How Front-Line Public Managers Become Institutional Entrepreneurs

How do front-line public managers become institutional entrepreneurs? This article answers that question through a longitudinal single-case study of a large Norwegian municipality's healthcare services. Drawing on organizational institutionalism and public management scholarship, I first show how front-line public managers initiate divergent change by leveraging a sensing–legitimation nexus. They detect external and internal triggers, frame the need for change, and secure political, administrative, and professional support through direct negotiation and compelling operational narratives. They then act as co-creation catalysts, engaging residents and building cross-sector partnerships to adapt service designs and mobilize scarce resources. Finally, they institutionalize transformative public healthcare delivery by embedding routines in daily operations, formalizing interdisciplinary team structures, clarifying roles, and demonstrating performance gains. Evidence from two innovation projects shows that resource-constrained, non-heroic actors can disrupt entrenched practices and stabilize innovation as the new institutional arrangement. The study contributes to institutional entrepreneurship theory by positioning front-line public managers as credible entrepreneurial agents and by identifying co-creation as a core mechanism of public sector institutional change.