Identifying Factors Affecting Entrepreneurship and Organizational Agility (Case Study: Mashhad University of Medical Sciences)

Introduction:

Nowadays, government agencies such as universities of medical sciences and private organizations are faced with a changing environment that has features like competitiveness, rapidly changing technologies, variety of public demand, speed in replication, and customer satisfaction while there is a need to reduce the costs. In order to effectively perform the functions of government agencies in such environments, some market-based approaches such as privatization, public-private partners, outsourcing, and organizational entrepreneurship have been introduced. Unlike the first three approaches, organizational entrepreneurship through improving the internal capabilities of the organization can be one of the useful tools of government agencies to deal with environmental changes and also the best approach to solve these perceptions that have failed to deliver optimal public sector services. There are many definitions for organizational entrepreneurship. Organizational entrepreneurship can be defined as the process of creating and pursuing opportunities, regardless of the resources under control (1). In other words, organizational entrepreneurship is the process of discovering, evaluating, and exploiting opportunities to create a new product or service in the future (2). Agility, on the other hand, means fast, agile, capable of moving fast and easy, and capable of quick thinking with a clever approach that has been introduced as opportunities to respond to changes in the business environment and exploit those changes. Agility in government agencies is very important because the results and successes of agile government agencies are impressive and commendable. In a study conducted by the IT Cornie Institute from 8 countries, the results showed that agile government agencies grew by 53 percent in productivity, 38 percent in employee satisfaction, and 3 percent in customer or consumer satisfaction. Governments that invest in speed, flexibility, and accountability are likely to achieve their goals because political, social, economic, and technological factors increasingly influence governments and their decisions and enable citizens to access services faster, so they need more expertise. As a result, they need to develop and implement policies faster than ever before, since agility can certainly help organizations and institutions accomplish this mission and achieve organizational goals (3).

The results of some studies, such as Sadat Khorramgan's research in 2012, which examined entrepreneurship and organizational agility among selected entrepreneurial firms in Tehran, showed that among individual, environmental and organizational entrepreneurial factors, there is a meaningful relationship between two individual and environmental factors with some Organizational agility components (4). Also in 2009, Alimardani et al. investigated the relationship between organizational structure (more agile structure) and entrepreneurship at Shahid Beheshti University. The results indicated that there is a positive relationship between organizational structure and organizational entrepreneurship (5).

However, Mashhad University of Medical Sciences is the largest health care center in the east of the country, providing services not only in the east but also in other parts of the country as well as in neighboring countries. Like all other government agencies, the university has been affected by adverse economic conditions in recent years; however, it is an issue that service delivery based on the university's mission will be hampered. On one hand, some actions were done to get out of the current situation as well as to create the right space in the long run, on the other hand it has been imperative to create a tool for vanguard. So in order to be able to choose the right path we need to identify the current situation and the capacities and potentials, otherwise we will have trouble planning. To this end, simply having a roadmap does not mean success, and it requires serious determination, so new approaches must be adopted. With a new approach to managing executive organs the key will be resistance economy, and putting entrepreneurship based in agility can greatly improve productivity, customer satisfaction, and speed in accountability. On one hand, by focusing on organizational entrepreneurship, it provides unique innovation in financial services and on the other hand, agile-based policies provide flexibility unto situations and quick responding. However, given the nature of organizational entrepreneurship, this can provide the basis for the emergence of creativity and innovation that is essential to implementing a resilient economy in real terms. Putting Entrepreneurship next to Agility is important because many government agencies have been accused for lack of agility, which is incompatible with environmental change, so putting these two variables together can go a long way toward enhancing University of Medical Sciences.

Also, since organizational entrepreneurship in universities has not been given enough attention so far, and there has always been distances between universities and the labor markets, in this study we decided to design an organizational entrepreneurship model with an agile approach to enhance the university's ability to cope with environmental change, resolve financial problems and constraints

Methods:

This study is a descriptive study in terms of purpose, and is the result of a realistic and systematic description of the characteristics of a phenomenon or a subject that is not merely about discovering and explaining relationships, correlations, and possibly hypotheses, but rather about describing situations. However, in terms of results and consequences, this study is an applied study. Applied study is an attempt to find solutions to the real-world problems and difficulties. From the perspective of implementation process, this is a mixed method study. Mixed research is a type of research that is characterized by qualitative and quantitative research. The mixed approach has many different types; this study is an exploratory sequential research. In this study, first, the qualitative data were collected and analyzed, and secondly, the quantitative data were collected. Finally, both quantitative and qualitative analyzes were examined simultaneously. From the perspective of logic implementation, this study can be considered as an inductive study. In this type of reasoning, the researcher attempts to derive results from observing or experiencing multiple objective evidences during an evolutionary process, by accepting a degree of error and probability, by assuming ambient environmental conditions to generalize other similar phenomena. And finally, from a temporal point of view, the present study is a cross-sectional study. An important feature of this study is that the data of the case study is focused only on one point in time and is in fact an image of a phenomenon. The present study was conducted in two phases: review of literature and expert poll by Delphi method. At first, the variables affecting agility and organizational entrepreneurship were extracted by reviewing related literature. Then the extracted components were finalized by Delphi method following the consensus of experts. When using the Delphi method to obtain the opinions of experts and specialists, it is necessary that the initial model (conceptual model) to be edited first. Based on the existing experiences in this field and based on the review of previous studies in accordance with the content analysis technique, the most important factors, components, and indices of the research background were identified and determined, as well as a basic conceptual model was proposed and presented in a questionnaire. Statistical population of the study included faculty members of Mashhad University of Medical Sciences, Mashhad Azad University, and Neyshabur Azad University. The research sample was selected purposefully based on inclusion criteria and data saturation. Finally, 20 eligible individuals were interviewed of whom, 14 were faculty members of Mashhad college of Health, Mashhad Azad University and Neyshabur University and 6 were senior managers in Mashhad University of Medical Sciences. The criterion for entering the study was sufficient familiarity with the concepts of entrepreneurship and agility of the organization and having an educational and research background in the field of entrepreneurship and agility of the organization.

In the first stage of the study, variables affecting agility and organizational entrepreneurship were extracted from reviewing related literature. In the second stage, these variables were submitted to the Delphi panel as a questionnaire to reduce the effective variables from the experts' point of view. In the second stage, the questionnaire was sent to the members in order to analyze the qualitative content of variables and classify them into two groups of dimensions and components affecting agility and organizational entrepreneurship. In the third stage, these dimensions and components reached the consensus of experts as influential factors on organizational agility and entrepreneurship. Finally, after three rounds of Delphi expert opinion polls, the results showed the consensus.

The data collection tool was a questionnaire containing open-ended questions in the first round and in the second round there were closed-ended questions based on the designed initial model consisting of the main axes of goals, data sources, minimum data set, data collection and analysis method, and reporting. In the second-round of questionnaire onwards, each component was scored on a 5-point Likert scale (strongly agree: 4, agree: 3, average: 2, disagree: 1, and strongly disagree: 0). these questionnaires were verified by a researcher and their validity were confirmed by experts through a review process.

The instrument for measuring data was a semi-structured questionnaire that its face validity was confirmed by academic experts. For Content Validity, Content Validity Ratio (CVR) was 0.78 and Content Validity Index (CVI) value was 0.75, respectively, which confirmed the content validity of the questionnaire. Also, its construct validity was confirmed by exploratory factor analysis. The reliability of the questionnaire was also calculated and confirmed by Cronbach's alpha 0.893.

In the first round, the questionnaire was sent to the experts via e-mail and simultaneously by phone call and if needed in person, the research explanations were provided to them. After two weeks, if the questionnaires were not returned, an e-mail was sent to the target individuals remind them. If no response was received within a week after the first reminder, necessary follow-up visits were made. Questionnaires that were not received until one week, after the in-person visit for the second reminder, were excluded from the study and they were substituted for purposeful sampling and continued until the desired outcome of this cycle was obtained.

For data analysis, Delphi first round content analysis was performed, and second round follow-up scores were calculated for each component based on a Likert scale of 0 to 4, (strongly agree: 4, agree: 3, average: 2, disagree: 1 and very disagree: 0). Finally, the results were analyzed using descriptive statistics. The criterion for acceptance of each component in the model was its placement in the quartile 3 to 4 (75 to 100%). If the consensus was on a component between the quarters 2 and 3 (50 to 75%), it was sent for re-polling in the next Delphi round. Components with a collective agreement between quartile zero to 2 (0 to 50%) were excluded from the model. At every stage of the Delphi method, the results of the previous step along with a questionnaire for that stage were sent to the experts.

Results:

The demographic characteristics of the interviewees at the Delphi stage are as follows.

Table 1. Frequency distribution of interviewees' demographic variables

A total of 376 variables were extracted from the literature review as influencing factors on organizational agility and entrepreneurship, of these 204 influenced entrepreneurship and 174 influenced organizational agility (supplement 1).

In the first stage, these variables were sent to the experts as a questionnaire and after summarizing the results of the experts' opinions, the variables affecting agility and entrepreneurship were reduced to 157. After removing duplicates and based on abundance, 70 of them affect organizational agility (Table 2) and 87 variables affect entrepreneurship (Table 3).

Table 2. Dimensions and Components Affecting Organizational Agility

Table 3. The Frequency of Dimensions and Components Affecting Organizational Entrepreneurship

In the second stage of Delphi, these variables were sent to the experts in a questionnaire for classification. The results of the organizational agility questionnaire resulted in 8 dimensions, while the entrepreneurship questionnaire resulted in 6 dimensions, and for organizational agility dimensions as well as entrepreneurship dimensions 27 and 39 components were identified respectively. (supplement2)

These dimensions and components were re-submitted to the experts in the third stage questionnaire after being summarized and sorted in the form of questionnaires. The results of expert opinions were obtained in terms of dimensions and components affecting entrepreneurship and organizational agility. The criteria used to determine consensus were Delphi panel responses and homogeneity, use of Kendall's coefficient of concordance, or consensus scale. The results of Kendall's coefficient of agreement or coefficients for the identified dimensions and components were 0.81 in the second Delphi stage and 0.88 in the third Delphi stage, indicating a strong and acceptable consensus among the panel members in relation to the dimensions and components of the research. Also, in order to confirm the findings of this study, the significance of each of the identified factors, components and indices and the results obtained from the third stage of Delphi technique were evaluated by means of statistical comparison with a constant number test (t-student test). In this test, Delphi panel members rating point of view for each variable was calculated and then their mean scores were compared with criterion 2. That is, it tests whether any of the identified factors, components, and indicators is above 2 or not.

According to the above explanation and estimating the required parameters, as well as calculating the test statistic t₀ and then the P-value; the results showed that all the dimensions obtained from the third stage of Delphi technique were significant and only 3 components of 66 dimensions were not significant, so they were removed from the final model.

Table 4.  T-student test for Significant Study of Delphi Panel Members' Agreement on Identified Factors on Organizational Agility

Table 5. T-student test for Significant Assessment of Delphi Panel Members' Consent on Identified Factors on Organizational Entrepreneurship

The results reported in Tables 4 and 5 show that according to the calculated P-values, the null hypothesis or, in fact, the hypothesis of expert group members' disagreement with each of the factors identified as affecting entrepreneurship and agility has been rejected at the test error level. It can be concluded with 95% confidence that shows these factors are effective and significant on entrepreneurship and agility of the organization.

ANOVA test was used to determine whether each of the dimensions was of equal importance. Therefore, by ANOVA test, F-Fisher and P-value were calculated as 1.741 and 0.131, respectively. Therefore, the null hypothesis cannot be rejected (because). Therefore, it can be stated with 95% confidence that from the experts' point of view, the degree of influence of the identified dimensions and components on organizational agility and entrepreneurship is the same or there is no significant difference between the importances of these factors. Therefore, according to the findings, the impact of every identified effective factor on organizational agility and entrepreneurship is the same and none of them have preference or priority over the other ones.

 Discussion

The fast-changing world has brought new conditions and challenges to organizations. However, much evidence indicates that many organizations do not sufficiently utilize the internal potential of the organization to achieve their goals. Indeed, many of the internal potentials of the organizations have been idle due to the lack of innovative solutions. Such a scenario is more realistic and objective for government agencies. Therefore, organizational entrepreneurship can function as a tool to get out of the current situation.

On the other hand, in the competitive market, there is a pressing need to develop and improve the flexibility and accountability of the organization. Nowadays, many organizations and companies are facing increasingly secure and uncertainty competition which are aggravated by technological innovations, changing market environments, and changing customer needs. This critical situation has led to major reforms in the organization's strategic outlook, business priorities, and revision of traditional and even relatively contemporary models.

In other words, past approaches and solutions have lost their ability and capability to dealing with organizational challenges and the external environment, or they may be replaced by new approaches and perspectives. One of the ways to respond these factors of organizational change is agility. Therefore, this study aimed to design an organizational entrepreneurship model with an agility approach.

A review of the literature on the movement of organizations toward entrepreneurship and agility shows that some researchers, as Ropke(13), Jacobs et al.(19), And Atzkowitz(2), have looked at entrepreneurial university from the perspective of entrepreneurial activities, and others as Goldman and Nieger (15) and Gonaskar (16) models have focused on the factors affecting organizational agility.

In line with the findings of the present study, different studies have been carried out inside and outside the country such as the study done by Lee et al who Investigated the relationship between agility of the organization, which is a complex and multidimensional concept, with entrepreneurship; however, the results of their research showed that the more agile organizational structure in organizations, the more capable they are in supporting creative and entrepreneurial approaches. According to these researchers, organizational agility is one of the basic prerequisites for moving to entrepreneurship (26).

The results of the research by Yaghoubi et al. Showed that the main issues leading to agility outcomes at Entrepreneurial University include the agility capabilities needed to enrich, satisfy customers, and provide solutions which can be witnessed through agility drivers and agility enablers at Entrepreneur University (27). Also, Amirnejad and his research colleagues, who were among the staff of one of the country's aviation organizations, concluded that there was a significant relationship between entrepreneurship and agility of the organization (28).

Although various research have been conducted on entrepreneurial or agile universities and their constituent factors and elements, however, can rarely be found to cohesively identify the factors affecting entrepreneurship and agility in medical universities of Iran, this was accomplished in the present study. It should be noted that the importance of moving towards entrepreneurial and agile universities in terms of educational deputy of the Ministry of Health is a fundamental goal and value of the whole package of evolution and innovation in medical science education based on higher education in the country. Entrepreneurship and agility in the health field will transform the cost economy into wealth, expand the country's export of medical services and products, enhance interactions of different governments in various fields, including valuation and reduce consumerism, and create thousands of job opportunities for health graduates.

The results showed that there are many different factors affecting entrepreneurship and agility of the organization, including factors affecting organizational agility, flexibility, organizational culture, human capital, organizational agility, change management, information and communication technology.

In addition, factors influencing entrepreneurship include human factors, entrepreneurship culture, motivational factors, accelerating variables, information technologies, and rehabilitation variables. It seems that, given the need for current organizations to move toward entrepreneurship and agility management, managers with a strong emphasis on their effective dimensions, providing the resources, facilities, and arrangements needed to achieve these dimensions can bring significant benefits to organization. It is hoped that the results of this research will help other researchers to develop and improve entrepreneurship and agility of organizations.

Due to the importance of selecting experts in the field of entrepreneurship and agility of the organization and their high occupation, responses were usually delayed and after repeated follow-up of the researcher, they which resulted in time consuming data gathering process.

Ethical considerations 

Ethical issues (Including plagiarism, informed consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc.) have been completely observed by the authors.

Acknowledgment

Regarding the research process, I would like to thank my esteemed colleagues, professors and mentors, as well as the experts who provided the detailed information needed to accomplish the research goals.

Financial Support: This article is part of the first author's PhD dissertation with code of ethics IR.MUMS.REC.1398.108.

    Conflict of interest

    The authors declare that there is no conflict of interest.