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Purpose Although the digital era has given rise to major transformations in many industries, health care has been remarkably resistant to radical innovations coming outside the field. The purpose of this paper is to explore and explain how new ventures aim to break institutional arrangements (i.e. regulations, normative rules, and cultural-cognitive beliefs) protecting the field by introducing digitally enabled service innovations into health care markets. Design/methodology/approach The study is qualitative and interpretative in nature and utilizes case study as a research strategy. The paper is based on data that were collected through narrative interviews and document analysis from seven new ventures participating in a start-up accelerator program. Findings Results indicate that service innovations that require a change in the institutional structures of the health care system are enacted through three highly iterative key processes: institutional sensemaking that creates an understanding of prevailing institutional arrangements and that constructs meaning for institutional change efforts, theorization of change through linguistic device, and modifications of institutions by building legitimacy and mobilizing external constituencies. Practical implications The findings provide practical insights into how new ventures struggle, navigate, and negotiate on specific alternatives related to institutional change while pursuing the introduction of innovations to market. Originality/value This research extends the institutional perspective on service innovation by zooming into micro-level processes of institutional change driven by new ventures. The study develops the theory of institutional entrepreneurship by highlighting cognitive processes of change, and suggests incorporating “institutional thinking” more tightly into the study and management of service innovation.

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PurposeThe article explores what forms of disruption are prioritized by top executives of large manufacturing companies in Finland and what strategies they consider appropriate for the management of disruptive threats and opportunities.Design/methodology/approachThe empirical study was based on interviews with top executives in some of Finland's largest manufacturing companies.FindingsBased on the data, we identify exploitative and explorative strategies in four dimensions that executives consider important in anticipating and responding to disruptions: internal development efforts, stance on new entrants, ecosystems and institutional change. Due to the presence of multiple potential disruptions, which often generate conflicting demands, executives have to consider them simultaneously and balance between them when making strategic decisions. They therefore do not necessarily have a specific response strategy, but their aim is to develop their companies' capabilities so that they are well-placed to face the future with confidence.Originality/valueThe findings indicate that the executives envision a disruption landscape that is more complex than typically described in the literature. In addition, it answers the call for a more systematic understanding of incumbents' response strategies by linking different disciplinary views with well-grounded empirical data.

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