Background: We are in an innovation age for healthcare delivery. Some note that the complexity of healthcare delivery may make innovation in this setting more difficult and may require more adaptive solutions. The aim of this study is to examine the relationship between unit complexity and innovation, using a complex adaptive systems approach in a hospital setting. Methods: We conducted a quantitative study of 31 hospital units within one hospital and use complex adaptive systems (CAS) theory to examine how two CAS factors, autonomy and performance orientation, moderate the relationship between unit complexity and innovation. Results: We find that unit complexity is associated with higher innovation performance when autonomy is low rather than high. We also find that unit complexity is associated with higher innovation performance when performance orientation is high rather than low. Our findings make three distinct contributions: we quantify the influence of complexity on innovation success in the health care sector, we examine the impact of autonomy on innovation in health care, and we are the first to examine performance orientation on innovation in health care. Conclusions: This study tackles the long debate about the influence of complexity on healthcare delivery, particularly innovation. Instead of being subject to the influence of complexity with no means of making progress or gaining control, hospitals looking to implement innovation programs should provide guidance to teams and departments regarding the type of innovation sought and provide support in terms of time and management commitment. Hospitals should also find ways to promote and make successful pilot implementations of such innovations visible in the organization. A close connection between the targeted innovation and the overall success and performance of the hospital unit is ideal.

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Background: Health innovation has been dominant in the pharmaceutical, biomedical, and to some extent insurance institutions for quite some time. Now we are in an innovation age for healthcare delivery. Some note that the complexity of healthcare delivery may make innovation in this setting more difficult and may require more adaptive solutions. The aim of this study is to examine the relationship between departmental complexity and innovation, using a complex adaptive systems approach in a hospital setting. Methods: We conducted a quantitative study of 31 hospital units within one hospital and use complex adaptive systems (CAS) theory to examine how two CAS factors, autonomy and performance orientation, moderate the relationship between departmental complexity and innovation. Results: We find that departmental complexity is associated with higher innovation performance when autonomy is low rather than high. We also find that departmental complexity is associated with higher innovation performance when performance orientation is high rather than low. Our findings make three distinct contributions: we quantify the influence of complexity on innovation success in the health care sector, we examine the impact of autonomy on innovation in health care, and we are the first to examine performance orientation on innovation in health care. Conclusions: This study tackles the long debate about the influence of complexity on healthcare delivery, particularly innovation. Instead of being subject to the influence of complexity with no means of making progress or gaining control, hospitals looking to implement innovation programs should provide guidance to teams and departments regarding the type of innovation sought and provide support in terms of time and management commitment. Hospitals should also find ways to promote and make successful pilot implementations of such innovations visible in the organization. A close connection between the targeted innovation and the overall success and performance of the hospital unit is ideal.

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