative study aimed to explore the potential of utilizing barbershops as an example of a nontraditional healthcare venue to promote and distribute HIVST. METHODS: Four virtual focus group discussions (FGDs) consisting of 19 participants in North Carolina were conducted with Black men, including barbershop business owners, barbers, and their customers, to assess perceptions of HIVST and the acceptability of partnering with barbershop businesses to promote HIVST. FGDs were digitally recorded, transcribed, and analyzed using a deductive coding approach to thematic analysis. RESULTS: Participants reported that the trusting relationship between barbers and their customers, which may not exist between Black men and health care providers, is a facilitator of collaborating with barbershop businesses to reach Black men for HIVST distribution. Participants recommended providing education for barbers on the use of HIVST, as well as how to inform self-testers about linkage to care following HIVST to build the credibility of the barbers in delivering the intervention. Participants also raised the issue of the cost of HIVST to barbershop customers as a potential barrier to implementation, as well as the possibility that the implementation of such interventions could be seen as out of place in a barbershop business venue. Participants also expressed a strong belief that compensation to barbershops and their employees should accompany any intervention. CONCLUSION: These findings suggest that barbershop business venues may provide an appropriate venue for HIVST promotion and distribution, though factors like cost, training, and incentivization of implementers are necessary to consider in implementation planning. Furthermore, partnerships between public health actors and the business community must be built on equitable engagement to ensure the long-term viability of these critical initiatives.

Accelerating decarbonized economic growth through net-zero entrepreneurship: Low-carbon economic development perspective.

Net-zero entrepreneurship is a novel concept introduced in the context of carbon neutrality, and exploring whether it can catalyze decarbonized economic growth is a worthy pursuit. This study constructs a comprehensive, low-carbon endogenous economic growth model to scrutinize the intricate nexus between net-zero entrepreneurship and decarbonized economic growth. Empirical validation employs a series of multiple regression models to rigorously test the hypotheses derived from the theoretical framework using an extensive dataset spanning Chinese provinces. The results reveal a nuanced landscape. (i) Net-zero entrepreneurship plays a remarkable role in promoting decarbonization growth, with considerable regional heterogeneity. (ii) Green technology progress exhibits a notable mediating effect. (iii) Environmental regulation and industrial structure optimization have positive moderating effects. (iv) The results passed alternative dependent variable and one-phase lag regression robustness tests. In a distinct contribution to entrepreneurship literature, this study augments the discourse on strategies to steer low-carbon transitions. The research findings indicate that net-zero entrepreneurship can accelerate the global decarbonization process, and green technology progress is a significant driving mechanism in this process. Additionally, it is essential to strengthen environmental agencies' regulatory oversight and optimize industrial structures to pave the way for transformative sustainable growth. In the future, more entrepreneurs should be encouraged to engage in green technology and business model innovation to contribute to global decarbonization efforts.

Effects of 3S business intelligence systems for nursing students: a repeated-measures randomized control trial.

BACKGROUND: The growing need for healthcare services as a result of a consistently rising prevalence of chronic diseases and rapid population aging calls for a new set of activities and practices. Therefore, we developed a program-3S (Simple, Smart, and Speed) Business Intelligence Systems (3S-BIS), which is an ERP software system that helps nursing business to support nursing entrepreneurship -and analyzed its effects on nursing students. METHODS: A repeated-measures randomized controlled trial was performed with two groups: experimental (n = 29) and control (n = 30) groups. The former group underwent the five-day 3S-BIS education program. Each session comprised four components: lectures 1 and 2, simulation case study, and debriefing. Post-tests were performed immediately post-intervention and four and eight weeks later. The effectiveness was measured using the following variables: simulation design assessment, evaluation of educational practices in simulation, education satisfaction, self-efficacy for learning, and entrepreneurship. The differences before and after intervention between the experimental and control groups were analyzed using the Friedman test. The Mann-Whitney U test was used for comparisons between groups at each time point, and the Wilcoxon signed-rank test was used for comparisons within groups at each time point. RESULTS: Post-intervention (8 weeks after intervention), the experimental group demonstrated higher simulation design assessment (z = -3.88, p = < .001), evaluation of educational practices in simulation (z = -3.34, p = .001), education satisfaction (z = -3.11, p = .002), self-efficacy for learning (z = -3.04, p = .002), and entrepreneurship (z = -2.15, p = .031) compared to controls. Furthermore, simulation design assessment score in the experimental group significantly differed between T1 (immediately after intervention) and T0 (baseline), and between T3 (8 weeks after intervention) and T0. Evaluation of educational practices in the simulation, education satisfaction, and self-efficacy also significantly differed between T1 and T0, and between T3 and T0. Entrepreneurship significantly differed between T3 and T2 (4 weeks after intervention), and between T3 and T0. CONCLUSIONS: The 3S-BIS program contributes to enhancing nursing start-up competency. Subsequent studies should evaluate the effects of the program on nurses who work in home healthcare services.

Effects of Project-Based Learning on Entrepreneurship Skills and Characteristics of Nursing Students.

Entrepreneurship is pivotal globally, reflecting a nation's potential. Effective education management is crucial for fostering an entrepreneurial mindset in nursing students. This cross-sectional quasi-experimental study, using a one-group pretest-posttest design, examines the impact of project-based learning on nursing students' entrepreneurial skills at the Institute of Nursing, Suranaree University of Technology. The sample included 59 fourth-year nursing students from the third semester of the 2022 academic year. A validated proactive teaching and learning management plan based on project-based learning was used. Research instruments were entrepreneurship skills and entrepreneurial characteristics assessment forms, with reliability coefficients of 0.71 and 0.83, respectively. Data collection spanned 6 weeks, analyzed with paired t-tests and ANCOVA to test mean differences after controlling covariates. Findings showed a statistically significant improvement in entrepreneurial skills and characteristics post-learning (p < 0.05). ANCOVA results, accounting for baseline scores and GPA, confirmed the project-based learning intervention's significant and robust impact on entrepreneurial skills and characteristics. Active learning through project-based approaches significantly enhances entrepreneurial skills and entrepreneurial characteristics among nursing students, with potential applicability across diverse disciplines.

Scoping review on the link between economic growth, decent work, and early childhood caries.

BACKGROUND: Early Childhood Caries (ECC) is a prevalent chronic non-communicable disease that affects millions of young children globally, with profound implications for their well-being and oral health. This paper explores the associations between ECC and the targets of the Sustainable Development Goal 8 (SDG 8). METHODS: The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In July 2023, a search was conducted in PubMed, Web of Science, and Scopus using tailored search terms related to economic growth, decent work sustained economic growth, higher levels of productivity and technological innovation, entrepreneurship, job creation, and efforts to eradicate forced labor, slavery, and human trafficking and ECC all of which are the targets of the SDG8. Only English language publications, and publications that were analytical in design were included. Studies that solely examined ECC prevalence without reference to SDG8 goals were excluded. RESULTS: The initial search yielded 761 articles. After removing duplicates and ineligible manuscripts, 84 were screened. However, none of the identified studies provided data on the association between decent work, economic growth-related factors, and ECC. CONCLUSIONS: This scoping review found no English publication on the associations between SDG8 and ECC despite the plausibility for this link. This data gap can hinder policymaking and resource allocation for oral health programs. Further research should explore the complex relationship between economic growth, decent work and ECC to provide additional evidence for better policy formulation and ECC control globally.

[Development of innovations for neighborhood care-Contribution of social innovation laboratories]. / Innovationsentwicklung für die Pflege im Quartier ­ Beitrag von sozialen Innovationslaboren.

The article demonstrates the contributions of the innovation program "D-Care Lab Baden-Württemberg 2023" to the development of innovative solutions for neighborhood care. The effects of the program are reconstructed on the basis of initial research findings pertaining to the innovation program. A distinctive aspect of the laboratory is its cross-sectoral collaborative structure. The levels of impact can be defined as follows: the acquisition of skills by the participants, the connection between skills acquisition and learning arrangement, the changes observed as a result of participation and the innovative solutions developed for care in the neighborhood. The initial results are presented in accordance with the theoretical research design and research methods previously outlined. The results demonstrate alterations in the competence profiles of the participants and the impact of the cooperative laboratory setting on the development of solutions. Based on these findings, the function of innovation programs becomes evident, thereby highlighting the necessity for mid-term to long-term impact analysis.

Plastic Venture Builder (PVB): An empirically derived assessment tool to support plastic waste management ventures in low- and middle-income countries.

Plastic waste management is a complicated challenge that in recent years has gained attention as a global policy priority. In low- and middle-income countries (LMIC), waste management is heterogeneous and context-specific and many organizations provide needed waste management services, including entrepreneurs. Sustainable entrepreneurs are uniquely positioned to provide these services; however, they face challenges such as limited support system and lack of capacity. The goal of this paper is to understand critical characteristics of successful plastic waste management ventures in LMIC and operationalize those insights into a strategic tool. A wide variety of successful ventures from diverse LMIC contexts are systematically analyzed to identify which factors contribute to their business viability and ability to deliver services. The identified success factors were built into a tool, the Plastic Venture Builder (PVB), based on the multi-criteria analysis methodology. This is validated using empirical cases, tested on projects currently in development and discussed with experts in the field. The results show that political, economic, financial, technological, operational, social, team and legal factors contribute to success; however pathways to success are diverse. We identify a strong team as the most critical factor, whereas financial, political and social factors have the least impact. The PVB can be used by entrepreneurs who want to set up or improve plastic waste management ventures by identifying weak spots or avenues for improvement. The assessment framework can also be used by policy makers, development agencies and financing organizations who want to support or assess waste management initiatives by prioritizing their resources to match the identified critical factors.

An Exploratory Study of the Perceived Need for and Acceptability of a Healthy Frozen Meal Product Among Rural Corner Store Customers in North Carolina.

This pilot study assesses barriers to obtaining healthy affordable food and the early-stage acceptability of a novel subsidized healthy frozen meal product designed to address food insecurity and nutritional status among corner store customers in rural North Carolina. A convenience sample of 50 customers were surveyed to examine the perceived availability of healthy food options, barriers to maintaining healthy diets, food shopping and consumption habits, and reception of the product. Findings confirmed barriers to obtaining healthy foods that the product seeks to address, the validity of corner stores as the intervention site, and approval of the product's taste and concept.

The relationship between succession and intellectual capital with entrepreneurship in hospitals.

BACKGROUND: The hospital environment is very dynamic and faces many internal and external changes. Healthcare knowledge and technology are developing at a swift pace. This study investigated the relationship between succession and intellectual capital with entrepreneurship at the Qazvin University of Medical Sciences hospital, Iran. METHODS: The number of employees working in six hospitals was 2256, and according to Morgan's table, the required number of samples was 331. We distributed three hundred sixty-five questionnaires considering 10% of sample loss. We used a multi-stage stratified sampling method. In the first stage, each hospital was considered a stratum. After that, occupational groups were considered the next stratum within each hospital, and based on the ratio, the required number of samples for each occupational group was randomly selected. We used the Sobel test to investigate the mediating role of intellectual capital and the structural equation model to fit the research model. RESULTS: Succession aspects, including culturalization, meritocracy, job promotion path, and the role of senior managers, have a positive and significant effect on intellectual capital. Succession is only effective on intellectual capital and does not affect the personnel's entrepreneurship directly or through intellectual capital. CONCLUSION: Conducting training classes and intervention programs and using localized succession models can create a suitable platform for increasing organizational creativity and entrepreneurship, motivating the hospitals' personnel, and increasing intellectual capital.

Using telehealth to support community health workers in Uganda during COVID-19: a mixed-method study.

BACKGROUND: At the onset of the COVID-19 pandemic, a local consortium in Uganda set up a telehealth approach that aimed to educate 3,500 Community Health Workers (CHW) in rural areas about COVID-19, help them identify, refer and care for potential COVID-19 cases, and support them in continuing their regular community health work. The aim of this study was to assess the functioning of the telehealth approach that was set up to support CHWs during the COVID-19 pandemic. METHODS: For this mixed-method study, we combined analysis of routine consultation data from the call-center, 24 interviews with key-informants and two surveys of 150 CHWs. Data were analyzed using constant comparative method of analysis. RESULTS: Between March 2020 and June 2021, a total of 35,553 consultations took place via the call center. While the CHWs made extensive use of the call center, they rarely asked for support for potential Covid-19 cases. According to the CHWs, there were no signs that people in their communities were suffering from severe health problems due to COVID-19. People compared the lack of visible symptoms to diseases such as Ebola and were skeptical about the danger of COVID-19. At the same time, people in rural areas were afraid to report relevant symptoms and get tested for fear of being quarantined and stigmatized. The telehealth approach did prove useful for other purposes, such as supporting CHWs with their regular tasks and coordinating the supply of essential products. The health professionals at the call center supported CHWs in diagnosing, referring and treating patients and adhering to infection prevention and control practices. The CHWs felt more informed and less isolated, saying the support from the call center helped them to provide better care and improved the supply of medicine and other essential health products. CONCLUSIONS: The telehealth approach, launched at the start of the COVID-19 pandemic, provided useful support to thousands of CHWs in rural communities in Uganda. The telehealth approach could be quickly set up and scaled up and offers a low cost strategy for providing useful and flexible support to CHWs in rural communities.

Entrepreneurship in care for elderly people with dementias: situated responses to NPM-based healthcare reforms in the Netherlands.

BACKGROUND: Despite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate "healthcare entrepreneurship", it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer's disease. METHODS: A four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have. RESULTS: The study records three subsequent strategies deployed at the local level: elimination of healthcare services; non-healthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship - two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level. CONCLUSION: Governmental policies for healthcare reforms may be more effective, if policymakers change output-based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients' mental disease and ultimate passing.

Beyond ambidexterity: universities and their changing roles in driving regional development in challenging times.

Around the world today, universities are expected to play a unique role as creators of regional growth and innovation. While there appears to be a consensus that the role of universities has been expanded, critiques show that the contribution of universities to their regions is still not well defined. There have been some developments in the literature on the concept of modern universities such as the triple helix, entrepreneurial university and engaged university. However, those concepts focus on enforcing universities' roles in a single domain such as entrepreneurship, innovation, or civic engagement. Little is known about how universities can facilitate regional growth that goes beyond knowledge transfer activities such as spin-off creation, licensing, and patenting. This paper contributes to a more comprehensive understanding of universities' role in regional growth through the theoretical lens of ambidexterity. Using ambidexterity, universities with a regional focus were distinguished from those engaged in research commercialization and traditional third-mission roles. Through two case studies, this study found that teaching, research, and engagement should not be separated, since they can serve both economic and social missions. As a result, a new model of multidextrous universities is proposed where universities meet both economic and social missions through teaching, research, and engagement. Contrary to previous contributions which presented universities as ambidextrous organizations where tension appears only between research commercialization and research publication or between teaching and research, this study suggests that universities need to overcome tensions and incorporate a sense of place in all activities to successfully contribute to regional growth.

Automation, organizational ambidexterity and the stability of employee relations: new tensions arising between corporate entrepreneurship, innovation management and stakeholder management.

While previous entrepreneurship research has only seldom drawn on organizational ambidexterity, the analysis of the important contemporary tensions among entrepreneurship, innovation management and strategic management issues may be facilitated by more closely analysing organizational ambidexterity in entrepreneurial settings. In this paper, we follow this thinking and more closely analyse an often applied form of corporate entrepreneurship: automation. Such automation is transferring work that was formerly conducted by humans to machines and may thus result in new tensions between corporate entrepreneurship, innovation management and the management of organizational stakeholders such as employees. The present paper investigates whether increased automation lowers the stability of firms' relationships with their employees. In addition, we expect that this relationship is moderated by organizational ambidexterity, as employees may have perceived ambidexterity as a signal that their firm will not overly invest in exploitation only, but maintain a balance between exploitation and exploration. Drawing on stakeholder theory, previous insights into corporate entrepreneurship and a survey of German Mittelstand firms, our findings show that highly ambidextrous firms are indeed more vulnerable to automation, leading to lower employee relational stability. Our findings thus suggest that in highly ambidextrous firms, novel tensions around automation-related corporate entrepreneurship will be detrimental to the stability of the firm's relations with one of its key stakeholder groups: employees.

A framework for sustainable capacity-building for collaborative North-South translational health research and training in a resource-constrained setting.

INTRODUCTION: Success with highly active antiretroviral therapy (ART) for the human immunodeficiency virus (HIV) in developing countries has been attributed to collaborative North-South resource-sharing and capacity-building. Academic research and training programmes have contributed towards policy entrepreneurship in a manner that influenced capacity-building within health systems. However, the documented capacity-building frameworks rarely elucidate how such programmes can be designed and implemented efficiently and sustainably. METHOD: We implemented the University of Zimbabwe (UZ)-State University of New York at Buffalo (UB) collaborative HIV clinical pharmacology capacity-building programme in Zimbabwe in 1998. We intuitively operationalized the programme around a mnemonic acronym, "RSTUVW", which spells out a supportive framework consisting of "room (space), skills, tools (equipment)", underpinned by a set of core values, "understanding, voice (clout) and will". Subsequent to our two decades of successful collaborative experience, we tested the general validity and applicability of the framework within a prospective programme aimed at expanding the role of health professionals. RESULTS AND CONCLUSION: Based on this collaborative North-South research and training capacity-building programme which has been positively validated in Zimbabwe, we propose this novel mnemonic acronym-based framework as an extra tool to guide sustainable capacity-building through collaborative North-South implementation research. Its extended use could also include assessment and evaluation of health systems within resource-constrained settings.

Squeezed out: Experienced precariousness of self-employed care workers in residential long-term care, from an intersectional perspective.

AIM: To understand self-employed long-term-care workers' experiences of precariousness, and to unravel how their experiences are shaped at the intersection of gender, class, race, migration and age. BACKGROUND: In the Netherlands, increasing numbers of nurses and nursing aides in long-term care (LTC) opt for self-employment. Societal organizations and policy makers express concerns about this development, as self-employment is seen as a risk factor for poor health. Self-employment is not necessarily precarious work but can contribute to the precariousness of specific groups. Knowledge about inequities among self-employed nurses and nursing aides in long-term care is lacking. DESIGN: A participatory, qualitative interview study. The research team consisted of four academic researchers and five (un)paid care workers. METHODS: Semi-structured interviews with 23 self-employed nurses and nursing aides in LTC (2019-2020). Data were analysed from an intersectional perspective. RESULTS: First, we describe that feeling precarious as a hired employee-due to increasing workloads, health risks, poverty and discrimination-shapes care workers' choice for self-employment. Second, we describe inequities between self-employed care workers who could (financially) afford to turn to self-employment as a health strategy and those who felt squeezed out of the organizations due to poverty or discrimination. They more often dealt with precarious work in the context of precarious lives, negatively impacting their health. Third, we describe how negotiating an entrepreneurial identity with a caring identity required material sacrifices and thus contributed to self-employed care workers' financial precariousness, particularly as women. CONCLUSION: Our findings indicate that working in LTC is becoming increasingly precarious for all care workers, both for hired and self-employed, with younger, lower-paid and racialized women with unpaid caring responsibilities seemingly most at risk for precariousness. IMPACT: Our findings urge policy makers and care organizations to develop gender and diversity-sensitive policy responses to address these inequities.

How can entrepreneurs experience inform responsible health innovation policies? A longitudinal case study in Canada and Brazil.

AIM: To foster equity and make health systems economically and environmentally more sustainable, Responsible Innovation in Health (RIH) calls for policy changes advocated by mission-oriented innovation policies. These policies focus, however, on instruments to foster the supply of innovations and neglect health policies that affect their uptake. Our study's aim is to inform policies that can support RIH by gaining insights into RIH-oriented entrepreneurs' experience with the policies that influence both the supply of, and the demand for their innovations. METHODS: We recruited 16 for-profit and not-for-profit organisations engaged in the production of RIH in Brazil and Canada in a longitudinal multiple case study. Our dataset includes three rounds of interviews (n = 48), self-reported data, and fieldnotes. We performed qualitative thematic analyses to identify across-cases patterns. FINDINGS: RIH-oriented entrepreneurs interact with supply side policies that support technology-led solutions because of their economic potential but that are misaligned with societal challenge-led solutions. They navigate demand side policies where market approval and physician incentives largely condition the uptake of technology-led solutions and where emerging policies bring some support to societal challenge-led solutions. Academic intermediaries that bridge supply and demand side policies may facilitate RIH, but our findings point to an overall lack of policy directionality that limits RIH. CONCLUSION: As mission-oriented innovation policies aim to steer innovation towards the tackling of societal challenges, they call for a major shift in the public sector's role. A comprehensive mission-oriented policy approach to RIH requires policy instruments that can align, orchestrate, and reconcile health priorities with a renewed understanding of innovation-led economic development.