The Cii-care Framework: A Contextual Adaptation and Validation of Entrecomp for Intrapreneurial and Innovative Competencies in Healthcare- a Mixed-methods Study in Flanders

Background The rapid evolution of healthcare demands professionals with intrapreneurial and innovative competencies to improve patient care and organizational efficiency. Although the EntreComp framework provides a well-established model for entrepreneurial competence development, a validated, contextualized adaptation for the healthcare sector is lacking. This study aimed to develop and validate the CII-CARE framework, an adaptation of EntreComp tailored to support healthcare professionals in Flanders, Belgium. Methods A mixed-methods approach was applied, combining the Nominal Group Technique (NGT) and Delphi method. Twelve experts from academia, policy, education, and healthcare sectors participated in one focus group and three iterative Delphi rounds. Qualitative thematic analysis refined the framework iteratively, while quantitative analysis included Content Validity Index (CVI) calculations, medians, and score distributions. Results The validated CII-CARE Framework consists of three competency clusters: Ideas and Opportunities , Resources , and Into Action , encompassing 15 competencies, 38 sub-competencies, and 150 behavioral indicators. Consensus was reached on most sub-competencies, with CVI scores exceeding 0.78 for most items, reflecting substantial agreement. Expert feedback led to refinements such as merging overlapping content and improving the clarity of behavioral indicators. Conclusions The CII-CARE Framework provides a validated tool for healthcare organizations to foster and evaluate intrapreneurial and innovative competencies. Integrating this framework into professional development programs may enhance healthcare professionals’ skills, improve job satisfaction, and support innovation, ultimately contributing to better patient care and organizational efficiency.