Healthcare organizations in entrepreneurial ecosystems: an integrative framework and future research agenda

Entrepreneurial ecosystems as lenses promoting innovation and entrepreneurship have attracted substantial interest in research. However attention towards the role of sector-specific actors, such as healthcare-related organizations, within entrepreneurial ecosystems remains underexplored. This paper investigates how healthcare-related organizations are conceptualized within entrepreneurial ecosystem research through an integrative review of the literature addressing EEs and healthcare. The findings show that healthcare entrepreneurs are often portrayed as actors addressing both commercial and public health purposes. Hospitals are perceived as laboratories of collaboration and learning, combining care delivery with innovation-oriented activities, while life sciences are seen as critical to regional innovation and development by attracting scientific knowledge and enabling translation into entrepreneurial opportunities. Institutional and resource dynamics are also perceived as important for healthcare and entrepreneurship ecosystems, through facilitation of resource mobilization and regulatory adaptation. Based on this review, the paper develops a framework that positions healthcare organizations within entrepreneurial ecosystems according to their degree of hybridity and ecosystem roles. This research contributes to EE literature by examining entrepreneurial ecosystems research through a sector-sensitive and relational perspective. The paper offers a framework and research agenda calling for more exploration of institutional complexity, patient-centred innovation, the evolving role of hospitals, and hybrid governance models in entrepreneurial ecosystems. • The paper conducts an integrative literature review and outlines four key themes linking healthcare and entrepreneurial ecosystems: • healthcare sector entrepreneurs, • hospitals as innovation hubs, • life-science anchors, and • institutional and resource dynamics. • The study develops an integrative framework positioning healthcare organizations along two dimensions: degree of hybridity (multiple institutional logics) and ecosystem role (from peripheral to central actors) and with this advances sector specific analysis of entrepreneurial ecosystems. • Findings show that hospitals and innovation support organizations are often high-hybridity and central orchestration actors, while healthcare entrepreneurs tend to be low-hybridity and peripheral. • The review highlights that entrepreneurial ecosystem literature has underexplored healthcare, despite increasing relevance due to crises, digital health growth, and societal challenges. A future research agenda is proposed, calling for work on healthcare institutional logics in EEs, patient-centred entrepreneurship, and the evolving role of hospitals as innovation and entrepreneurship intermediaries within the entrepreneurial ecosystems.