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Introduction: A Queensland project team secured grant funding to pilot Project ECHO®, a telementoring model, to drive vertical and horizontal integration across paediatric, education and primary care services. This study sought to understand what influenced healthcare executives’ decision-making processes to organisationally commit to and financially invest in the pilot proposal within an organisational context.

Theory and Methods: A phenomenological approach methodology was adopted to investigate healthcare executives’ conscious decision-making processes. Semi-structured interviews with key stakeholders were conducted alongside project documentation analyses to create a thematic framework.

Results: The qualitative thematic analysis identified five key themes that influenced the decision-making processes of healthcare executives to invest in Project ECHO® as an integrated care pilot. The themes were: (i) personal experiences, (ii) benefits, (iii) risks, (iv) partnerships, and (v) timing. Executives’ reflections explored how their decision-making processes considered the intrapreneurial project team as an indicator of future sustainability.

Discussion: Findings highlighted healthcare intrapreneurs’ drive to foster more integrated and people-centred approaches to care. Intrapreneurial aims of financial sustainability, ongoing improvement and scalability of the proposal positively influenced investment confidence.

Conclusion: Intrapreneurial champions must provide a compelling narrative to convince executive decision-makers that benefits will outweigh risks, that integration is achievable through strengthened partnerships as well as future sustainability beyond the pilot phase.