Institutional Entrepreneurs and Social Innovation in Danish Senior Care

AuthorBarbara Fersch,Per H. Jensen
Published date01 February 2019
Date01 February 2019
Subject MatterArticles
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Administration & Society
2019, Vol. 51(2) 250 –271
© The Author(s) 2016
Article reuse guidelines:
Entrepreneurs and
DOI: 10.1177/0095399715624945
Social Innovation in
Danish Senior Care
Per H. Jensen1 and Barbara Fersch2
This article discusses the social, political, and administrative dynamics behind
shifting welfare policies and social innovations in the senior care provided by
Danish municipalities. The main argument is that institutional entrepreneurs
are key agents of change and that institutional entrepreneurship is rooted in
exogenous (e.g., scarce resources) and endogenous (e.g., cognition) factors.
The article shows how exogenous factors challenge existing practices or
necessitate change, while new ideas among institutional entrepreneurs in
politics and administration give direction to institutional change.
social innovation, changing welfare policies, eldercare, social actors, drivers
for change, institutional entrepreneurs
The care for the elderly who require care is currently being reorganized in
most European welfare states. The social rights of frail seniors have been
strengthened and new modes of governance are emerging (e.g., Bode, 2007;
Jensen & Pfau-Effinger, 2005; Knijn & Verhagen, 2007; Pavolini & Ranci,
2008; Pfau-Effinger & Rostgaard, 2011; Rostgaard, 2006). As convincingly
1Aalborg University, Denmark
2University of Southern Denmark, Denmark
Corresponding Author:
Per H. Jensen, Centre for Comparative Welfare Studies, Aalborg University, Fibigerstraede 1,
Aalborg 9220, Denmark.

Jensen and Fersch
argued by Birgit Pfau-Effinger (2005), however, these new trends have been
analyzed as a national, state-centered, and top-down orchestrated evolution-
ary process, while the social dynamics of change—especially the role of
social actors, such as those who bring about changes in citizens’ rights and
welfare policies—have more or less been neglected.
This article offers a new explanatory framework for the area of changing
eldercare policies. Combining the emerging social innovation literature with
the literature on institutional entrepreneurship, the article argues (a) that
changes in eldercare policies are made topical top-down as well as bottom-up
and (b) that institutional entrepreneurs are important drivers for change. The
article analyzes innovative changes in public administration in the eldercare
area as the dependent variable, while institutional entrepreneurship is ana-
lyzed as the independent variable. An in-depth case study of new eldercare
policies in three Danish municipalities serves as the empirical basis for the
article. In Denmark, extensive political decentralization has left the munici-
palities responsible for designing, financing, organizing, and delivering elder-
care to the frail elderly. The broad autonomy of municipalities has meant that
eldercare is developing in different directions in the different municipalities.
The Field of Study
Scholars contributing to the emerging social innovation literature argue that
social innovation represents a novel solution to social needs and problems,
and that social innovations improve the quality of life, create new roles and
relationships, empower individual citizens, and at the same time suppos-
edly reduce costs and strengthen social sustainability (Bureau of European
Policy Advisers, 2011; Caulier-Grice, Davies, Patrick, & Norman, 2012;
Ewert & Evers, 2014; Giraud, Lucas, Falk, Kümpers, & Lechevalier, 2014;
Moulaert, MacCallum, & Hillier, 2013; Moulaert, MacCallum, Mehmood,
& Hamdouch, 2013; Phills, Deiglmeier, & Miller, 2008; Sinclair &
Baglioni, 2014). In Danish eldercare, three types of path-breaking innova-
tion can be observed:
•• Bureaucratic decision making has been replaced by co-administration
(to some extent self-regulation) in the delivery of home help (free
choice schemes).
•• Passive recipients have been transformed into the co-producers of their
own living conditions (re-ablement and “food from scratch” schemes).
•• Voluntary organizations have increasingly assumed the role as the pro-
vider of “emotional” eldercare, while practical and personal care has
remained a public responsibility.

Administration & Society 51(2)
These innovations support a general shift in the relationship between the wel-
fare state, the market, the family, civil society, and the clients—a shift which
is reshaping the character of public eldercare.
In the social innovation literature, it is argued that social innovations are
enabled or made topical in response to growing social, environmental, and
demographic challenges, economic stagnation, and budgetary constraints.
Danish municipalities have undoubtedly been forced to act by new structural
economic, legislative, and demographic conditions. But changes do not
occur without actors initiating and implementing innovations. It is therefore
noteworthy that there are very few existing analyses investigating how
social innovations have been designed, diffused, supported, and imple-
mented by social actors.
The role of social actors is poorly developed in welfare state theory,
although several competing hypotheses exist: class mobilization theory (e.g.,
Korpi, 1983), with its spin-offs, including the strength of the Women’s
Movement hypothesis (Siim, 2000); or critical mass theory (e.g., Beckwith &
Cowell-Meyers, 2007; Berkman & O’Connor, 1993), arguing that a “critical
mass” of women within the legislature can affect state policies in women-
friendly directions. It has also been argued that the color of government
(Flora & Heidenheimer, 1981) or predominant ideological or cultural orienta-
tions, epitomized as the welfare regime approach (Esping-Andersen, 1990),
help structure policies in specific directions. Unfortunately, however, these
theories have proven wrong when tested on the basis of a large and compre-
hensive data set using the differences in the quality of Danish municipal
eldercare as the dependent variable (Jensen & Lolle, 2013).
We have therefore included the theory of institutional entrepreneurship
(DiMaggio, 1988), which we believe provides a powerful theoretical and
analytical tool to explain social innovation in Danish eldercare. The theory of
institutional entrepreneurship ties in with the social innovation approach.
Like the social innovation approach, institutional entrepreneurship theory
argues that change is preconditioned by enabling exogenous factors (e.g.,
budget constraints, scarce resources, environmental changes) that challenge
the existing norms and practices; that is, the functioning of institutions.
Exogenous factors possibly trigger change; however, the direction in
which welfare policies will develop is not predetermined. Different
responses to the same challenge in different contexts are feasible. The
theory of institutional entrepreneurship argues that institutional entrepre-
neurs formulate, initiate, give direction to, or enact institutional change,
and that the social action of institutional entrepreneurs is founded in
endogenous factors, such as reflexivity, the adaptation to new ideas, and/
or abilities of social actors to think in new ways.

Jensen and Fersch
This article is guided by the following research questions:
Research Question 1: What circumstances and conditions have led to
social innovations in Danish eldercare?
Research Question 2: Which ideas and cultural values guide institutional
entrepreneurs and lead them to act differently in different localities?
Research Question 3: Which actors have assumed the role as institutional
Danish Municipalities as Cases
In Denmark, the care for the frail old people is a public matter in the sense
that citizens are entitled to it and it is to be delivered by public welfare
institutions. Politics and administration in Danish eldercare, however, is a
multi-level governance system, the core components being the central state
and local municipalities. The central state establishes the overall frame-
work conditions for local municipalities. The relevant legislation passed by
the National Parliament—the Social Service Act—stipulates that munici-
palities bear the responsibility for eldercare. Still, municipalities have con-
siderable autonomy and power to define the actual extent and substance
(e.g., quality, coverage) of the care and the situations in which one is enti-
tled to it (cf. Andersen & Jensen, 2011). The provision of eldercare is thus
based on the principle of local democratic governance, and eldercare
expenditures are covered entirely by the municipalities financed through
local, personal taxation. This strong local autonomy has given rise to sub-
stantial variations from municipality to municipality in the provision of
eldercare (Jensen & Lolle, 2013).
As indicated, the local municipal council has extensive power to define
the level of municipal services for its frail senior citizens. Each municipal
council, however, will usually appoint standing committees elected from
among the council members. These standing committees are responsible
for each department in the local government, and most municipalities have
appointed a senior committee. The senior committee is politically respon-
sible for the eldercare area and...

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