This study develops a multi-level model to examine how industry-level environmental turbulence – including market, technological and pandemic disruptions – drives institutional change and shapes hospitals’ strategic decisions to form health-care alliances (HCAs) in Taiwan.
Adopting a theory-driven qualitative multiple-case study design, the research investigates 10 dyadic HCAs through in-depth interviews with 25 key informants from hospitals, government agencies and academic institutions. The data were analyzed using an abductive, multi-level coding strategy that integrates Transaction Cost Theory (TCT), the Resource-Based View (RBV) and Institutional Theory to explain how turbulence influences alliance formation across different phases of development.
The results show that market turbulence motivates cost-efficiency alliances, technological turbulence fosters resource-based collaborations and pandemic turbulence triggers government-led institutional reforms that enhance hospitals’ pursuit of legitimacy. These findings collectively reveal a multi-level progression from environmental turbulence to institutional change and organizational determinants, ultimately leading to the formation of hospital-led or government-led alliances.
Understanding these distinct drivers enables managers and policymakers to design adaptive alliance strategies that balance efficiency, resource acquisition and legitimacy, thereby enhancing resilience and care quality in turbulent health-care environments.
This study contributes a novel integrative framework linking environmental turbulence with organizational responses in the health-care sector. By combining TCT, RBV and Institutional Theory with Das and Teng’s Alliance Development Process model, it advances theoretical and practical insights into the dynamics of HCA formation under conditions of uncertainty.
