Organizational Agility as an Explanatory Link Between Strategic Capabilities, External Pressures, and Hospital Performance: Evidence from 173 Hospital Directors in Indonesia

Background Hospitals operate under simultaneous market, regulatory, technological, and resource pressures, yet evidence remains limited on how these conditions are associated with hospital performance through organizational agility. Methods A cross-sectional organizational survey was conducted among 173 hospital directors representing 173 hospital operating units in Indonesia. The model related industry competitive intensity, innovation ambidexterity, resource orchestration capability, and regulatory pressure to organizational agility and hospital performance, while testing digital orientation as a moderator of the organizational agility–hospital performance relationship. Partial least squares structural equation modeling was performed in SmartPLS 4. All seven latent variables were estimated as reflective global constructs. Bootstrapping used 5,000 subsamples, two-tailed testing, α = 0.05, and percentile confidence intervals. Results Innovation ambidexterity (β = 0.338, p < 0.001), resource orchestration capability (β = 0.405, p < 0.001), and regulatory pressure (β = 0.175, p = 0.002) were positively associated with organizational agility, whereas industry competitive intensity was not (β = 0.064, p = 0.132). Organizational agility was positively associated with hospital performance (β = 0.587, p = 0.001), while direct antecedent–performance paths were not supported. Significant indirect associations through organizational agility were found for innovation ambidexterity (β = 0.199, p = 0.004), resource orchestration capability (β = 0.238, p = 0.009), and regulatory pressure (β = 0.103, p = 0.030). The digital-orientation interaction was not supported (β = −0.056, p = 0.347). Conclusions Organizational agility was a statistically supported explanatory and mediating link between three antecedents and hospital performance. Given the cross-sectional design, these findings should not be interpreted causally. Explanations for the unsupported digital-orientation interaction remain hypotheses for future research.