Putting institutions and agency into innovation system theory.

The Oslo Cancer Cluster

from innovation system and institutional entrepreneurship perspectives
Arne Isaksen, University of Agder and James Karlsen, Agderforskning and University of
Agder
Abstract
Innovation system has become an important concept in academic and policy circles. The
concept underlines the interactive and socio-cultural element of innovation processes. The
concept is, however, also criticized for being too static, too occupied with systems at the
expense of actors, and for giving little concrete policy advices. The paper discusses if the
concept of institutional entrepreneurship can enrich the innovation system approach and offset
some of the alleged weaknesses of this approach. The paper tests the possibilities of linking
the innovation system and institutional entrepreneurship approaches through a case study. The
study examines the development of the organisation Oslo Cancer Cluster to become a key
actor in a dynamic innovation system centred on research and production of new cancer
treatments in the Oslo region, and to achieve the status of a Norwegian Centre of Expertise by
Innovation Norway. The case points amongst others on the long term building of
organizations and knowledge in cancer research in the Oslo area, recent institutional changes
that paved the ways for the Oslo Cancer Cluster organizations, and the efforts of a few
entrepreneurs and organizations to bring about the changes. The study illustrates possibilities
of adding perspectives from the institutional entrepreneurship approach into the innovation
system way of thinking.
Introduction
Both researchers and policymakers have shown increasing interest in the concept of regional
innovation system (RIS) over the last three decades (Asheim et al., 2011). The concept
belongs to a wider innovation of system approach which since the 1990s has become a
dominating way of conceptualising innovation processes in much of the literature, as evident
in the emphasis of the Oxford Handbook of Innovation (Fagerberg et al., 2005), and the
appraoch is also seen as highly relevant for understanding industrial development processes
and for designing public policy in developing countries (Lundvall et al., 2009). The
innovation system school has contributed strongly to enhance the understanding of the
complexities of innovation activities (Asheim et al. 2011, p. 877), the embedding of
innovation processes in social and institutional structures, the importance of collaboration and
collective efforts among a range of actors (rather than the work of lonely heroes) in
achieving successful innovations, and the evolutionary and often long-term nature of
innovation activity.
Despite these advances in our understanding of innovation processes, some deficiencies exist
in the innovation system research. This article aims to address two deficiencies pointed out by
Asheim et al. (2011). The first is that the innovation system school remains under-theorised,
while the second points to a need to enhance our understanding of the dynamics of RIS and
the emergence and evolution of new knowledge intensive industries (op.cit., p. 880). This
article aims for a theoretical contribution by combining the innovation system school and the
approach of institutional entrepreneurship. This last approach can contribute with a dynamic
element, especially with regard to institutional change, and with a focus on individual
entrepreneurs and agency to the rather structurally based innovation system school.
The second deficiency mentioned by Asheim et al. (2011) is addressed by a study of the
emergence, development and status of the Oslo Cancer cluster. This is a cluster organisation
established in 2006. Oslo Cancer Cluster received the status as one of 12 Norwegian Centres
of Expertise already in 2007, a status which is reserved for the internationally most
competitive clusters in Norway. The cluster organisation consists of more than 60 partners
including research institutes, global biotech and pharmaceutical firms located in Oslo and
beyond, established and venture based Norwegian firms, hospitals and patient organisations
(Furre & Flatnes, 2010; Oslo Cancer Cluster). The core activity of the cluster and the cluster
organisation is the long-lasting and expensive commercialisation process from basic research
to products on the market. Even established as a cluster organisation in 2006, the activity
builds on several decades of cancer research in hospitals, universities and R&D-institutes in
Oslo. The cluster organisations has experienced a fast increase in number of participants since
2006, and the cluster appears to be dynamic as demonstrated by 11 firm start-ups between
2007 and 2009 (Furre & Flatnes, 2010).
This article focuses on the institutional change demonstrated by the creation of the Oslo
Cancer Cluster and the apparently increase in joint activities among cluster participants the
last few years. The main empirical research questions are: What is the core of the institutional
change that spurred the emergence and development of the Oslo Cancer Cluster? Who were
the central institutional entrepreneurs in this case? These questions are followed up by a
theoretical question regarding in what way the institutional entrepreneurship approach can
bring more dynamism and agency into the innovation system school of thought.
The article is organised as follows: first, the innovation system school and the approach of
institutional entrepreneurship are described and discussed. Thereafter, the article presents the
empirical context of the Oslo Cancer Cluster seen through the lenses of the innovation system
approach. Third, the article analyses aspects of the development of Oslo Cancer Cluster from
the viewpoint of the institutional entrepreneurship approach. The final section discusses the
possible added value of combining the innovation system and institutional entrepreneurship
approaches.
The innovation system school
An innovation system (IS) approach has been developed over two decades as a generic
framework to analyse international competitiveness in terms of innovation and learning rather
than merely via labour costs (Asheim & Gertler, 2005; Lundvall, 2007). The approach
conceptualises innovation activity as an interactive and dynamic process carried out through a
rather stable network of private and public actors. The actors constitute two main subsystems
(Cooke et al., pp. 104-105). The first consists of firms in the industrial sector in question,
including their upstream and downstream activities. The second subsystem includes the
knowledge infrastructure of education, research and technology transfer institutions. The
system of innovation approach by the Aalborg school highlighted userproducer interaction
as vital for innovation, and cooperation between the actors is underpinned by an institutional
framework of informal rules of conduct, government regulations and policy instruments
(Edquist, 2005; Lundvall, 2007). Some actors enter into long-standing co-operation
characterised by interactive learning in an atmosphere of mutual understanding and common
rules.

Innovation systems are classified according to the context considered most important for the
main actors and institutions (Edquist, 2005; Wicken, 2008). The important context can be
defined by geography (national and regional systems), industrial sectors (sectoral systems) or
generic technologies (technological systems). Firms are often part of several of these
innovation systems; however, one type of system may be the most relevant to specific firms.
A number of global competitive Norwegian firms are, for example, part of regional
innovation systems, but depend on Norwegian sectoral innovation systems within the oil and
gas and the maritime sector for R&D co-operation (Isaksen, 2009).

The concept of regional innovation system (RIS) is geared towards the study of informal co-
operation, knowledge spillovers and the exchange of tacit knowledge between co-located
partners. Innovation processes are triggered by a wide range of factors as a regions
competitiveness is determined by the productivity, in the widest sense, of its firms, workers
and other economic, social, institutional and infrastructural assets(Martin, 2011, p. 236).
Sectoral and technological innovation systems focus on the technology, the knowledge base
and the institutional context in which firms act (Malerba, 2004). Innovation processes are
affected by industrial sectors, and firms that face similar technologies are seen to share some
common behavioural and organizational traits and develop similar range of learning patterns,
behaviour and organizational forms(Malerba, 2004, p. 15). The national level is particularly
important when it comes to the policy dimension; As long as national states exist as political
entities with their own agendas related to innovation, it is useful to work with national
systems as analytical objects (Lundvall et al., 2002, p. 215). The last quotation points to the
fact that the innovation system concept must be seen as a focusing devise, i.e. an analytical
tool, rather than a standard prescription for policy makers (Lundvall, 2007).

The IS-approach is, however, criticised on various grounds, amongst other for being
structural, static, geographically closed, and applied as a normative policy prescription. Critics
point to the fact that the approach is primarily concerned with the structural elements of the
innovation system, demonstrated in the institutional set-up of the knowledge and industrial
sub systems and knowledge flow between these (Uyarra, 2011). The importance of actors,
such as entrepreneurs in universities and firms, for innovation performance are much less
considered. Likewise, the role of uneven power among actors when it comes to prioritising
tasks and resources in organisations in the innovation system seems to be absent in IS studies.
Furthermore, IS studies have often been snapshots focusing on the characteristics, and
strengths and weaknesses, of particular well developed national or regional systems, while the
historical development of the systems is less reflected upon (Doloreux & Parto, 2005). The
regional innovation system approach, in particular, is accused to overstating regional inter-
firms relations and the role of the regional knowledge infrastructure at the expense of extra-
regional relations and factors (Fitjar & Rodguez-Pose, 2011, which build on empirical results
from five large Norwegian cities). Critics also maintain that the approach has been used in an
instrumental way in fostering standardised models for best innovation practise that often
neglect differentiated contexts (Flysand & Jakobsen, 2010). This is seen in statements such
as countries possessing national and regional innovation systems in specific sectors will
become wealthier (Niosi, 2010, p. 43).

Much of these criticisms are nevertheless misplaced and outdated. With regard to the static
character of innovation system research, recent contributions in evolutionary economic
geography, for example, aim to understand precisely how the real economy evolves through
real time (Boschma & Martin, 2010, p. 4). This approach departs from the micro level,
focusing on how firms learn and innovate based on their routines. It is well established in this
approach that competitive advantages are seen as a dynamic process, and not a static state of
affairs (Martin, 2011, p. 240). Even so, empirical studies of innovation systems still most
often focus on a specific point in time. The critique pointing to closed innovation systems is
also misinformed as social systems are always open and, thus, regional innovations systems
usually have diverse links to national and international actors and innovation systems
(Tdtling & Trippl, 2011, p. 457). Innovation system research is, however, a mainly structural
approach with little focus on the activity of individual entrepreneurs. The article now turns to
another methodological approach with discussion of the institutional entrepreneurship school
of thought which is more actor based.
Institutions, organizations and entrepreneurs
The concept institution is associated with conceptual diffuseness within the IS approach. It is
sometimes used about actors such as organizations, while other times about formal and
informal rules of behaviour (Edquist, 2005, p. 186). To increase the rigor, the specificity of
the approach and to make it more theoretically consistent it is necessary to discuss and define
key concepts. The concepts institution, organisation and entrepreneur are examples of
concepts developed within other approaches and then adopted to the IS approach.
The concept entrepreneur has a wide range of meanings. At the one extreme an entrepreneur
is a person that dares to take a risk and generate changes in the economy, and at the other end
it is often used about a person that establishes any kind of business. Schumpeter (1934/1968)
underlined the connection between the entrepreneur and the creation of innovations. The
function of the entrepreneur is to create innovations, and Schumpeter was very clear that if the
entrepreneur did not continue to create new innovations he/she was no longer an entrepreneur.
In Schumpeters approach the entrepreneurs function is to create radical changes, and this
can only be done through a process of creative destruction. This implies that in order to
innovate something else have to de destructed so that resources can be used for new
innovations.
The concept of entrepreneur has a different meaning within institutional theory because of the
concept institution. There are two different approaches to the concept institutional
entrepreneur within institutional theory; an economic/political, and a
sociological/organizational (Bruton et al., 2010; Hardy and Maguire, 2008). In this article the
first approach which is used with the work of Alfred North (1990) is the main source of
inspiration.
Norths approach is founded in his understanding of institutions as the rules of the game in
society or, more formally, are the humanly devised constraints that shape human interaction
(North, 1990, p. 3). Institutions are both formal, such as laws in a country and codified rules
in organizations, and informal, such as norms and codes of behaviour Institutions regulate
human behaviour; i.e. state what people should do and what they should not do. Institutions
are different between different IS. Laws and regulations are different between countries and
informal institutions may vary between nations, regions and organizations. The institutional
set-up (the specific configuration of formal and informal institutions) of an IS therefore varies
between different countries, region and industries.
Institutions are relatively enduring. This means that they are relatively hard to change but can
be changed in a long time perspective. Institutional change must therefore be analysed over
long time. In short term perspective, changes can be hard to identify because they are usually
slow and incremental.
North (1990) distinguishes between institutions and organizations. The latter are groups of
individuals bound by some common purposes to achieve goals. Organisations are such as
political, economic, social and economic bodies. Organisations are the players in games in
society and their behaviour in the game is regulated by institutions (rules). It is the interaction
between institutions and organisations that create institutional change, and the function of the
entrepreneur is to act as the change agent.
North, as Schumpeter, argued for the entrepreneur as the change agent of institutions, but
change in Norths approach is slow and incremental. However, even small changes can have a
huge impact once the development in locked into a specific development path. The most
important reason for change is the price mechanism. Once an entrepreneur experiences a
change in the price he/she tries to change the contract or agreement. When changes in
contracts or agreements and are repeated over a long time, and the development has properly
been locked in to a specific development path, a new institution may emerge (North, 1990, p.
84).
The direct cause, i.e. which entrepreneur that first initiated the change, can be hard to
identify since the cause may have occurred a long time ago and identified at a much later
stage. The cause of an institutional change can be a critical incident a long time ago. Critical
incidents are significant happenings that are important for the change process (Pettigrew,
1990). Establishment of new organizations or new ways of working in, for example, a region
or an industry can be critical incidents and indicators of institutional change. Based on this
view the article aims to identify critical incidents and important institutional entrepreneurs for
the development of the Oslo Cancer Cluster.

Context and method
Oslo Cancer Cluster (OCC) is part of the NCE (Norwegian Centre of Expertise) program,
which marks the preliminary end point of a long term institution building process among the
organizations that are occupied with research and production of new cancer treatments in the
Oslo region. The NCE program was launched in 2006 by Innovation Norway with the aim of
strengthen innovation and internationalization processes further in already strong regional
clusters, and where the members of the cluster organisations agree to enter long-term binding
collaboration (Isaksen, 2009).
The NCE program has a long-term perspective. The participating firms are offered
professional and financial support for development processes up to ten years. Regional
clusters program have to apply for membership. The criteria for membership are quite
restricted, and there is severe competition to become a member. First, local/regional actors
have to establish a partnership (or use an already existing partnership) of relevant players to
form an application. The application must be embedded in the most important firms in the
region, in knowledge organizations such as university, higher education organizations, and
other R&D organizations, public support organizations and financial actors. Through the
application process the numbers and the geographical area of the cluster are defined.
Second, the applications are evaluated by the national owners of the program, supported by
external experts. Innovation Norway aims making a brand out of the NCE. Thus, only the best
applications are approved, and the program now has 12 regional clusters as members. The
description and analysis of Oslo Cancer Cluster from the regional innovation system
perspective depart from the member list of the cluster. Key information about the member
organizations, such as year of establishment, number of employees and turnover, are obtained
from the database Purehelp, which collects information from public sources. Further
information about ownership, key products and services, organization, annual reports etc.,
was gathered from the home pages of the member organizations.
The database Purehelp and home pages were also used to find out if the key firms in the
pharmaceutical industry in Oslo (NACE 21 Manufacture of basic pharmaceutical products
and pharmaceutical preparations) are members of Oslo Cancer Cluster. The question is
whether the members of Oslo Cancer cluster include the key actors in the manufacturing
industry that develop and produce cancer treatment as their core activity. Purehelp reports 14
firms within NACE 21 in the Oslo region which are not members of Oslo Cancer Cluster.
Two of these are pharmacies. The others, except one firm, are Norwegian producers of a wide
specter of drugs and health-related products. None of these firms are specialized within cancer
research or production, thus, the firms do not belong to the innovation system of cancer
research and production in Oslo.
The above mentioned information was used to analyse Oslo Cancer Cluster from an
innovation system perspective but it was not sufficient to discuss the case from an
institutional entrepreneurship approach. We supplemented with available written material of
main organization in the cluster and their development, and also with in-depth interviews with
two key informants with regard to the establishment and development of the cluster.
The informants were selected on basis our knowledge about the cluster and the cluster
organization. We decided to have two interviews, one with the leader of the cluster
organization and one with a CEO from a firm. It is what Flyvbjerg (2006, p. 230) calls
information-oriented selection of cases where the research strategy is to maximize the utility
of information from small samples and single cases, such as in our case. We created a semi-
structured interview guide with some main questions, however were flexible to follow up with
new questions.
The interview with the firm representative aimed to gather information about his opinion
about OCC, such as its function in the cluster. The person we interviewed has been working
for a long period in several pharmaceutical firms in the Oslo region and could provide us with
important information about the development of OCC. The interview with the manager of
OCC gave us in-depth information about the cluster organization, since he had both been the
leader of the chair and was now the leader of the cluster organization, in addition to central
positions in other organizations as well.

Oslo Cancer Cluster from the innovation system perspective
Oslo Cancer Cluster is as said the name of the member organization consisting of
organizations that in different ways are engaged with development of new cancer diagnostics
and medicines. We use, however, the cluster concept in analytical terms to denote
geographically bounded concentrations of interdependent firms (Asheim and Isaksen, 2002).
Regional innovation systems denote regional clusters of firms that are surrounded by
supporting knowledge exploration and diffusion organizations, which may be located in or
beyond the region in question (op. cit.). The innovation system approach is deemed to be
particularly relevant in studies of the pharmaceutical industry. This industry can be
considered as a system or network because innovative activities involve, directly or indirectly,
a large variety of actors, who are heterogeneous in many respects (McKelvey et al., 2004, p.
112). Important actors in the sectoral innovation system of pharmaceuticals include large
multinationals, small, specialised and research intensive firms, research institutes,
universities, venture capital companies, regulatory authorities (of e.g. patent laws), and the
publich healt system as an important customer. The innovation system has some specific
industry characteristics, such as the fact that the pharmaceutical industry is extremely R&D-
intensive, requires a scientific workforce that is connected to the wider research community,
has strong IPR (Intellectual Property Right) regimes, strict rules for the approval of new drugs
which demands sophisticated and expensive clinical trials, and as a result high barriers to
entry, and the industry is subject to cost containment policy (op. cit.). A further characteristic
is the fact that pharmaceutical and biotechnology industry clusters are found in relatively few
places (Gertler and Levitte, 2005). While efficient international circulation of scientific
knowledge in codified form (Gertler and Levitte, 2005, p. 488) takes place in biotech, firms
also benefit from geographical proximity to scientific research, to venture capital and the
expertise that comes with it, and from access to highly educated people in a local labour
market. Clustering is strengthened by the fact that entrepreneurs, who are often scientists,
most often locate in their local area (op. cit.). Such characteristics also point to the relevance
of using regional innovation system as lenses to describe the structure and working of the
industry focused on cancer medicine research, development and production in Oslo. In doing
this we focus on member organizations in Oslo Cancer Cluster.
Table 1 sum up a few key facts about members of the Oslo Cancer Cluster
1
. The table
indicates that the regional innovation system of cancer development and production includes
organizations that fill various and key roles. The industry category consists of 39 firms. As
much as16 of these are Norwegian divisions of often very large pharmaceutical
multinationals, which are the dominant players within the industry. Nine of the12
pharmaceutical corporations found on Fortunes list of the worlds 500 largest corporations
2

that have a division in Oslo. Most of the Norwegian divisions are occupied with marketing,
selling and informing about the corporations products to Norwegian customers. In about five
firms the Norwegian divisions also take part in clinical tests and research where Norwegian
patients and doctors participate. Boehringer Ingelheim Norway, for example, is responsible
for a number of clinical studies in cooperation with Norwegian medical centers and hospitals,
and this firm leads large, international projects within the corporation.
The divisions of international corporations represent the bulk of jobs among the members of
Oslo Cancer Cluster. However, a number of younger, independent and mostly small
pharmaceutical firms are also part of the cluster organization. These are most often academic
spin-offs but also industrial spin-offs or start-up companies with Norwegian entrepreneurs and
venture capital. The firms are in general still in the clinical test phase of their first products or
occupied with developing further a technological platform. The firms often cooperate with
national and foreign R&D institutes and are supported by the research council of Norway and
the EU. These are typical dedicated biotechnology firms (Chiaroni and Chiesa, 2006) or what
McKelvey et al. (2004) denote as specialised new biotechnology firms. These are science-
based companies based on a new idea about new pharmaceutical compounds or technical
devices, and the firms often aim to license products to larger pharmaceutical companies at the
latest possible stage; typically clinical test phase II and III.
Although the firms generally are in the clinical test phase a few also have put patent protected
products on the market under their own brand name or have license agreement with a global
biotechnology company. Norway has 122 patent applications in biotechnology in the period
2006-2009 filed under the Patent Cooperation Treaty (according to OECD Patents Statistics).
This is low in international comparisons. A bit more than half of these patent applications
come from firms in the Oslo region. Photocure is one of few Norwegian owned
pharmaceutical firms with marketed products and world leadership in a specific technology.

1
The information builds on the database Purehelp.no, and on home pages of members of Oslo Cancer Cluster. A
few member organizations such as two interest groups have not been placed in any of the categories.
2
http://money.cnn.com/magazines/fortune/global500/2009/industries/21/index.html
Photocure was founded by the Norwegian Radium Hospital in 1997, and has also spun off a
new firm.
Table 1: Classification of members of Oslo Cancer Cluster in 2012
3

Sub system Type of organization Number of
organizations
Median age of
organizations
Ca. number of
employees in
Norway
Industry Norwegian divisions of
multinationals
16 1990 1,000
Norwegian owned firms 23 2001 300
Knowledge
organizations
R&D institutes 6 1998 600
HEIs 4 1971 n.a.*
CROs 4 1997 20
Financial
actors
Seed and venture capital
funds
6 2007 50
Source: Key information of members of the Oslo Cancer Cluster from Purehelp.no and members home pages.
* It is not possible to state clearly the number of employees occupied with teaching and research within the field
of cancer in HEI

The Oslo Cancer Cluster also includes a number of different knowledge organizations. Six of
these are classified as R&D-institutes which contain a total of 600 employees. Half of these
are found at the Institute of Cancer Research at Oslo University Hospital. This
multidisciplinary institute has since its start in 1954 been central in Norwegian and
international cancer research. Norway also has comparatively many publications within
cancer research (oncology) (Reve and Sasson, 2012). Other public research institutes also
focus on cancer research. The Centre for Cancer Biomedicine with about 100 employees and
located at the University of Oslo and The Norwegian Radium Hospital is appointed as a
center of excellence by the Research Council of Norway. The Norwegian Institute of Public
Health, Department of Biopharmaceutical Production with 35 employees is a contract
manufacturer and service provider for biopharmaceutical products in general and aims to
accelerate product development and supply products for clinical trials. Important is also the
Cancer Registry of Norway, Institute of Population-based Cancer Research. The Register was
established in 1951 as one of the worlds oldest national cancer registries. All medical doctors
in Norway are instructed by law to notify new cancer cases to the Cancer Register. The large
amount of data and the unique personal identification number in Norway, makes the Cancer
Registrys data suitable, also internationally, for research. A similar, but smaller register is
organized by HUNT Bioscience. This is a public company which offers industry access to the
HUNT Bio- and Databank which is a fully established Norwegian-population-based
prospective health survey and biobank collected through 30 years in three phases from a
regional cohort of 130,000 individuals. The HUNT Study is one of the largest and most
comprehensive population-based health studies ever performed.

3
Build on membership list in May 2012 (www.oslocancercluster.no)
The knowledge organization also include four higher education institutions (HEIs) and
recruiting companies, including the University of Oslo, and four contract research
organizations (CROs). The HEIs are important both when it comes to providing employees,
performing research, and as sources of several spin-off firms. The CROs provide a range of
support, such as running clinical trials and developing documentation for products, to the
pharmaceutical and biotechnology industries in the form of research services outsourced on
contracts. Three of the four CROs operate from Sweden.
The last group in Table 1 includes six seed and venture capital funds. Included here is
Innovation Norway which is the Government's most important instrument for innovation and
development of Norwegian firms. The other funds are focused on supporting academic spin-
offs and on life science start-ups. Inven2 is the largest actor within commercialization of
research in Norway, owned by the University of Oslo and Oslo University Hospital and
particularly occupied with innovations from these organizations. A similar fund is the
Norwegian Radium Hospital Research Foundation (RF), which is a pre-seed investor and
project developer, aimed to strengthen cancer research at the Radium Hospital and also invest
in companies based on a larger group of leading Nordic research institutions. Bio-Medisinsk
Innovasjon AS (BMI) is an investor and incubator for biomedical start-ups, cooperating
closely with Inven2, RF, the TTO (Technology Transfer Office) for Oslo University Hospital
and the University of Oslo. BMIs project portfolio includes all ongoing projects from RF,
which is also one of BMIs major owners. The two other funds include a seed capital fund and
a venture company focused on life science sectors, and where the venture fund has invested in
many of the start-ups firms in Oslo Cancer Cluster. These funds typically have deep
knowledge of the technology in which they are investing, and contribute with managerial
advices.
Table 1 demonstrates that Oslo Cancer Cluster represents a fairly well-developed innovation
system. It consists of a combination of Norwegian divisions of global pharmaceutical
corporations and an undercurrent of mainly small Norwegian firms which are mostly in
clinical test phases. The firms are supported by a number of dedicated R&D-institutes,
university education, contract research organizations, seed funds and venture companies
focused on the life science industry, in addition to the networking activity, promotion of the
cluster and efforts to increase the availability of capital by Oslo Cancer Cluster. The
innovation system then includes the key actors and factors that can feed a cumulative circle of
development (Chiaroni and Chiesa, 2006). This is a much more positive assessment than the
one by Reve and Sasson (2012) of the indeed much wider health and biotechnology sector in
Norway, which is said to lack a well-developed industrial cluster and local investors (p. 217).
The distinctiveness of the pharmaceutical industry becomes hidden within the large health and
biotech sector which includes among other things pharmacies. The innovation system
centered on cancer research and production in Oslo is, however, in an early stage of
development which is seen in the quite many spin-off and start-up firms in clinical trials, and
the full potential of the Oslo Cancer Cluster is still to be proven. It is however interesting to
examine which institutional change that spurred the fast emergence of the Oslo Cancer
Cluster, which is the question that we now address.
Oslo Cancer Cluster from an institutional perspective
Oslo Cancer Cluster, OCC, was established as a cluster organization in 2006, and approved as
a member of the NCE program in 2007. The midterm evaluation in 2010 gave OCC a very
positive assessment (Furre & Flatnes, 2010). Compared to many of the other NCE members
OCC has used short time to fulfill the NCE criteria. The usual way is that cluster
organizations first become members of the Arena program, a cluster program also
administrated by Innovation Norway, but with a much lower profile and statues as NCE. Why
have OCC been so successful in such a short time? What is the story behind OCC?
Discussed from the institutional change approach the story behind OCC consists of two parts.
One part of the story is the long term development process of diagnosis, treatment and later
research on cancer in the Oslo region. This is a complex story about an institutional
development process that goes back almost 100 years and involves many actors at different
points of time. This story is not the main issue in this article, and will therefore not be
discussed in-depth. However, some critical incidents and organizations are important to
mention in order to understand the institutional set-up which OCC has developed from, see
Table 2.
Some formal institutions and organizations have been very important for development of
cancer research in Norway, such as the establishment of a law registration of cancer,
establishment of the Cancer Register and the Radium Hospital, cf. the previous section. Two
of these organizations, the Radium Hospital and the research foundation Norwegian Radium
Hospital Research Foundation, (NRHR), have a direct connection with the establishment of
OCC. The Norwegian Radium Hospital has been an important national player since its
establishment in 1932 within cancer research and cancer treatment in Norway. Due to
institutional changes in the Norwegian health system the hospital was merged together with
another hospital in the Oslo region in 2005 and then merged together with two other hospitals
to Oslo University Hospital in 2009.
The second part of the story about OCC starts in the early 2000s with the idea of establishing
the project Oslo Life Science, and the change in the strategy of NRHR in 2005. In 1986 the
Radium Hospital established The Norwegian Radium Hospital Research Foundation (NRHR).
Up to 2005 the foundation had a TTO function but in connection with the merger of the
Radium Hospital the foundation changed strategy. One part of the new strategy was to invest
in companies that are working with applied cancer research. NRHR tries to stimulate
researchers to commercialize their findings instead of writing a new academic article about
their findings. In mid-2012 the research foundation had invested in 13 companies with a total
stock value of over 200 million NOK (about 27 million euro). Many of the physicians that
have established these companies have been researchers at the Radium Hospital, and many of
the companies are working with new types of medicines that make cancer to a chronic
disease, and not a deadly one.
The establishment and development of OCC is also a story about concrete collaboration
between some key persons. The most important of these is the CEO of OCC and NRHR. He
was leading the Oslo Life Science project, was the first chairman of OCC and then later
became the CEO of OCC. He is also in the board of many of the start-up companies, which
also are members of OCC. When this person and a colleague were working with the Oslo Life
Science (OLS) project in 2006 they were informed that a new program (NCC) was established
with the aim of facilitating already strong regional clusters in Norway and were asked if they
should apply. Even if OLS was only a project idea at that time, they applied. The application
was turned down but the idea was so interesting that they were invited to a meeting with the
representatives of the NCE program. In the meeting they were told that the profile as a life
science cluster was too broad and that they should create a more distinct profile. They
followed the advice, and decided to focus only on cancer and named the new organization
Oslo Cancer Cluster. Since the CEO was also a board member of several cancer intensive
research companies he recruited these as members of the new cluster organization. In 2007 a
new application was sent and this time with a positive result. Since then OCC has amongst
others been working with marketing and promotion of the cluster through participation in
international conferences and arrangement of conferences in Oslo. OCC is besides Cancer
Bio-Sant, in France, one of two specialized cancer clusters in Europe.
Participation in the NCE program made it possible to speed up already planned activities in
the OLS project; i.e. to follow an already created path but with a more distinct profile, higher
speed, involvement of more actors, and support and advice from the program. One example of
planned activity was to extend collaborations between research organizations in different
hospitals and universities, public actors, biotechnology firms, the cluster organization etc.
This strategy was planned in OLS but at that time they did not know about the cluster
concept. The cluster concept and the work methods used in the NCE program turned out to be
meaningful Oslo Cancer Cluster and were adopted and adapted to this context.
The matching of the idea of the NCE program and the idea of the OLS project demonstrates
some common understandings. These relate to change of the behavior of researchers, such as
from the production of scientific articles only to be more concerned about commercialization
of research findings. It includes increased collaboration between actors in the industry, the
research and public sectors in order to coordinate and utilize resources. The research activity
has led to a change in the understanding of cancer treatment, from seeing cancer as a deadly
disease to a chronic disease.
The key person, the CEO of Oslo Cancer Cluster and NRHR, is educated as a physician, he
has long experience as a municipal physician, and he was involved with establishing the first
private hospital in the Oslo region and Norway. He has been an important player in the
organizations he has been involved in, has managed to identify new opportunities and see
how these can be used by OCC and NRHR to increase innovations from cancer research. It is
not possible to state definitely that he and the organizations he is working inare the cause of
the institutional change in cancer research and production in the Oslo region. This person and
organizations like the Norwegian Radium Hospital, its research foundation, the Oslo Life
Science project and Oslo Cancer Cluster have been important in identifying a change towards
more focus on cluster building and commercialization, have adapted to that change, and
through their actions have reinforced an institutional change process in the Oslo region.


Table 2: Important Incidents in the development of Oslo Cancer Cluster

Important incidents Year of
establishment
Main purpose
Establishment of the
Radium Hospital
1932 Specialist on cancer treatment. One of the biggest centers in
Northern Europe.
Law of cancer register 1951 Law imposing hospitals, pathological institutes and x-ray
departments to notify all cancer cases to the Cancer Registry of
Norway from 1. January 1952.
The Cancer Registry of
Norway
1952 One of the oldest national cancer registries in the world.
Combined with the unique personal identification number used
in Norway, the Cancer Registrys data is suitable for research
and spreading of information on cancer.
Institute for cancer
research
1954 The Institute has seven research departments and about 340
employees (master students included). About 70% of the
employees and projects are externally funded.
The Norwegian Radium
Hospital Research
Foundation (NRHR)
1986 NRHR is an independent organization founded by The
Norwegian Radium Hospital and the Norwegian Ministry of
Health with the aim to strengthen cancer research at the current
Oslo University Hospital.
Oslo Life Science 2004 Established as a project.
Establishment of a new
hospital
2005 Radium Hospital merges with Rikshospitalet. In 2009 this new
organization merges together with Ullevl and Aker Hospitasl
to Oslo University Hospital.
Establishment of the NCE
program
2006 Innovation Norway, the Research Council Norway and SIVA
establish the program.
Oslo Cancer Cluster 2006 Formally established as a cluster organization.
Oslo Cancer Cluster 2007 Becomes a member of the NCE program

Discussion and conclusion
The introduction raised three questions: what is the core of the institutional change that
spurred the emergence and development of Oslo Cancer Cluster? Who were the central
institutional entrepreneurs in this case? In what way can the institutional entrepreneurship
approach bring more dynamism and agency into the innovation system school of thought?
The specific and concrete answer to the first question is that a connection appeared between
the ideas of the NCE program and the ideas that the Oslo Life Science project (OLS) were
working with. The connection was made by a researcher that knew about the plans of OLS
and the NCE program. The ideas of both organizations fitted very well, OLS adapted their
ideas to become Oslo Cancer Cluster (OCC) which became a member of the NCE program.
Without these concrete incidents; i.e. actions, OCC would not have been established at that
point of time. Without the concrete actions the ideas could have remained as ideas and talk.
The actions made them concrete.
The core of the institutional change behind the emergence of OCC is new ideas of industrial
development (the idea of clustering), a change in understanding of how research should
contribute to society (from writing yet another scientific article to commercializing research
results), a change in the understanding of cancer treatment (from curing cancer to live with
cancer as a chronic disease), and more awareness that actors in different organizations need
to collaborate to reach common objectives.
The second question is hard to answer in a concrete way. Several organizations have been
important players at distinct points of time in the development of OCC, such as NRHR and
OLS. Without their actions OCC would not have been established. In specific moments these
organizations have played the role as entrepreneurs; i.e. to make actions that made a
difference and pulled the change one step ahead. In addition, also persons, in particular the
CEO in OCC and NRHR, have played an important role by having positions in different
organizations and initiating necessary actions. With regard to the third question the article
demonstrates both strengths and weaknesses with the innovation system approach as this
approach is usually applied. By use of the innovation system way of thinking the article
describes the main actors in the system of cancer research and production of cancer medicine
and treatment in the Oslo region, as summed up in Table 1.The article describes the role of
individual actors with regard to research, clinical testing, production, marketing, sources of
spin-offs, commercialization, sources of seed and venture capital and so on. The article also
analyses where, in which organizations, and how research and innovation activities occur, and
we could conclude that Oslo Cancer Cluster represents a fairly well-developed innovation
system.
However, the empirical analysis of Oslo Cancer Cluster as an innovation system also
demonstrates some weaknesses with the system approach as the bare mapping of
organizations in the system leaves several important questions unanswered. These include
why the organizations play their specific roles in the system, how they achieved or got their
roles, which institutions or rules of the game that coordinate knowledge flow and cooperation
between actors in the system, how institutions have changed, and who are important change
agents. Thus, as emphasized above the innovation system approach would benefit from being
more dynamic and actor oriented. The key question is if our interpretation and use of the
institutional entrepreneurship way of thinking can contribute in that endeavor.
Based on our experience the adding of a dynamic aspect to the innovation system approach is
fairly straightforward. The article has traced the establishment of key organizations, described
as important incidents in Table 2, and how new organizations arise from existing ones. One
example is how the establishment of OCC was a result of ideas in the OSL project which in
turn was based on ideas from key persons in The Norwegian Radium Hospital Research
Foundation (NRHR). There is, however, a risk in finding only the success stories when
going backward into the history from the existing organizational set-up.
The institutional aspect is more difficult to handle. We see that new understandings, such as
increased local collaboration following the cluster concept and a changed emphasis from
basic research and publication to research, development and commercialization, paved the
way for the establishment of the Oslo Cancer Cluster. These are important institutional
changes which can be linked to the activities of a few key entrepreneurs in NRHR and to the
start up of the NCE program. The actual entrepreneurs and mechanisms behind the
institutional changes are however difficult to trace in detail. Nevertheless, the article has
demonstrated can the concept of institutional entrepreneurship may very well supplement the
innovation system approach. A main mission of the institutional entrepreneurship way of
think is to raise awareness of the fact that innovation system analyses should also examine
how central organizations have been established, have given rise to new organizations, how
institutions as rules of the game coordinate activities in the system and how and why these
institutions change.


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