Introduction

The importance of entrepreneurial orientation for the national, regional and local development of the economy is widely acknowledged. Recognized as a multidimensional and complex phenomenon, entrepreneurship has triggered changes and reforms worldwide, namely in terms of labor force qualification and economic and organizational progress (Audretsch 2007; Gómez-Haro et al. 2011; Huarng and Yu 2011; Anderson et al. 2012; Audretsch 2012).

An entrepreneur is an individual who is able to identify and/or to create opportunities and innovations, deploying resources that allow him/her to extract the maximum benefits from such innovations (Gartner and Shane 1995; Cambra-Fierro et al. 2011; Chang et al. 2011; Gallego-Álvarez et al. 2011; Goktan and Miles 2011; Hotho and Champion 2011; Rowley et al. 2011; Battistella et al. 2012; Chaston and Scott 2012). According to several authors (e.g. McClelland 1961; Green et al. 1996; Koh 1996), entrepreneurs possess common personal attributes, the most common ones being the need for achievement, self-control, propensity to risk exposure, tolerance of ambiguity, self-confidence and innovation. Shaver’s (1995) research on psychological and cognitive characteristics revealed that entrepreneurial attitudes and interpersonal skills, as well as cognitive processes, can be acquired over time, more specifically through education and/or training.

Considering the variety and complexity of the meaning of entrepreneurship/entrepreneur, this study is focused on the role of the psychological and cognitive characteristics of the entrepreneur, as well as on the influence of the sociological/cultural theory on those characteristics. According to Hannan and Freeman (1989) and Delacroix and Rao (1993), among others, the sociological/cultural theory has as its primary focus the adaptation processes of entrepreneurial organizations to the environment in order to determine which circumstances are more conducive to entrepreneurial activity (for further discussion, see also Elsbach and Sutton 1992; Aldrich and Fiol 1994). The sociological/cultural theory also assumes that exogenous factors (i.e. conditions of the economic environment) influence the decision of firm creation. This means that social and cultural factors are also determinants of entrepreneurial orientation, justifying the growing necessity of empirical investigation of the entrepreneurial orientation among different professional groups in order to define entrepreneur profiles and best practices.

In a changing environment, innovators and entrepreneurs play an important role in developing new approaches that allow for the provision of health care services with overall lower costs. In this sense, it seems extremely important to analyze the entrepreneur’s profile and motivation within a specific entrepreneurial industry group: health care professionals (HCP), namely diagnostic and therapy technicians.

Considering the psychological attributes of the entrepreneur (see McClelland 1961; Kourilsky 1980; Bygrave 1989; Begley 1995; Brandstatter 1997; Stewart and Roth 2001; Van Praag and Cramer 2001), cognitive actors (see Mitchell 1994; Baron 1998; Mitchell et al. 2000; Mitchell et al. 2004; Tang et al. 2007), motivations for enterprise start up (see Tang et al. 2007) and the social/cultural environment (see Delacroix and Rao 1993; Aldrich and Fiol 1994), it is possible to address three main research questions:

  1. 1.

    Are HCP entrepreneurs characterized by common psychological characteristics with an entrepreneurial orientation?

  2. 2.

    Have HCP cognitive characteristics similar to the profile of other entrepreneurs?

  3. 3.

    Does motivation to start up a business play an important role in mediating the psychological/cognitive factors and entrepreneurial profile?

This study builds on previous work of Marques et al. (2011c) but highlights new findings and presents further discussion in terms of entrepreneurial orientation and motivation to start up a business in the health service industry. In particular, this study discusses the entrepreneurial orientation of HCP and their motivation to start up a business and compares entrepreneurial HCP’s and non-entrepreneurial HCP’s psychological and cognitive structures. Within this context, this research study aims to investigate the entrepreneurial orientation and motivation to start up a business in a specific professional group of health care professionals, namely diagnostic and therapy technicians. The empirical study uses primary data collected through a sample of 367 Portuguese HCP.

The reminder of the paper is structured as follows. Section two provides a theoretical discussion of entrepreneurs’ psychological and cognitive attributes and the motivation to create businesses before detailing the research hypotheses. Section three presents the method, sample and the data collecting and variable measurement processes. Section four presents and discusses the research results. Section five sets out the main findings and highlights some implications for management, as well as some limitations and avenues for future research.

Literature review

Defining entrepreneurial propensity is a complex endeavor because there is no unanimous definition in the literature (cf. Shapero and Sokol 1982; Ajzen 1991; Liñán and Chen 2009; Rodrigues et al. 2010; Covin and Wales 2011). Nevertheless, some related common characteristics have supported the attempt to create a single entrepreneur profile. Based on the existing literature, this section presents a selection of psychological and cognitive characteristics, as well as social and economic factors, that are common at the individual level and can support the definition of entrepreneurial propensity. It should be explained, however, that listing the characteristics more repeated in literature seems to be an (apparent) easy procedure and thus can be easily done. Nonetheless, the difficulty relies in the fact that those characteristics cannot be aggregated in a single entrepreneurial profile. According to Storey (1996) and Wiklund et al. (2003), among others, the entrepreneurial attitude is not innate. Although different combinations of personal attributes, motivation and leadership may lead to higher entrepreneurial orientation, there are some factors that can be taught and skills that can be trained and developed.

Davidsson and Delmar (1992) suggested that even the individuals who may not have innate entrepreneurial orientation can become entrepreneurs if the stimulus provided by the society is positive and supportive. According to the authors, culture, formal education and public policies also play an important role in terms of entrepreneurial orientation and motivation. Particularly in terms of culture, Davidsson and Delmar (1992) and Dana (1995), among others, highlight the importance of an entrepreneurial culture as a manner of fostering entrepreneurship. Starting from this premise, several factors play a key role in explaining successful entrepreneurial initiatives, which can be grouped into three main categories: (a) individual level; (b) organizational level; and (c) environmental level (cf. Covin and Slevin 1991; Zahra 1993).

At the individual level, Beugelsdijk and Noorderhaven (2005) defend that the most relevant characteristics of the individual personality are necessity, knowledge, skills and values. At the environmental level, the most relevant factors are socio-economical, socio-cultural, psychological and physiological, geographical and governmental. Finally, the organizational level includes factors related to interpersonal relationships and group objectives. Additionally, Rodrigues et al. (2010) proposed a conceptual framework in which the relationships among variables that may influence entrepreneurial propensity are analyzed. Those variables include: (a) personal characteristics; (b) family’s entrepreneurial legacy; (c) professional background; (d) demographic profile; (e) formal education and training; and (f) obstacles to the entrepreneurial activity. From a complementary perspective, Gerry et al. (2008) suggested a typology of determinants that distinguishes behavioral theories from strategic and ecologic theories. This allows for the identification of determinants of entrepreneurship by considering different explanations for the entrepreneurial success. It should be highlighted, however, that entrepreneurship is an emerging field of research, in which there are no established theories yet (cf. Filion 2002). As such, it can be assumed that there is a large number of previous studies adopting environmental, demographic, psychological and, more recently, cognitive characteristics as predictors of the entrepreneurial behavior. The next subsections present further discussion about these predictors.

Psychological factors

Despite being among the less understood factors, psychological characteristics of entrepreneurs have received increased attention in terms of academic research (cf. McClelland 1961; Brockhaus 1980). Until recently, researchers typically focused on the personality traits of aspirant or active entrepreneurs (McClelland 1961; Brockhaus 1980). A series of psychological characteristics considered to be good predictors of entrepreneurial behavior were gradually assembled as a result of the pioneering work of McClelland (1961) and the contributions of those inspired by his research (Hornaday and Aboud 1971; Bygrave 1989; Koh 1996). Readers conversant with behavior theory in general, and the analysis of business motivation in particular, will already be familiar with the psychological characteristics listed in Table 1, which provides a chronology of those traits currently associated with entrepreneurial behavior and some of the authors responsible for their identification.

Table 1 Different authors’ perspectives on entrepreneur’s psychological characteristics
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According to the literature review presented in Table 1, one can conclude that entrepreneurial success results from a set of factors such as the entrepreneur’s personality, self-recognition of achievement, entrepreneurial attitudes and self-esteem (cf. Marques et al. 2011c). Nevertheless, the social context, unexpected events, recognition of favorable opportunities and access to the necessary resources may also induce entrepreneurial success (cf. Storey 1996; Wiklund et al. 2003; Bhasin 2012). From this observation, the following research hypothesis can be formulated:

  1. H0.1:

    There is a positive relationship between psychological factors and HCP’s entrepreneurial orientation.

Cognitive factors

As previously outlined, and following Begley and Boyed (1987), Green et al. (1996) and Haynie and Shepherd (2009), it is possible to identify common psychological characteristics that distinguish entrepreneurs from non-entrepreneurs. Nevertheless, several authors (e.g. Gartner et al. 1994) suggest that these characteristics can change over time through human interaction, education and/or training. As defended by Drucker (1985), there are cases in which entrepreneurs do not present the necessary characteristics and are still able to successfully start up a business. This observation seems to be supported by Shapero (1981), Shaver and Scott (1991), Cavalcante et al. (2011), Chou (2011) and Bonzo et al. (2012), who defend that, apart from psychological characteristics, potential entrepreneurs may present an adequate cognitive structure for entrepreneurial activities.

Presently, few would contest that the most recent developments in cognitive psychology have increased the interest in studying the cognitive variables that may lead entrepreneurs to find business opportunities and to efficiently explore them (cf. Mitchell et al. 2000; Baron 2004). According to Gardner (1999), this increased interest in studying cognitive variables emerged to provide answers to epistemological questions, namely those referring to the nature, origins, development and application of human knowledge (e.g. learning skills, memory, language and perception). Following previous research, distinguished cognitive thinking from psychological thinking based on the fact that the former refers to the relationships of cause and effect that psychological determinants have on the cognitive dimension (for further discussion, see Bird 1992). In this context, it should be pointed out that the first studies approaching these issues considered the concept of cognitive bias and highlighted the importance of heuristic processes in terms of strategic decision making (cf. Busenitz 1992; Hess and Bacigalupo 2011; Huang et al. 2011; Jansen et al. 2011). These research contributions have also focused on the entrepreneurs’ capacity to measure their perception and self efficiency (cf. Krueger 1993; Krueger and Dickson 1994; Mousa and Wales 2012), considered of critical importance to entrepreneurial success (Eisenberger 1992; Markman et al. 2005; Fernández et al. 2009; Yang and Li 2011). It should be mentioned, however, that cognitive psychology was used for the first time to distinguish entrepreneurs from non-entrepreneurs in a study conducted by Mitchell (1994). The importance of cognitive mechanisms on the entrepreneurial behavior was later confirmed by Baron (1998).

Within the process of identifying entrepreneurial opportunities, an important tool has been recognized: “the state of alert”, which refers to the perception by which entrepreneurs’ characteristics are translated into the ability to find opportunities without consciously seeking them (Kirzner 1979; Tang et al. 2007). Palich and Bagby (1995) have also approached the study of entrepreneurship from the cognitive psychology perspective, and they concluded that entrepreneurs can be distinguished from non-entrepreneurs due to their capacity to interpret and to categorize situations. In line with the authors, entrepreneurs seek opportunities ignored by others and can anticipate the outcome of these opportunities with higher returns than non-entrepreneurs (see also Marques et al. 2011c).

In conclusion, Baron (2004) pointed out what he considers to be the main cognitive factors in the field of entrepreneurship: (a) higher risk exposure; (b) perception of probability of success; (c) recognition of opportunities; (d) higher sensibility to cognitive biases; and (e) alertness and speculative thought. For Chen et al. (1998), the emergence of the cognitive approach has contributed to attracting more researchers to this field. From the perspective of these authors, the potential entrepreneur is an individual who can be distinguished from the others based on her/his cognitive mechanisms. In this sense, the following research hypothesis is proposed:

  1. H0.2:

    There is a positive relationship between cognitive factors and HCP’s entrepreneurial orientation.

Motivation

Entrepreneurs face different challenges. Among those challenges, we can include the motivation to start up a new business and the motivation for business expansion/growth. According to several authors (e.g. Farmer et al. 2011), the analysis of entrepreneurial motivation is difficult to conduct because it lacks of objectivity and varies across cultures and individuals. Among the existing theories of entrepreneurial motivation, the one that has received relatively more attention is the theory of McClelland (1961) (cf. Stanworth and Currn 1973; Miner 1990; Davidsson and Wiklund 1999). From McClelland’s perspective, and considering that a person has a high necessity of self-recognition, starting up a new business involves assuming risks, taking on responsibilities and paying attention to the firm’s finances, as much as discovering innovative manners to develop products and/or provide services (McClelland 1961). However, under scenarios of unfavorable economic circumstances, non-motivation related factors are the most narrowly connected to entrepreneurship (e.g. unemployment).

Minitti et al. (2005) named entrepreneurs who recognize a business opportunity (and, consequently, start up a firm) as “opportunity entrepreneurs”. On the other hand, the authors named entrepreneurs who started up a firm because they were unemployed or unhappy with their current job as “necessity entrepreneurs”.

In the context of female entrepreneurship, the dichotomy push/pull can also be presented (cf. Granger et al. 1995; BarNir 2012). The push factors (i.e. factors that restrict women and lead them to abandon the firm) are associated with frustration, boringness with the previous activity, concerns regarding family, etc. On the other hand, the pull factors (i.e. factors hindering women to follow a new personal challenge) can be associated with recognition of a business opportunity, independency, self-achievement, etc. (for further discussion, see Mallon and Cohen 2001; Renko et al. 2012). For men, the push factors are less important and assume the form of difficulties in career progression, frustration in their present jobs and working under uncertainty conditions.

Among the studies explored by Buttner and Moore (1997), only one presented a female-based analysis (and only considered 10 % of female entrepreneurs in the respective sample). The results of this study show that men are more motivated to improve their social condition and/or the social and economic condition of their families. In their turn, female entrepreneurs felt more motivated by personal goals. Additionally, it is widely accepted that both men and women started up their firms based on reasons of self-recognition, status and power, as well as autonomy and finance (for further details, see Brush and Gatewood 2008). In this sense, the following hypotheses were formulated:

  1. H0.3:

    There is a positive relationship between motivational factors and HCP’s entrepreneurial orientation.

  2. H0.4:

    Motivation to start up a business plays an important role in mediating the relationship between psychological factors and HCP’s entrepreneurial orientation.

  3. H0.5:

    Motivation to start up a business plays an important role in mediating the relationship between cognitive factors and HCP’s entrepreneurial orientation

The conceptual model presented in Fig. 1 was conceived based on the literature review presented herein.

Fig. 1
figure 1

Conceptual model of hypotheses

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Methods

Sample

The analysis formulated the results from primary data collected through a direct and an online survey. The inquiry process covered 367 health care professionals (HCP), namely diagnostic and therapy technicians, and the response rate was 24.5 %. From the 367 HCP, 24.5 % are male. In terms of age, the responses’ distribution is the following: (a) 25.9 % between 21 and 25 years old; (b) 23.7 % between 26 and 30 years old; (c) 25.6 % between 31 and 35 years old; and (d) 24.8 % are above 35 years old. Most of the respondents hold a university degree – 5 years (82.3 %); 10.9 % have a technical university degree – 3 years; and 6.8 % hold a master’s degree. Most of the HCP surveyed have no formal education in the scientific area of management and business (88.6 %).

Measurement

Psychological factors

In order to profile respondents’ psychological traits, a series of 17 questions based on a seven-point Likert scale (1: “never” to 7: “always”) was employed according to Luchinger and Bagby (1987), Bygrave (1989), Douglas (1999) and Marques et al. (2011a).

Cognitive factors

In order to assess cognitive factors potentially influencing respondents’ entrepreneurial motivation and performance, 15 questions with a seven-point Likert scale (ranging from 1: “never” to 7: “always”) were asked according to Gaglio and Katz (2001), Baron (2004), Tang et al. (2007) and Marques et al. (2011a).

Motivation

A battery of 7 questions measuring enterprise start up motivations based on a five-point Likert scale (ranging from 1: “never” to 5: “always”) were asked according to Tang et al. (2007).

For validity of the theoretical models, we used AMOS 18.0 structural equation models (SEM) with a statistical methodology able to establish a confirmatory approach. The SEM includes statistical techniques that allow establishing causal relations between indirectly observable variables. The advantages of this technique make it a better alternative because it: (a) allows for the variance to be unstable over time; (b) enables the calculation of measurement errors; (c) enables rapid calculation of statistical significance for each causal effect analyzed; and (d) allows overall adjustment of the model of hypotheses (Byrne 2001).

As a result of the calculations required for testing each model, which include factorial analysis and factor validation (using Cronbach’s alpha), the final selection of factors was made based on the average of the variables associated to each factor. Indicators used for the latent variables were taken as being reflexive. An assessment of the measurement models was then carried out using overall and specific measures of “fit”, with the overall result showing the extent to which the data fit the model’s covariance matrix. The methods adopted for final decision making were χ2, χ2/gl, CFI and RMSEA (Byrne 2001; Schreiber et al. 2006).

Results

Psychological and cognitive factors

In order to identify the changes towards the professional future of university student respondents, regarding psychological and cognitive factors, we first undertook an exploratory factorial analysis of the questionnaire. In doing so, we aimed to obtain a reduced number of factors, enabling the identification of structural relations between psychological and cognitive factors. The method used for extracting the factors was the main component method, through the Varimax approach. In accordance with the Scree Plot and the retained variance percentage, the factors retained were those registering an eigenvalue greater than 1 (for technical details, see Hair et al. 2005). Additionally, aiming to evaluate the validity of the exploratory factorial analysis, the Kaiser-Meyer-Olkin (KMO) criteria were adopted, and the scores of each subject in consideration across each of the retained factors were obtained by the Bartlett technique. Table 2 presents the factors for each dimension under examination, the actual values of each factor, the explained variance percentage and the internal consistency of each factor based on Cronbach’s alpha coefficient (for further details, see Marques et al. 2011c).

Table 2 Principal components analysis
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The internal consistency analysis showed that a considerable number of factors reached an acceptable level (i.e. Cronbach’s alpha > 0.60), namely necessity/family influence, self-recognition, creativity/innovation, self-esteem/self-confidence, self-control, social status, autonomy, professional and personal self-realisation, alertness to external business opportunities, problem solving, influence of the affective state, etc. These factors are part of the research model established in the following section.

Entrepreneurial profile

Structural equations were employed to evaluate the model linking psychological, cognitive and motivational factors with regards to the profile of the HCP entrepreneurs. CFI and GFI indices were used to evaluate the quality of the adjustment because they perform well for values above 0.90. RMSEA was also applied, with a confidence level of 90 % and a probability ≤0.05, with a value of ≤0.10 indicating an acceptable fit and, in line with Hair et al. (2005), ≤ 0.05 indicating a very good fit. The conceptual model, adjusted to 367 Portuguese HCP, is shown in Fig. 2.

Fig. 2
figure 2

Model of the psychological and cognitive factors and motivations of entrepreneurship on the business start up

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The model was considered well adjusted to the structure of the variance-covariance of the 13 items under analysis (i.e. (χ2(49) = 44.677; p = 0.649); χ2/g.l. = 0.912; CFI = 1.000; PCFI = 0.628; GFI = 0.982; PGFI = 0.529; RMSEA = 0.000; p (rmsea ≤ 0.05) = 1.000; IC (90 %) =]0.000; 0.029[). Additionally, chi-square tests for each variable revealed that motivational factors have a higher importance in the construction of the total chi-square.

Cognitive factors are positively related to attention paid to the business opportunities (i.e. (COGNI1) [λ = + 1.00]); experience and knowledge (i.e. (COGNI2) [λ = + 3.67]); and to the optimistic perception of success (i.e. (COGNI4) [λ = + 0.73]). On the other hand, they are negatively related to the influence of the affective state (i.e. (COGNI5) [λ = - 0.61]).

Psychological factors are positively related to creativity and innovation (i.e. (PSICO1) [λ = + 1.00]); self-esteem and self-confidence (i.e. (PSICO2) [λ = + 0.01]); self-control (i.e. (PSICO3) [λ = + 1.39]); and autonomy (i.e. (PSICO4) [λ = + 1.54]).

As for the motivational factors, they are positively related to self-esteem (i.e. (MOTIV1) [λ = + 1, 00]) and necessity/family influence (i.e. (MOTIV2) [λ = + 0.54]); and negatively related to social status (i.e. (MOTIV3) [λ = -0.43]), indicating that motivation increases with self-esteem and “necessity/family influence” and decreases with “social status” increases.

There was a significant correlation between cognitive factors and psychological factors (i.e. (π = 0.04; P = 0.030)), indicating that the higher the cognitive factors are, the higher the psychological factors will be and vice-versa. Also, the influence of psychological factors on motivation has shown to be significant (i.e. β = 1.65; P = 0.002): when the score of psychological factor increases one unit, the score of motivation increases 1.65. Similarly, there is a significant influence of cognitive factors on motivation (i.e. β = +4.35; P = 0.031), denoting that, when the score of cognitive factors increases one unit, motivation increases 4.35 units.

Finally, results show a positive impact of the direct effects of motivation (β = 0.05; P = 0.172), cognitive factors (β = 0,25; P = 0,126) and psychological factors (β = 0.13; P = 0.012) on the creation of the new business. This allows for the strengthening of previous studies (e.g. Gaglio and Katz 2001; Baron 2004; Hisrich et al. 2004; Markman et al. 2005; Sharir and Lerner 2006; Tang et al. 2007; Fernández et al. 2009).

Entrepreneurial intention to start up a business

The model of psychological, cognitive and motivational factors was evaluated by a structural equations model. The adjustment was done using AMOS software (v. 18.0, SPSS, Inc., Chicago, IL). CFI, GFI and PCFI, PGFI indices were used to evaluate the quality of the adjustment because they perform well for values above 0.90 and 0.60 respectively. RMSEA was also applied with a confidence level of 90 % and a probability ≤0.05 with a value of ≤0.10 indicating an acceptable fit and, in line with Hair et al. (2005), ≤0.05 indicating a very good fit. The model of the psychological, cognitive, and motivational factors of HCP profiles and their future willingness to start up a business, adjusted to 332 Portuguese non-entrepreneurs HCP, is provided in Fig. 3.

Fig. 3
figure 3

Model of psychological, cognitive and motivational factors of the HCP profile and their future willingness to start up a business

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The model fits well with the structure of variance-covariance of the 13 items under analysis (i.e. (χ2(49) = 56.275; p = 0.221); χ2/g.l. = 1.148; CFI = 0.981; PCFI = 0.616; RMSEA = 0.021; p (RMSEA ≤ 0.05) = 0.989; IC (90 %) =]0.000; 0.043[). Based on the value of the chi-square test for every item, it was shown that motivational factors are the ones weighting more on the total construction of the chi-square.

Motivation factors are positively related to self-recognition (i.e. (MOTIV1) [λ = + 1.00]) and necessity/family influence (i.e. (MOTIV2) [λ = + 0.31]). On the other hand, it is negatively related to social status (i.e. (MOTIV3) [λ = -0.38]). These results indicate that motivational factors increase with an increase in “self-recognition” and “necessity/family influence” and decrease when “social status” increases.

Cognitive factors have shown to be positively related to attention to the business opportunities (i.e. (COGNI1) [λ = + 1.00]); knowledge and previous experience (i.e. (COGNI2) [λ = + 3.89]); precision/resolution of problems (i.e. (COGNI3) [λ = + 2.74]); and optimistic perception of success (i.e. (COGNI4) [λ = + 0.91]). Contrarily, they are negatively related to the influence of the affective state (i.e. (COGNI5) [λ = -0.77]).

Psychological factors, in turn, are positively related to creativity and innovation (i.e. (PSICO1) [λ = + 1.00]); self-control (i.e. (PSICO3) [λ = + 1.39]); and autonomy (i.e. (PSICO4) [λ = + 1.54]). They are negatively related to self-esteem and self-confidence (i.e. (PSICO2) [λ = - 0.04]).

Significant positive correlation exists between cognitive factors and psychological factors (π = 0.04; P = 0.039), meaning that the higher the cognitive factors are, the higher the psychological factors will be and vice-versa. The influence of psychological factors on motivation has shown to be significant (β = 1.64; P = 0.006): when the score of psychological factors increases one unit, the score of motivation increases 1.64 units. Similarly, there is significant influence of cognitive factors on motivation (β = +4.86; P = 0.046), revealing that, when the score of cognitive factors increases one unit, the score of motivation increases 4.86 units. Finally, regarding the direct impact of motivational factors (β = 0.12; P = 0.042), cognitive factors (β = 0.52; P = 0.123) and psychological factors (β = 0.19; P = 0.035) on the intention of a future business start up, we found a direct influence between variables, supporting, as expected, previous studies (e.g. Gaglio and Katz 2001; Baron 2004; Hisrich et al. 2004; Sharir and Lerner 2006; Tang et al. 2007; Gerry et al. 2008; Rodrigues et al. 2010).

In broad terms, results show that the Portuguese HCP display a similar profile to other entrepreneurs, considering that there is a relationship between the factors presented in this research and that Portuguese HCP have created or are in the process of creating a firm, as supported by the theory, namely in terms of motivational factors (e.g. McClelland 1961; Cromie 1987; Baron 2004; Minitti et al. 2005; Sharir and Lerner 2006; Tang et al. 2007; Gerry et al. 2008; Brush and Gatewood 2008; Fernández et al. 2009; Rodrigues et al. 2010), psychological factors (e.g. McClelland 1961; Luchinger and Bagby 1987; Bygrave 1989; Douglas 1999; Markman et al. 2005; Gerry et al. 2008; Rodrigues et al. 2010), and cognitive factors (e.g. Kirzner 1982; Gaglio and Katz 2001; Ardichvili et al. 2003; Baron 2004; Markman et al. 2005; Tang et al. 2007).

Conclusions

As previously outlined, the importance of entrepreneurial orientation for the national, regional and local development of the economy is widely acknowledged. Within this context, this study aimed to investigate the entrepreneurial orientation and motivation to start up a business in a specific professional group of health care professionals – diagnostic and therapy technicians. It was underlined that our contribution builds on the previous work of Marques et al. (2011c) but highlights new findings and presents further discussion in terms of entrepreneurial orientation and motivation to start up a business in the health service industry. In particular, this study discusses the entrepreneurial orientation of HCP and their motivation to start up a business and compares entrepreneurial HCP’s and non-entrepreneurial HCP’s psychological and cognitive structures.

After data analysis and application of the SEM model to test the proposed framework, our results supported the hypothesis that HCP who have created a firm have psychological characteristics that support entrepreneurial activities. Motivation also influences the willingness of firm creation. More specifically, HCP with intention to start up a business in the future can be characterized as individuals who have motivations such as self-achievement, necessity/family influence and social status; they are creative, innovative and autonomous. Additionally, these entrepreneurs are always alert to business opportunities and they have gained the necessary knowledge and experience within the industry (see also Marques et al. 2011c). Following this, and based on the results of the statistic analysis carried out in this study, it is possible to conclude that HCP display an entrepreneurial orientation, confirming all research hypotheses presented and supporting previous research in terms of motivation (e.g. Cromie 1987; Baron 2004; Minitti et al. 2005; Sharir and Lerner 2006; Tang et al. 2007; Brush and Gatewood 2008; Gerry et al. 2008; Fernández et al. 2009; Rodrigues et al. 2010), psychological factors (e.g. McClelland 1961; Luchinger and Bagby 1987; Bygrave 1989; Douglas 1999; Gerry et al. 2008; Rodrigues et al. 2010), and cognitive factors (e.g. Kirzner 1982; Gaglio and Katz 2001; Ardichvili et al. 2003; Baron 2004; Tang et al. 2007).

Implications

The study has identified the direct influence of the motivational factor “necessity/family influence” with regards to all its sub-factors in the HCP entrepreneurs and a direct influence with psychological factors with a significant correlation with the cognitive factors and influence on motivation. A similar influence is observed in the cognitive factors of HCP entrepreneurs. The main policy implication of these results is that there is a lot to be done in order to promote the emergence of context-relevant conditions within the workplace that would allow HCP to launch their own business ventures more readily or to develop corporate entrepreneurship. Amongst the priorities frequently emphasized by specialists in national and sectorial business development are improved access to financial information and skills in entrepreneurship (via formation), the publicity and expansion of micro-credit, additional help in the design of business plans and supplementary training in management techniques specifically developed to one professional group. More detailed studies could more clearly identify the priorities for stimulating entrepreneurship or corporate entrepreneurship in HCP or in another professional group.

In our view, some of the crucial questions raised by this particular result, which would require detailed analysis and appropriate policy formulation in the future, include the following:

  1. 1.

    What are the respective roles of local stakeholders in the promotion of entrepreneurship in health sector?

  2. 2.

    Who are the key local agents best placed to provide the management skills, services and information required?

  3. 3.

    Is network-based cooperation crucial for stimulating the sustainable creation of health enterprises?

  4. 4.

    Are the new-technology-based services leading the motivations of HCP entrepreneurs to converge?

  5. 5.

    Are there significant differences in the gender entrepreneurial motivations in health sector?

Limitations and future research

This study is not without limitations and future research can be valuable in providing a clearer view of how the variables analyzed here are interlinked with other variables. The size of the sample may also be indicated as one of the limitations in terms of representativity. In this sense, future research studies including larger samples can strengthen the research line presented herein. Another limitation, which can also be seen as a strength, concerns the fact that there are very few studies devoted to exploring entrepreneurship in the health care sector. In this sense, the apparent innovativeness of this study results in the absent possibility of comparisons.

Considering that these limitations may provide interesting opportunities for further research, it can be pointed out that this study should be replicated with a larger number of variables. Another avenue for research can be based on finding gender differences. Finally, considering the HCP entrepreneurial intention model, a study of corporate entrepreneurship in this industry seems to be important to strengthen the line of research presented herein.