How Organizational Agility Translates Internal Capabilities into Hospital Performance: Evidence from 173 Hospital Directors in Indonesia

<ns5:p>Background Hospitals operate under simultaneous market, regulatory, technological, and resource pressures, yet evidence remains limited on how strategic antecedents are converted into hospital performance. This study examined organizational agility as a conversion capability linking external pressures and internal capabilities to hospital performance in Indonesia. Methods A cross-sectional organizational survey was conducted among 173 hospital directors in Indonesia. The model linked 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 agility-performance relationship. Hypotheses were tested using partial least squares structural equation modeling in SmartPLS 4, and a priori sample adequacy was assessed using G*Power 3.1.9.4. Results Innovation ambidexterity, resource orchestration capability, and regulatory pressure had significant positive effects on organizational agility, whereas industry competitive intensity did not. Organizational agility positively affected hospital performance and mediated the effects of innovation ambidexterity, resource orchestration capability, and regulatory pressure on hospital performance. The direct effects of the antecedents on hospital performance were not significant, and digital orientation did not strengthen the agility-performance relationship. Conclusions The findings position organizational agility as the central mechanism through which hospitals translate strategic capabilities and institutional demands into performance outcomes. The study clarifies that digital strategic intent alone is insufficient to amplify agility returns unless supported by implementation capability and organizational alignment.</ns5:p>