Implementational entrepreneurship and the local implementation of national health policy in China: A comparative case study in a Southwestern province

Yuda SHI

Research output: ThesisDoctoral Theses


For decades, implementation research has sought answers to a simple question: Why do some policies yield notable outcomes in practice, while others don’t? While many previous studies have explored a variety of factors, the influences of micro individual behaviors remain largely unexamined. This dissertation attempts to fill this research gap by analyzing local implementation of national policy in China from an actor-centric perspective. Built on the research on policy entrepreneurship, this doctoral research puts forth the concept of “implementational entrepreneurship” to describe the innovative and entrepreneurial actions undertaken by local technocrats during policy implementation. By researching implementational entrepreneurship, this dissertation also aims to broaden scholarly understanding of how individuals influence policy implementation and how their actions take effect. In particular, this study focuses on three research questions: (1) How do mid-rank officials and street-level bureaucrats in China act as catalysts of policy implementation? (2) What are the strategies adopted by implementational entrepreneurs in China to accelerate policy implementation and how do they overcome various hurdles to maximize the outcomes of policy? (3) Why does implementational entrepreneurship in China succeed or fail at the local level?
Encompassing both mid-rank officials and street-level bureaucrats, implementational entrepreneurs are sandwiched between various competing objectives and mandates. This complex situation casts implementational entrepreneurs into an intermediary role in terms of coupling national policies with local problems, thus offering them possibilities of accelerating policy implementation. Moreover, this dissertation argues that entrepreneurial traits and contextual environment have a combined influence on effective implementational entrepreneurship. On the one hand, entrepreneurial traits include both the commitment of entrepreneurial officials and their competence in carrying out public policies. While commitment reinforces persistence and risk-taking, successful policy implementation requires entrepreneurs to possess strong abilities in regard to political acuity, persuasion, and network management. On the other hand, support from the external environment offers implementational entrepreneurs the resources necessary to clear hurdles and mitigate bureaucratic fragmentation. This dissertation contends that, when confronting difficulties, implementational entrepreneurs do not passively wait for opportunities to occur, but rather adopt various strategies to improve their own abilities and change unsupportive contextual conditions.
Based on this analytical framework, a qualitative comparative case study design is adopted in this dissertation. Two flagship programs integrating health services in Guizhou Province—the Telemedicine Program and the County Medical Alliance Reform—are selected for qualitative investigation. Controlling key contextual factors across cases, this comparative case study sheds light on the causal dynamics of implementational entrepreneurship in China by showing key variables of interest and their impacts on the reform process. By investigating the two cases, this dissertation underlines that, in both cases, implementational entrepreneurs intelligently used their domain expertise and familiarity with local conditions to develop action plans. In the meantime, coordination requires implementational entrepreneurs to maneuver within fragmented bureaucratic systems and realign conflicting interests in both horizontal and vertical directions. All rights reserved.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • The Education University of Hong Kong
  • HE, Jingwei Alex, Supervisor
  • LEE, Siu Yau, Supervisor
Publication statusPublished - 2022


  • Implementational entrepreneurship
  • Policy implementation
  • Local innovation
  • China
  • Integrated care
  • Thesis (Ph.D.)--The Education University of Hong Kong, 2022


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