Linking Health IT and Learning Organization to Sustainable Hospital Performance: Mediating Effect of Adaptive Agility Strategy

Tresia Mahaputeri Nusantari Maghfirah; Denny Bernardus; Cliff Kohardinata; Halek Mu'min

doi:10.61255/jeemba.v4i4.1599

Authors

Tresia Mahaputeri Nusantari Maghfirah Universitas Ciputra Surabaya, Indonesia
Denny Bernardus Universitas Ciputra Surabaya, Indonesia
Cliff Kohardinata Universitas Ciputra Surabaya, Indonesia
Halek Mu'min INTI International University, Malaysia

DOI:

https://doi.org/10.61255/jeemba.v4i4.1599

Keywords:

Health Information Technology, Learning Organization, Adaptive Strategy Based Agility, Sustainable Hospital Performance, Dynamic Capability Theory

Abstract

Purpose – This study examines whether Adaptive Strategy Based Agility (ASBA)—a novel construct synthesizing Dynamic Capability Theory and Institutional Theory—mediates the effects of Health Information Technology (HIT) and Learning Organization (LO) on Sustainable Hospital Performance (SHP) in Indonesian hospitals, addressing prior inconsistent findings on HIT's direct performance effects.

Design/methodology/approach – Data were collected from 240 respondents (hospital directors and senior management) across 80 hospitals in Jakarta, Bandung, Semarang, and Surabaya, three respondents per hospital, using a seven-point Likert questionnaire. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) with SmartPLS 4 to test seven hypothesized relationships spanning direct effects, antecedent-to-ASBA paths, and ASBA's mediating role.

Findings/Results – All five direct paths were statistically significant and positive. HIT and LO each had significant direct and indirect effects on SHP, both classified as complementary (partial) mediation through ASBA, which itself was the strongest single predictor of SHP. The model also showed meaningful out-of-sample predictive relevance via PLSpredict and CVPAT.

Originality/Value – The study contributes theoretically by integrating Dynamic Capability Theory and Institutional Theory within a single mediating construct (ASBA), and practically by clarifying how hospitals can convert technological and learning-based resources into sustained performance through deliberate, institutionalized strategic agility.

Abstract views: 0 ,

PDF downloads: 0

Downloads

Download data is not yet available.

References

Barbosa, C. L., da Cruz Lima, A., Sobrinho, A. C. L., Calado, R. D., & Lordelo, S. A. V. (2021). Information, Communication and Knowledge for Lean Healthcare Management Guidelines, a Literature Revision. IFIP Advances in Information and Communication Technology, 631 IFIP, 250–257. https://doi.org/10.1007/978-3-030-85902-2_27

Bardhan, I. R., & Thouin, M. F. (2013). Health information technology and its impact on the quality and cost of healthcare delivery. Decision Support Systems, 55(2), 438–449. https://doi.org/10.1016/J.DSS.2012.10.003

Bollen, K. A., & Ting, K. F. (2000). A tetrad test for causal indicators. Psychological Methods, 5(1), 3–22. https://doi.org/10.1037/1082-989X.5.1.3

Bucheli, J. M., Santa, R., Tegethoff, T., & Quintero, K. (2024). The Mediating Role of Eco-Innovation between Adaptive Environmental Strategy, Absorptive Capacity, and Environmental Performance. Sustainability (Switzerland), 16(15). https://doi.org/10.3390/SU16156504

Bush, P. D. (1987). The theory of institutional change. J Econ Issues, 21(3), 1075–1116.

Cho, N. E., Ke, W., Atems, B., & Chang, J. (2018). How Does Electronic Health Information Exchange Affect Hospital Performance Efficiency? the Effects of Breadth and Depth of Information Sharing. Journal of Healthcare Management, 63(3), 212–228. https://doi.org/10.1097/JHM-D-16-00041

Coltman, T., Devinney, T. M., Midgley, D. F., & Venaik, S. (2008). Formative versus reflective measurement models: Two applications of formative measurement. Journal of Business Research, 61(12), 1250-1262. https://doi.org/10.1016/j.jbusres.2008.01.013

DiMaggio, P., Hargittai, E., Neuman, W. R., & Robinson, J. P. (2001). Social Implications of the Internet. Annual Review of Sociology, 27(1), 307–336. https://doi.org/10.1146/annurev.soc.27.1.307

DiMaggio, P. J., & Powell, W. W. (1983). The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields. American Sociological Review, 48(2), 147. https://doi.org/10.2307/2095101

Teece, D. J., Pisano, G., & Shuen, A. (1997). Dynamic capabilities and strategic management. Strategic Management Journal, 18(7), 509–533. https://doi.org/10.1002/(SICI)1097-0266(199708)18:7<509::AID-SMJ882>3.0.CO;2-Z

Dymock, D., & McCarthy, C. (2006). Towards a learning organization? Employee perceptions. Learning Organization, 13(5), 525–536. https://doi.org/10.1108/09696470610680017

Gudergan, S. P., Ringle, C. M., Wende, S., & Will, A. (2008). Confirmatory tetrad analysis in PLS path modeling. Journal of Business Research, 61(12), 1238–1249. https://doi.org/10.1016/J.JBUSRES.2008.01.001

Esdar, M., Hübner, U., Thye, J., Babitsch, B., & Liebe, J. D. (2021). The effect of innovation capabilities of health care organizations on the quality of health information technology: Model development with cross-sectional data. JMIR Medical Informatics, 9(3). https://doi.org/10.2196/23306

Fang, S. R., Chang, E., Ou, C. C., & Chou, C. H. (2014). Internal market orientation, market capabilities and learning orientation. European Journal of Marketing, 48(1), 170–192. https://doi.org/10.1108/EJM-06-2010-0353

Feldman, S. S., Buchalter, S., & Hayes, L. W. (2018). Health information technology in healthcare quality and patient safety: Literature review. JMIR Medical Informatics, 20(6). https://doi.org/10.2196/10264

Fornell, C., & Bookstein, F. L. (1982). Two Structural Equation Models: LISREL and PLS Applied to Consumer Exit-Voice Theory. Journal of Marketing Research, 19(4), 440. https://doi.org/10.2307/3151718

Hair, J. F., Hult, G. T. M., Ringle, C. M., Sarstedt, M., & Thiele, K. O. (2017). Mirror, mirror on the wall: a comparative evaluation of composite-based structural equation modeling methods. Journal of the Academy of Marketing Science, 45(5), 616-632. https://doi.org/10.1007/s11747-017-0517-x

Hair, J. F., Sarstedt, M., & Ringle, C. M. (2019). Rethinking some of the rethinking of partial least squares. European Journal of Marketing, 53(4), 566–584. https://doi.org/10.1108/EJM-10-2018-0665

Han, X., Lowry, T. Y., Loo, G. T., Kuperman, G. J., & Shapiro, J. S. (2019). Expanding Health Information Exchange Improves Identification of Frequ ent Emergency Department Users. Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2018.07.024

Jarvis, C. B., MacKenzie, S. B., & Podsakoff, P. M. (2003). A critical review of construct indicators and measurement model misspecification in marketing and consumer research. Journal of Consumer Research, 30(2), 199-218. https://doi.org/10.1086/376806

Harris, S. G. (1990). The fifth discipline: The art and practice of the learning organization, by Peter Senge, New York: Doubleday/Currency, 1990. Human Resource Management, 29(3), 343–348. https://doi.org/10.1002/HRM.3930290308

J., *Real, J., R., A., L., Real, J. C., Roldán, J. L., & Leal, A. (2014). From entrepreneurial orientation and learning orientation to business performance: Analysing the mediating role of organizational learning and the moderating effects of organizational size. British Journal of Management, 25(2), 186–208. https://doi.org/10.1111/J.1467-8551.2012.00848.X

Knoche, H. T. (2022). Thinking about cooperative learning: The impacts of epistemic motives and social structure on cooperative learning environments. International Journal of Management Education, 20(2). https://doi.org/10.1016/j.ijme.2022.100643

Lawshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 28(4), 563-575. https://doi.org/10.1111/j.1744-6570.1975.tb01393.x

Lee, S. (2019). Learning-by-moving: Can reconfiguring spatial proximity between organizational members promote individuallevel exploration? Organization Science, 30(3), 467–488. https://doi.org/10.1287/ORSC.2019.1291

Lichtenthaler, U. (2009). Absorptive capacity, environmental turbulence, and the complementarity of organizational learning processes. Academy of Management Journal, 52(4), 822–846. https://doi.org/10.5465/AMJ.2009.43670902

Liu, S. S., Luo, X., & Shi, Y. Z. (2002). Integrating customer orientation, corporate entrepreneurship, and learning orientation in organizations-in-transition: An empirical study. International Journal of Research in Marketing, 19(4), 367–382. https://doi.org/10.1016/S0167-8116(02)00098-8

Mu’Min, H., Bernardus, D., Kaihatu, T. S., Mu’min, H., Bernardus, D., & Kaihatu, T. S. (2025). Unlocking Digital Success: A TOE Framework Analysis of Digital Marketing Adoption for Enhanced SMEs Competitiveness. International Journal of Accounting and Economics Studies, 12(5), 303–319. https://doi.org/10.14419/n81qcx19

Nassani, A. A., Badshah, W., Grigorescu, A., Cozorici, A. N., Yousaf, Z., & Zhan, X. (2024). Participatory leadership and supportive organisational culture Panacea for job satisfaction regulatory role of work-life balance. Heliyon, 10. https://doi.org/10.1016/j.heliyon.2024.e36043

Payne, J. W., Bettman, J. R., & Johnson, E. J. (1988). Adaptive Strategy Selection in Decision Making. Journal of Experimental Psychology: Learning, Memory, and Cognition, 14(3), 534–552. https://doi.org/10.1037/0278-7393.14.3.534

Polit, D. F., & Beck, C. T. (2006). The content validity index: Are you sure you know what's being reported? Critique and recommendations. Research in Nursing & Health, 29(5), 489-497. https://doi.org/10.1002/nur.20147

Richard, H., & Tolbert, P. (2005). Organizations: structures, processes, and outcomes. Pearson.

Sarstedt, M., & Liu, Y. (2024). Advanced marketing analytics using partial least squares structural equation modeling (PLS-SEM). In Journal of Marketing Analytics (Vol. 12, Number 1, pp. 1–5). Palgrave Macmillan. https://doi.org/10.1057/s41270-023-00279-7

Shmueli, G., Ray, S., Velasquez Estrada, J. M., & Chatla, S. B. (2016). The elephant in the room: Predictive performance of PLS models. Journal of Business Research, 69(10), 4552–4564. https://doi.org/10.1016/J.JBUSRES.2016.03.049

Teece, D. J. (2007). Explicating dynamic capabilities: The nature and microfoundations of (sustainable) enterprise performance. Strategic Management Journal, 28(13), 1319–1350. https://doi.org/10.1002/SMJ.640

Tsang, E. W. K. (1997). Organizational learning and the learning organization: A dichotomy between descriptive and prescriptive research. Human Relations, 50(1), 73–89. https://doi.org/10.1177/001872679705000104

Volberda, H. W., Khanagha, S., Baden-Fuller, C., Mihalache, O. R., & Birkinshaw, J. (2021). Strategizing in a digital world: Overcoming cognitive barriers, reconfiguring routines and introducing new organizational forms. Long Range Planning, 54(5). https://doi.org/10.1016/J.LRP.2021.102110

White-Williams, C., Asi, Y. M., Raffenaud, A., Bagwell, M. T., & Zeini, I. M. (2016). The effect of information technology on hospital performance. Health Care Management Science. https://doi.org/10.1007/s10729-015-9329-z

Zhao, X., Lynch, J. G., & Chen, Q. (2010). Reconsidering Baron and Kenny: Myths and Truths about Mediation Analysis. Journal of Consumer Research, 37(2), 197–206. https://doi.org/10.1086/651257

Zhihan, S., Mohammadiounotikandi, A., Ghareh Khanlooei, S., Ehsani, A., & Lee, S. (2023). A new conceptual model to investigate the role of hospital’s capabilit ies on sustainable learning. Heliyon. https://doi.org/10.1016/j.heliyon.2023.e20890