Contextual ambidexterity and innovation in healthcare in India: the role of HRM
| Pages | 1358-1380 |
| Date | 16 October 2017 |
| DOI | https://doi.org/10.1108/PR-06-2017-0194 |
| Published date | 16 October 2017 |
| Author | Ashish Malik,Brendan Boyle,Rebecca Mitchell |
| Subject Matter | HR & organizational behaviour,Global HRM |
Contextual ambidexterity and
innovation in healthcare in India:
the role of HRM
Ashish Malik
Newcastle Business School, University of Newcastle, Ourimbah, Australia, and
Brendan Boyle and Rebecca Mitchell
University of Newcastle, Callaghan, Australia
Abstract
Purpose –The purpose of this paper is to examine innovation in the resource-constrained context of India’s
healthcare industry. It is argued that the process of innovation in addressing healthcare management
challenges in such a context occurs through organisational ambidexterity and that human resource
management (HRM) plays an important role.
Design/methodology/approach –A qualitative research methodology is applied to explore the role of HR
practices in facilitating contextual ambidexterity and subsequent innovations in healthcare in India. The unit
of analysis is the “case”of healthcare providers in India and in-depth interview and documentary data in two
case sites are analysed to reveal the role of HRM in facilitating contextual ambidexterity and innovation. Data
analysis was undertaken first at a within-case and then at a cross-case analysis level using interpretive
manual coding based on how the data explained the role of HRM in delivering innovative outcomes and
supporting organisational ambidexterity.
Findings –The authors found evidence of the use of sets of high-involvement HRM practices for exploration
of new ideas and efficiency-driven HRM practices for creating contextual ambidexterity in the case
organisations. Further, managerial/leadership style was found to play an important role in creating
cultures of trust, openness, risk-taking and employee empowerment, supported by an appropriate mix of
intrinsic and extrinsic rewards. Finally, training was also reported as being central to creating an
ambidextrous context for delivering on various innovations in these healthcare providers.
Originality/value –This study represents an exploration of innovation in the context of India’s healthcare
sector through intersecting literatures of ambidexterity, innovation and HRM practices. In light of the
emerging economy research context, an important empirical contribution is palpable. Moreover, through a
study design which included collecting data from multiple informants on the role of human resources in
facilitating innovative outcomes, the authors reveal the role of HR-related initiatives, beyond formal HR
practices in creating contextual ambidexterity. This study also reveals the degree to which contextual
idiosyncrasies enhance our understanding of the role of HR in facilitating innovation in emerging economies.
Keywords Innovation, Qualitative, Healthcare, Ambidexterity
Paper type Research paper
Introduction
India is a populous nation that faces numerous social challenges, including that of providing
access to quality and affordable healthcare (International Institute for Population Sciences and
Macro International (IIPSMI), 2007).In addition to the scale of its healthcare challenges, unlike
Anglo-Saxon nations that rely extensively on public healthcare infrastructure, the Indian
context is unique in its extensive reliance on non -subsidised, privately funded healthcare.
Reliance on private healthcare providers is as high as 70 per cent in urban areas and
60 per cent in rural areas (IIPSMI, 2007). The quality of care, though of a variable standard,
comes at a cost that most Indians find difficult to afford. Until the mid-2000s, there was no
Personnel Review
Vol. 46 No. 7, 2017
pp. 1358-1380
Emerald Publishing Limited
0048-3486
DOI 10.1108/PR-06-2017-0194
Received 30 June 2017
Accepted 9 August 2017
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/0048-3486.htm
© Ashish Malik, Brendan Boyle and Rebecca Mitchell. Published by Emerald Publishing Limited.
This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may
reproduce, distribute, translate and create derivative works of this article ( for both commercial and
non-commercial purposes), subject to full attribution to the original publication and authors. The full
terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode
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comprehensive national health insurance scheme for those living at the bottom of the economic
pyramid (the “BoP”; earning less than USD5,000 per annum); this further compounded the
challenge of accessing healthcare. Despite the recent development of a national scheme, access
to quality healthcare is still a challenge for most.Furthermore,withtheIndianhealthcare
industrynow worth over USD110billion in revenueand growing at a compounded annualrate
of 16.5 per cent (IBEF, 2016), different classes of providers offering services to India’s
burgeoning middle class (referred to as the “middle of the pyramid”(MoP) are rapidly
emerging. This has led to the rise of innovative tertiary and quaternary speciality hospitals to
serve the MoP segment, which demands high-quality healthcare at reasonable costs. MoP
providers have employed frugal, context-specific innovations in their business models
and processes to help provide quality affordable care. They have implemented process and
clinical innovations to simultaneously balance the exploration of new ideas with the
exploitation of existing resources to provide a higher-end serv ice within the resource
constraints of a developing country (Prahalad and Lieberthal, 1998; Tiwari and Herstatt, 2012).
In a scholarly context, the simultaneous pursuit of exploration and exploitation of
resources and knowledge has been defined as organisational ambidexterity, a characteristic
central to innovation (O’Reilly and Tushman, 2008; Raisch and Birkinshaw, 2008). O’Reilly
and Tushman (2008) define “ambidexterity”as organisation’s ability to simultaneously
develop learning processes by engaging in experimentation while also aligning with current
goals, throughrefinement, efficiency and strongimplementation routines.This ambidexterity
leads to innovations that are both technological and administrative in nature (Raisch and
Birkinshaw, 2008). Organisational ambidexterity is vital for achieving a variety of
innovations; however, its role in facilitating administrativeinnovations (relating to processes,
people and business models) are comparatively under researched (O’Reilly and Tushman,
2008; Raisch and Birkinshaw, 2008; Evan, 1966). Moreover, we would argue that the
implementationof new technologies oftenbrings about changes to a firm’sserviceofferingsor
the way in which suchservices are delivered (Damanpour, 1987; Totterdell et al., 2002). Thus,
innovation is defined in line with this study’s goals and follows a broader management
conceptualization, encompassing all new-to-firm changes in structures, processes and
practices (Damanpour and Aravind, 2012) that are intended to achieve these healthcare
organisation’s goals. Innovation includes new activities by individuals, teams and users,
which improves a health system’s performance or caters to an unmet market need
(Ansari et al., 2010). Such innovations in a healthcare context encapsulates developing new
hospital processes, clinical procedures or a new business model for creating and capturing
value for patients and the stakeholders through context-specific human resource (HR) and
organisational management practices for delivering such innovations.
Additionally, the literature classifies innovations as administrative which occur when
organisations change their processes and structure to implement new ideas, for example, by
making changes to “the recruitment of personnel, the allocation of resources, the structuring of
tasks, of authority, of rewards”(Evan, 1966, p. 51). Such innovations can be incremental (minor)
and/or radical (significant) in nature. As explained by Tushman and O’Reilly (1996, p. 24),
ambidexterity includes the “ability to simultaneously pursue both incremental and
discontinuous innovation”. In this context, exploitation often involves seeking improvements
and refinements (incremental innovations) to the existing service portfolio, wherein the nature of
change is generally minor and serves existing or similar markets, whereas exploration involves
looking for variation in existing routines (discontinuous innovation) that is major or radical and
leads to new products/services or the serving of new markets or customers.
Ambidextrous organisations are those that are successful in “simultaneously
exploiting existing competencies and exploring new opportunities”without affecting
their core business (Raisch et al., 2009, p. 685). There are inherent tensions in managing
such a duality (March, 1991), and research into how firms manage these tensions is
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