Journal of Business & Industrial Marketing: Article Information

Journal of Business & Industrial Marketing
The influence of organizational culture on healthcare supply chain resilience: moderating role of
technology orientation
Santanu Mandal,
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Santanu Mandal, "The influence of organizational culture on healthcare supply chain resilience: moderating role of
technology orientation", Journal of Business & Industrial Marketing, https://doi.org/10.1108/JBIM-08-2016-0187
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The influence of organizational culture on healthcare supply chain resilience:
moderating role of technology orientation
Purpose: To explore the influence of dimensions of organizational culture viz. development

culture, group culture, rational culture and hierarchical culture on healthcare supply chain
resilience (HCRES). Further, the study explored the moderating role of technology orientation on
organizational culture dimensions and healthcare resilience linkages.
Design/ Approach/ Methodology: The study adopted a multi-unit study of different hospital
supply chains. Consequently, perceptual data were gathered from seven dominant entities in a
typical medical/hospital supply chain: hospitals, hotels, chemistry and pharmaceutical,
marketing/public relations/ promotion, medical equipment manufacturers and surgical suppliers,

food and beverage providers (i.e. restaurants) and insurance providers. The responses were
gathered using online survey and were analyzed using structural equation modeling.
Findings: Based on 276 completed responses, we found positive influences for development,
group and rational cultures on HCRES. As expected, a negative influence of hierarchical culture
was found on HCRES. Further, technological orientation was found to enhance the positive
effects of development, group and rational cultures on HCRES. However, no prominent
moderation was noted for hierarchical culture’s influence on HCRES. The findings suggested
managers to focus more on developing CVF based dimensions of organizational culture
dimensions for effective risk mitigation so as to provide healthcare services in a timely manner
to patients.
Originality/ Value: The study is the foremost to investigate the effects of organizational culture
‘s dimensions on resilience. The study has empirically established the association between CVF
view and dynamic capabilities. The study underlined the importance of resilience in healthcare
SCs. Resilience is an important dynamic capability in healthcare SCs to provide uninterrupted
treatments and services to patients. Any failure in such service can be fatal. Further, the study
developed the measures of development, group, rational and hierarchical culture for further
investigation in healthcare. Our study is also the foremost to develop a measure for resilience in
healthcare sector.
Keywords: healthcare, resilience, supply chain, organizational culture, technology orientation
Introduction
Healthcare firms require a supply chain perspective to control escalating costs and enhanced
service delivery (Syahrir et al., 2015). Such a perspective can only be realized in practice once
the key entities in healthcare supply chains (SCs) work in close coordination for delivering
effective healthcare services. Hospitals are also troubled with increasing competitive pressures
for providing effective and timely healthcare services (Zepeda et al., 2016). While healthcare
research is increasingly becoming important as a consequence of lifestyle changes and increasing
complications (Zepeda et al., 2016; Patel et al., 2016); an assessment of risks associated with
healthcare service delivery is equally relevant (Zepeda et al., 2016). Risk assessment would help
healthcare entities to prepare well for adverse conditions and adapting to the same.
Healthcare services require proactive planning complemented with efficient execution. Increased
adversities in associated service environments urges hospitals for developing risk management
strategies (Dobrzykowski et al., 2014). In this regard, hospitals and their partners in healthcare
supply chains(SCs) should devise capabilities that can safeguard their operations in the event of a
disruption. The study defines disruption in the healthcare SC context as an unexpected event that
can hinder the delivery of healthcare services to patients (Harvey, 2016; Zepeda et al., 2016).
Supply chain risk management (SCRM) literature has acknowledged SC resilience as the
essential SC capability required for safeguarding operations (Wieland and Wallenburg, 2013).
SC resilience is a dynamic capability that enable firms to prepare for uncertainties through
adequate planning with their SC partners so as to sustain performance in the event of a disruption
(Christopher and Peck, 2004; Jüttner and Maklan, 2011; Scholten and Schilder, 2015). Resilience
is more important in healthcare services compared to manufacturing. This is because failure to
provide timely treatment and associated services to patients can have fatal effects (Zepeda et al.,
2016; Dobrzykowski et al., 2014; Harvey, 2016).
While most of the industry sectors extensively use SC cost minimization tools (Elmuti et al.,
2013); the healthcare sector still lack such applications. While the average inventory turnover is
44 for consumer electronics, 10 for automotive and 6 for consumer packaged goods; for medical
devices, it’s just over 2 (Dooner,2014). As a result, the healthcare sector suffers from inefficient
capital and resource utilization. This suggests the need of a change in organizational culture that
can eliminate such issues. With appropriate organizational culture, firms in healthcare SCs would
have efficient resource utilization as a result of joint planning, enhanced coordination and
synchronizing of operations. Such effective coordination, planning and execution of activities are
the primary requisites for developing SC resilience for healthcare SCs. The study refers to
healthcare SC resilience (HCRES) as the capability of healthcare SC entities to work in a
synchronized manner so as to provide uninterrupted treatments and care to patients in the event
of a disruption.
Further, the importance of organizational culture in effective supply chain management is
undeniable (Braunscheidel et al., 2010; Fawcett et al., 2008). Organizational culture shapes the
attitude of employees with respect to information sharing, teamwork and risk taking. Appropriate
organizational culture improves trust and inter-firm associations (Schilke and Cook, 2014).
Accomplishment of objectives often become a challenging task in the absence of a proper
organizational culture (Cao et al., 2015).
The importance of resilience is more prominent for healthcare services as failure in providing
timely services can have fatal effects. As safeguarding healthcare operations and ensuring
uninterrupted services to patients is compulsory; healthcare research therefore should explore the
importance of organizational culture in the development of HCRES (Kwon et al., 2016; Syahrir
et al., 2015; de Vries and Huijsman, 2011).
Organizational culture has different conceptualizations, the prominent being the competing
values framework (CVF) view (Hartnell et al., 2011; Shih and Huang, 2010). The CVF view has
the potential to reshape organizational capabilities through resource reconfiguration and
deployment (Jones et al., 2005). Hence, it can aid in the development of dynamic capabilities
through reshaping organizational capabilities and resource reconfiguration (Teece et al., 1997).
CVF exhibits two axes: the flexibility-control and internal-external axes (Cao et al., 2015).
Organizational culture is subdivided into four components with these axes: the development,
group, hierarchical and rational (Gregory et al., 2009; Stock et al., 2007; Zu et al., 2010). Such
components reflect residing values e.g. strategic or routine orientation i.e. development culture;
cooperation and team spirit i.e. group culture; reward systems i.e. rational culture and centralized
or decentralized control i.e. hierarchical culture (Gregory et al., 2009; Hartnell et al., 2011; Stock
et al., 2007; Zu et al., 2010). Therefore, the study adopts the CVF view to explore the influence
of different types of organizational culture viz. development culture, group culture, rational
culture and hierarchical culture on HCRES.
Further, Technology Orientation (TO) has been a critical factor for success in different aspects of
SC operations (Limbu et al., 2014; Chen et al., 2014; Tseng and Liao, 2015). As a result, TO
would be an influential factor in determining the success of different organizational cultures in
generating HCRES. The study therefore explores the moderating role of TO on development
culture HCRES; group culture HCRES; rational culture HCRES and hierarchical culture
HCRES linkages. Accordingly, the study explores the following research questions:
(1) What are the influences of development, group, rational and hierarchical culture on
HCRES?
(2) How does technology orientation (TO) moderate the influence of development, group,
rational and hierarchical culture on HCRES?
The paper is structured as follows. The next section discusses the literature on resilience from
manufacturing and extends it to healthcare sector. The subsequent section discusses the various
forms of organizational culture and develops the proposed hypotheses with HCRES. The
following section elaborates on the research methodology and concludes with findings and
implications.
Theoretical background
Resilience in Healthcare Supply Chains
With increased complexity in managing globalized operation in recent times, SC resilience is an

essential SC capability (Ambulkar et al., 2015). Apart from several definitions proposed
(Ponomarov, 2012); a more popular efinition of SC resilience was given by Ponomarov and
Holcomb (2009): “The adaptive capability of the supply chain to prepare for unexpected events,
responds to disruptions, and recovers from them by maintaining continuity of operations at the
desired level of connectedness and control over structure and function” (Mandal, 2016).
Different investigations have highlighted various enablers of SC resilience: viz. collaborative
relationships, agile characteristics, supply chain re-engineering and risk awareness (Christopher
and Peck, 2004); collaboration, flexibility, visibility and velocity (Juttner and Maklan, 2011);
structural, relational and cognitive factors (Johnson et al., 2013); knowledge management
(Scholten et al.,2014); and effective procurement (Pereira et al., 2014).
Further, collaborative activities (information-sharing, collaborative communication, joint
knowledge creation and joint relationship efforts) increase SC resilience via increased visibility,
velocity and flexibility (Scholten and Schilder, 2015). A disruption orientation may not be able
to aid in risk mitigation for firms. Extent of disruption has a profound influence in formulation of
risk mitigation strategies (Ambulkar et al., 2015). Firms with appropriate resource configuration
and disruption orientation can successfully mitigate high and low disruption risks (Ambulkar et
al., 2015). While recently it was found that quality function deployment can be used to improve
maritime resilience (Lam and Bai, 2016); other researches contend that resilience is an important
capability for service sector and requires further investigations (Tukamuhabwa et al., 2015;
Kamalahmadi and Prast, 2016).
Service firms need resilience to manage their increased complexity, mitigate disruption risks and
provide an optimal performance. Medical chain entities therefore need to plan their resources
deployment so as to sustain their services even during disruptions. Therefore, we extend the
notion of resilience to medical SCs and define it as the capability of medical SC entities to work
in a synchronized manner with an objective to provide uninterrupted medical services to patients
in the event of a disruption. In this study, we contend resilience as a dynamic capability (Blome
et al., 2013; Ponomarov, 2012; Hohenstein et al., 2015) that enable medical chain entities to
adapt to uncertain situations and can sustain their services. Resilience in Healthcare Supply
Chains
With increased complexity in managing globalized operation in recent times, SC resilience is an
essential SC capability (Ambulkar et al., 2015). Apart from several definitions proposed
(Ponomarov, 2012); a more popular efinition of SC resilience was given by Ponomarov and
Holcomb (2009): “The adaptive capability of the supply chain to prepare for unexpected events,
responds to disruptions, and recovers from them by maintaining continuity of operations at the
desired level of connectedness and control over structure and function” (Mandal, 2016).
Different investigations have highlighted various enablers of SC resilience: viz. collaborative
relationships, agile characteristics, supply chain re-engineering and risk awareness (Christopher
and Peck, 2004); collaboration, flexibility, visibility and velocity (Juttner and Maklan, 2011);
structural, relational and cognitive factors (Johnson et al., 2013); knowledge management
(Scholten et al.,2014); and effective procurement (Pereira et al., 2014).
Further, collaborative activities (information-sharing, collaborative communication, joint
knowledge creation and joint relationship efforts) increase SC resilience via increased visibility,
velocity and flexibility (Scholten and Schilder, 2015). A disruption orientation may not be able
to aid in risk mitigation for firms. Extent of disruption has a profound influence in formulation of
risk mitigation strategies (Ambulkar et al., 2015). Firms with appropriate resource configuration
and disruption orientation can successfully mitigate high and low disruption risks (Ambulkar et
al., 2015). While recently it was found that quality function deployment can be used to improve
maritime resilience (Lam and Bai, 2016); other researches contend that resilience is an important
capability for service sector and requires further investigations (Tukamuhabwa et al., 2015;
Kamalahmadi and Prast, 2016).
Service firms need resilience to manage their increased complexity, mitigate disruption risks and
provide an optimal performance. Medical chain entities therefore need to plan their resources
deployment so as to sustain their services even during disruptions. Therefore, we extend the
notion of resilience to medical SCs and define it as the capability of medical SC entities to work
in a synchronized manner with an objective to provide uninterrupted medical services to patients
in the event of a disruption. In this study, we contend resilience as a dynamic capability (Blome
et al., 2013; Ponomarov, 2012; Hohenstein et al., 2015) that enable medical chain entities to
adapt to uncertain situations and can sustain their services. Resilience is more important in
healthcare services compared to manufacturing. This is because failure to provide timely

treatment and associated services to patients can have fatal effects (Zepeda et al., 2016;
Dobrzykowski et al., 2014; Harvey, 2016).
Organizational culture and CVF
The origin of organizational culture can be traced to 1980s with the works of Hofstede (e.g.
Hofstede, 1981) and several others (Pettigrew, 1979; Schwartz and Davis, 1981). There was
substantial disagreement in its conceptualization although it was one of the influential concepts
in management (Jarnagin and Slocum, 2007; Ashkanasy et al., 2000). While few referred it as a
comprehensive set of behavioral norms, rules and rituals (Trice and Beyer, 1984); others defined
it as a set of shared values, beliefs or shared patterns of understanding (Schwartz and Davis,
1981; Louis, 1985; Smircich, 1983; Deshpande and Webster, 1989). While earlier studies set out
a research agenda for organizational culture in the domain of marketing (Deshpande and
Webster, 1989); subsequent studies e.g. Moorman (1995) suggested clan culture, hierarchy
culture, adhocracy culture and market cultures as key enablers of governance and orientation in
marketing firms through appropriate information acquisition, transmission and utilization. While
clan culture facilitates information transmission and utilization; adhocracy culture facilitates
acquisition with market culture facilitating instrument information utilization.
The hierarchy culture inhibits all the phases viz acquisition, transmission and utilization of
information (Moorman, 1995). Based on a sample of Japanese firms, Deshpande et al. (1993)
further empirically established that firms stressing adhocracy and market culture to supersede
firms following clan and hierarchy cultures. While shared beliefs and ideas provide a platform
for expected behavior in an organization; the “stored knowledge” or organizational memory also
has dominant influences on firm’s product performance (Moorman and Miner, 1997). While
higher levels of organizational memory can result in short term financial gains for new products;
the same could result in enhanced performance and innovation with higher variability.
One of the prominent conceptualizations of organizational culture was that of Schein’s (2004):
assumptions, values and artefacts as essential constituents of organizational culture. While
assumptions are more deep rooted implicit notions regarding human nature; values referred to
shared ideologies that directs employee behavior and artefacts are explicit facts or ideologies
(Rokeach, 1973; Jones et al., 2005; Hofstede, 2001; Leidner and Kayworth, 2006; Naor et al.,
2008). The current study connotes organizational culture as the values and beliefs shared by all
employees of an organization. There has been different conceptualization of organizational
culture based on values; the most popular among them being the CVF (Hartnell et al., 2011; Shih
and Huang, 2010; Zu et al., 2010).
Studies have mainly focused on values for understanding organizational culture as they are
deemed to govern organizational behaviors (Howard, 1998). Subsequently, the Competing
Values Framework(CVF) was developed based on values (Quinn and Rohrbaugh, 1981, 1983;
Quinn et al., 1991).
The CVF suggests different organizational requirements can be explored along two axes. Along
one axis, firms may choose either flexibility or control for managing organizations. In the other
axis, firms may choose either an internal orientation or external orientation. Consequently, this
has given rise to four quadrants or culture types. Firms that prefer a culture sustained on human
relations aims to achieve a high degree of cohesion and morale through appropriate planning and
executing training programs, informal communication and joint decision making (Jones et al.,
2005; Linnenluecke and Griffiths, 2010). Such a culture is commonly referred to as group culture
(Cao et al., 2015). Firms emphasizing an open systems orientation aims for new ideas
development and implementation through cultivating adaptability and readiness, visionary
communication, and adaptable decision-making (Linnenluecke and Griffiths, 2010; Zammuto et
al., 2000). Such a culture is commonly referred to as development culture (Cao et al., 2015).
Firms with internal orientation aims for stability and control through effective information
sharing, timely and to the point communication and information based decision-making
(Zammuto et al., 2000; Linnenluecke and Griffiths, 2010; Jones et al., 2005). However, a rational
goal and external orientation suggests firms to aim for efficiency and productivity through
effective goal planning, instructional communication and centralized decision-making (Jones et
al., 2005; Zammuto et al., 2000; Linnenluecke and Griffiths, 2010). While all four culture types
can reside simultaneously in an organization; one may dominate others based on firm’s
preferences (Quinn and Kimberly, 1984; Quinn et al., 1991).
Effects of Organizational Culture on HCRES
Several arguments may be made for the association of organizational culture and HCRES. In the
first place, shared beliefs and values in an organization develops the vision and mission of its
business (Barney,1986; Nahm et al., 2004). Organizational culture aids in execution of
operations relevant for business achievements. It represents shared values that guide employees
in theire routine and strategic roles and responsibilities (Schilke and Cook, 2014; Braunscheidel
et al., 2010). Organizational culture further facilitates learning for SC entities through developing
ambience and relationships; that helps in idea and experience interchange (Zhao et al., 2011).
Gaining knowledge from disruptions and sharing the same aids in contingency planning and
disaster readiness. Presence of such knowledge sharing culture therefore would help in building
risk mitigation strategies. Hence, we argue that organizational culture facilitates HCRES.
Literature suggests presence of cooperation among SC entities as an essential precursor to effect
resilience (Ponomarov, 2012; Scholten and Schilder, 2015). Such a capacity to cooperate and
synchronize cross-functional processes allow SC firms to enhance their relational ties.
Relational ties are indeed a prime requisite for resilience (Wieland and Wallenburg, 2013). A
desire to cooperate facilitated by trust and commitment helps in internal and external integration
in SCs (Cao et al., 2015). Successful integration in SCs can enhance resilience (Mandal, 2016;
Gligor and Holcomb, 2012; Ponomarov, 2012; Frankel and Monelkopf, 2015). Hence
organizational culture promotes HCRES through improving relational ties. It also promotes
HCRES through enhancing the capacity and willingness to cooperate. So, it is expected that
organizational culture would be a dominant enabler of HCRES.
Organizational culture is normally manifested in an organization’s norms, value and practices
(De Long and Fahey, 2000). Culture has tremendous role in fostering a sense of commitment
towards an organization’s vision and mission through developing a sense of identity and
emphasizing codes of behavior (Green berg, 2011; Tong et al., 2015). Organizational culture has
acted either as facilitator or inhibitor for managerial and technological innovations (Zammuto et
al., 2000). Organizational culture has been frequently cited (based on empirical support) as the
cause for failure of change programs (Linnenluecke and Griffiths, 2010; Cameron et al., 1993;
Jarnagin & Slocum, 2007). With growing uncertainties and challenges in the service
environments; healthcare firms should be ready to respond to such environmental changes.

Hence, organizational culture is the key for healthcare firms for developing organizational
readiness and contingency plans. Organizational culture would facilitate the integration of
collaborative efforts for addressing disruptions. The CVF view of organizational culture can be
further linked to HCRES. Firms need to have flexibility in their resource deployment to facilitate
faster resource reconfiguration to address uncertainties. Firms also need to have control over
existing processes and routines for developing responsiveness. There is need for collaboration
among the healthcare entities based on human relations values for fighting contingencies. As a
cohesive group, health care entities must prepare themselves for contingencies through
appropriate training, timely information exchange and joint decision-making. Further, innovation
is also required to cope up with sudden challenges. Healthcare entities therefore must develop
the capacity to innovate through cultivating adaptability at all important stages. Preparing for
uncertainties therefore require a culture of change. Hence it requires an organizational culture
facilitating such change. As a dynamic capability, resilience requires appropriate resource
reconfiguration and deployment. CVF view of organizational culture facilitates the development
of dynamic capabilities through appropriate resource reconfiguration and deployment (Jones et
al., 2000; Teece and Pisano, 1994; Teece et al., 1997). Hence it is the contention of this research
that CVF view would facilitate HCRES through influencing the way healthcare entities think,
arrange their values and ideologies and process information (Cameron & Quinn, 2006; Quinn,
1988). Consequently, the four dimensions of organizational culture viz. development, group,
rational and hierarchical would be positively associated with HCRES.
Hypotheses Development
Development Culture and HCRES

Development culture denotes the value of strategic goals set and shared by the employees of an
organization. With a firm focus on development, workers focus on sustaining operations creating
strategic value (Zahra et al., 2004). As HCRES also focusses on creating long term value through
business continuity and risk mitigation plans; HCRES is more likely to be achieved in SCs
practicing development culture.

Development culture improves a firm’s existing processes for long term sustainability. Long
term value can be created through renewing existing infrastructure, employee skills and other
assets. As healthcare SCs are more complex (Dobrzykowski and Tarafdar, 2015); firms in such
complex SCs need to focus more on developing their respective assets and capabilities.
Participating firms like hospitals, pharmaceuticals, hotels, restaurants etc. need to focus on
implementing latest technologies supporting their routine operations and enhancing collaboration
(Cao et al., 2010). With updated routines and procedures; firms in healthcare SCs are well
equipped for effective cross-functional integration and collaboration (Cao et al., 2010; Gligor
and Holcomb, 2012; Flynn et al., 2010; Cao et al., 2015). Such collaborative efforts and cross
functional integration improves resilience (Juttner and Maklan, 2011; Achour et al., 2015).
Development culture emphasizes on improving SC relationships based on trust and commitment
(Schilke and Cook, 2014). This further enhances collaborative efforts and improves resilience
(Juttner and Maklan, 2011). While development culture focuses on improving operational
routines and procedures; synchronization of firm level efforts with those of key partners become
easier. This further aids in bringing the a culture of change at all organizational levels and
improve collaborative activities in the long run. Studies has undersigned collaborative activities
as a key enabler of resilience (Juttner and Maklan, 2011). While collaboration is all the more
relationship based unification of efforts; integration suggests unification at the operational level
through appropriate governance mechanisms (Flynn et al., 2010). Hence a development culture
leads to enhanced collaborative efforts and operational integration that could result in higher
HCRES. Accordingly, the study hypothesizes that:
H1: Development culture is positively associated with HCRES.

Group Culture and HCRES
Group culture denotes the assessment of joint efforts shared by all members in a firm. HCRES
requires that the diverse medical SC entities work together to resolve issues (de Almeida et al.,
2015; Flynn et al., 2010). Cooperation is a prerequisite for employees in firms for ascertaining
success of their joint efforts. Group culture develops the understanding that cooperation is the
key to sustain in competition for such healthcare SCs.
The need for cooperation suggest organizations to develop good relationships with their key
partners. Effective SC relationships could reduce conflict in complex SC operations and result in
enhanced collaboration; thereby resulting in enhanced HCRES (Papadopoulos et al., 2016;
Johnston et al., 2013). Brain storming can be successfully employed to develop a universal
language required for exchanging information and ideas (Naor et al., 2008; Nonaka, 1994).
Group culture emphasizes intra-firm and inter-firm collaborative efforts. Hence in more
complex service settings; group culture mandates timely sharing of information for faster
decision making and effective service delivery (Xie et al., 2013). Fast decision making is the key
to retain patients and gain reputation in healthcare SCs (Exprúa and Barberena, 2016). Further,
group culture aids joint planning and execution (Xie et al., 2013). Such joint activities facilitate
distribution of goods to relief camps during disasters. Hence, group culture can lead to greater
involvement of medical SC partners in intra and inter firm activitie. This can result in greater
transparency and enhanced trust and commitment. Hence group culture fosters trust and
commitment that are essential for HCRES (Wieland and Wallenburg, 2013; Johnston et al.,
2013; Schilke and Cook, 2014). Accordingly, the study hypothesizes that:
H2: Group culture is positively associated with HCRES.
Rational Culture and HCRES
By rational culture, we refer to commonly shared values and reward mechanisms developed to
satisfy the objectives of an organization. This component of organizational culture stresses on
usage of rewards for attaining routine and strategic goals of a firm e.g. enhanced medical SC
performance (Braunscheidel et al., 2010; Naor et al., 2008; Zu et al., 2010).
Further, cross-functional coordination and integration with upstream and downstream partners in
SCs are a must for success in competition (Wong et al., 2011; Prajogo and Oke, 2016). Presence
of rational culture urges employees to work as cohesive groups and respond to disruptions
through syndicated efforts (Juttner and Maklan, 2011; Wieland and Wallenburg, 2013). Effective
reward systems motivate employees and firms to fight back competition and environmental
challenges as cohesive units (Ruppel and Harrington, 2001; Bikard et al., 2015). Rational culture
encourages employees for idea exchange and knowledge transfer across organizational units. As
a result, rational culture facilitates cross functional collaboration and integration through
knowledge sharing (Flynn et al., 2010; Kwon et al., 2016). With increased collaboration and
integration, medical SCs can develop effective risk mitigation strategies for business continuity
at all levels (Zepeda et al., 2016).

Rational culture also emphasizes effective reward schemes for employees. With performance-
based incentives, employees are also motivated to collaborate with one other for achieving
strategic goals. Every medical SC entity aims to ensure sustainability of operations during
disruptions. So, we argue that rational culture would aid in HCRES development through
increasing the collaborative efforts among medical SC entities for ensuring sustainability. Hence
rational culture enhances resilience development efforts through improved coordination and
collaborative efforts in service SCs (Prajogo and Oke, 2016). Accordingly, the study
hypothesizes that:
H3: Rational Culture is positively associated with HCRES.
Hierarchical Culture and HCRES
Hierarchical culture refers to shared values of vertical and horizontal echelons of control and
cooperation in an organization (Cao et al., 2015). With a strong hierarchical culture in place,
firms can efficiently develop formalized procedures, routines and decision making mechanisms.
In such cases, formal approval is being sought from supervisors for approval (Zu et al., 2010).
Such culture has negative implications for HCRES. Organizations with a strong hierarchical
culture are usually governed by a mentality of “functional silos” (Braunscheidel et al., 2010).
Such rigid culture hinders informal communication across the organization. Therefore, inter-
departmental cooperation and collaborative efforts are negatively affected. Consequently, such
an environment in the organization adversely affects resilience (Scholten and Schilder, 2015).
Such hierarchical structures in organizations does not promote inter-departmental integration and
also intra-departmental integration; as the functional silos prohibit employees from responsibility
sharing (Braunscheidel et al., 2010). Employees in a hierarchical organization tend to follow
established rules and procedures (Ruppel and Harrington, 2001). This reduces their flexibility
and firms become less adaptive to dynamic situations.
Hierarchical culture enforces conventional rules and practices that offers reduced flexibility for
responding to uncertain situations. The contingency perspective emphasizes informal structures
and procedures to provide a positive response to uncertainties (Yuan et al., 2016; Jiang et al.,
2016). As a dynamic capability, resilience is more directed to meet contingencies and sustain
operations at an optimal level. Hence medical SC firms must focus on abolishing formal
structures for increased flexibility required for developing resilience (Juttner and Maklan, 2011).
Successful collaboration, cooperation and integration in healthcare SCs requires sufficient
flexibility in development and execution of policies and procedures. Hence, functional silos must
be broken to enhance firm’s capacity to adapt to dynamic situations (Birkinshaw et al., 2016).
So, it is argued that hierarchical culture hinders the process of resilience development. Such a
culture brings a reluctance to change for employees. This adversely affects their motivation to
learn from upcoming challenges. Consequently, their ability to innovate and develop solutions to
new problems are also reduced. Accordingly, we hypothesize that:
H4: Hierarchical culture is negatively associated with HCRES.

Moderating Role of Technology Orientation
Technology orientation (TO) incorporates product, service, production and innovation
orientations. It is “the ability and the will to acquire a substantial technological background and
use it in the development of new products” (Gatignon and Xuereb, 1997, p. 78). In the current
investigation, a technology oriented healthcare SC entity is considered as the one that is
dedicated to adopt newer and emerging technologies for exchanging real time information with
its SC partners so as to improve coordination and provide enhanced healthcare services to its
patients (Slater et al., 2007; Zhou et al., 2005; Lee et al., 2013; Ho et al., 2016).
Extant studies suggest discovery, variation and innovation to have effective influence on
technology oriented organizations (Lee et al.,2013). So, firms must focus on optimizing these
processes (Ho et al., 2016). For medical SC entities, TO increases the capacity to provide
effective healthcare services with updated technologies ensuring enhanced customer value and
satisfaction (Gatignon and Xuereb, 1997; Grinstein, 2008; Ozkaya et al., 2015).
Healthcare SC entities that are ready to develop and adapt to newer technologies, stand in a
better position to attain service differentiation and enjoy cost advantages. TO can enable such
entities to become technology leader and generate positive innovation performance (Ho et al.,
2016). Service innovation initiatives aided by technology orientation enable hospitals to develop
exploratory and exploitative innovation competences (Quintana-Garcia and Benavides-Velasco,
2008). Therefore, hospitals with a technology orientation stand in a better position to realize the
benefits of service innovation (Lichtenthaler, 2016).

The study contends that TO would enable healthcare SC entities to collaborate better and
developing effective HCRES. The development culture suggests firms to have a long-term
orientation for sustainability. With higher levels of TO; such firms would be able to develop a
flexible infrastructure for fighting back disruptions. The group culture suggests the formation of
cohesive groups for enhanced collaboration and synchronization of processes. Higher levels of
TO would complement such developments through providing an effective infrastructure.
Rational culture focuses on effective reward systems on attainment of firm’s objectives. Positive
TO levels would motivate employees to collaborate for achieving firm objectives through
adequate technology infrastructure support. Hierarchical culture does not encourage change and
focuses on stability. Subsequently, TO may not be a crucial factor in its relation with HCRES.
This discussion gives our next segment of hypotheses:
H5a: TO positively moderates the relationship between development culture and HCRES.
H5b: TO positively moderates the relationship between group culture and HCRES.
H5c: TO positively moderates the relationship between rational culture and HCRES.
H5d: TO may not have any significant influence on the relationship between hierarchical
culture and HCRES.
Figure 1 shows the theoretical model.

Figure 1. Theoretical Model

Research Methodology
Sampling and Data collection

Medical SCs vary widely in their composition owing to presence of different constituent units
viz. hospitals, accommodation providers (i.e. hotels), chemistry and pharmaceutical etc. (Lee and
Fernando, 2015). Consequently, the targeted strata in our study consisted of the following: (a)
hospitals (b) hotels (c) chemistry and pharmaceutical (d) marketing/public relations/ promotion
(e) medical equipment manufacturers (f) food and beverage restaurants and (g) insurance
companies (Chen et al., 2013; Lee and Fernando, 2015).

It is advisable to collect responses from multiple entities in SC studies for a more accurate
picture of the operational issues (Chen et al., 2013; Lee and Fernando, 2015; Dobrzykowski et
al., 2016). So, the study targeted to collect responses from the above mentioned multiple entities.
The data was collected through an online survey questionnaire. Senior professionals with the
designations e.g. manager- operations, senior manager-operations, manager-procurement etc.
working in the allied firms for at least 5 years or more were targeted for collecting perceptual
responses. The study targeted two cities that are well reputed for providing routine and advanced
healthcare services. The two cities were labeled as: (a) Medical-hub I and (b) Medical-hub II.
The study utilized several online portals for collecting the names, addresses and contact numbers
of hospitals, hotels etc. The list of hospitals located in the two hubs were obtained using
Medicards.in (http://www.medicards.in/hospitals/). A list of hotels were obtained using the sites
like Yatra.com (https://www.yatra.com/) and Goibibo.com (https://www.goibibo.com/).
However, the search used appropriate available filters for collecting a list of budget hotels. For
example, with a filter of 3-15 USD per night for Hub 1, the search resulted in 96 hotels and a
filter of 6-15 USD for Hub 2 per night resulted in 30 hotels. The budgets hotels were the most
preferred choice for accommodation for patients and their relatives (Dogra and Dogra, 2015;
Kumar and Yang, 2016). The study acknowledges the presence of a small proportion of patients
and their relatives who actually prefers premium facilities.
However, such a proportion is actually insignificant in a country like India. Using Medindia
portal (http://www.medindia.net/) as estimate of (1) chemist and pharmaceutical companies (2)
medical equipment manufacturers and surgical suppliers were made for the two hubs. Estimate
of marketing/promotion companies, restaurants and insurance companies were made using

Justdial (https://www.justdial.com/) and Indiacom (http://www.indiacom.com/) portals. The
usage of online portals for building contact list for survey is well recognized (Ramanathan and
Ramanathan, 2011; Mohammed et al., 2015).
Table 1. Description of Strata

Medical- Medical-
Strata
hub I hub II
Hospitals 325 149
Hotels 96 30
Chemistry and Pharmaceuticals 673 1049
Marketing/public relations 2782 708
Medical Equipment Manufacturers+ Surgical Suppliers 158 215
Food and Beverage Providers (Restaurants) 5192 3697
Insurance 22 22
Total 9248 5870
For building the database, a combination of organization visits and phone contacts were used in
addition to an email address list provided by a consultancy. While initial decision was to include
at least 2 respondents per firm; several practical difficulties and constraints limited the data
collection to one respondent per firm. A database of over 3000 email addresses was developed
containing contacts of potential respondents working in different sectors involved with medical
SCs. The study applied the filtering criteria resulting in 1473 valid email contacts.
Development of Measures
The study involved seven latent first order factors. The study followed Churchill (1979)’s
prescribed procedures for developing and adapting (as required) the measurement items for each
and every latent factor. The extant literature on each and every latent factor were extensively
scanned for their conceptualization and subsequently collecting their existing scale items.
Existing items were utilized as starting point for developing and contextualization of scale items
for medical SCs. The study also utilized the opinion and feedback of an expert panel for
improving, contextualizing and developing the scale items. A group of five researchers and ten
practitioners with considerable experience in the healthcare industry and allied SCs constituted
the panel. The study employed a grounded approach in developing the scale items from their
existing literature to be utilized in the medical SCs. The scale items underwent suitable
modifications in their clarity and expression based on the suggestions received from the expert
panel. This step by step approach ensured that the resultant scale items possess greater levels of
face and content validity. Further, the study utilized different set of respondents for checking the
face and content validity of the measurement items for each latent factor.
After the scale items were finalized, the entire questionnaire was subjected to a pre-testing with
61 random contacts. The pre-test sample had the following composition: 4 restaurant managers
(experience > 5 years); 22 hospital operations managers (experience > 10 years); 6 pharma
managers (experience > 7 years); 9 insurance managers (experience > 6 years); 6 hotel managers
(experience > 10 years); 5 marketing managers (experience > 7 years) and 9 managers in medical
equipment manufacturing (experience > 5 years). This further enhanced the validity of the scale
items for utilization in medical SCs. The final scale items were measured on a one to seven
Likert scale (1= strongly disagree; 7= strongly agree). Some demographic information was also
enquired of the respondents. An online questionnaire was created in Google Docs and the survey
invitation were mailed to 1473 contacts. The survey invitation contained a cover letter describing
the purpose and scope of the survey and confidentiality of responses. Repeated follow ups
resulted in 276 complete and usable responses, resulting in a response rate of 18.73. Such a
response rate is generally considered acceptable for online surveys (Sinclair et al., 2012). Table 2
shows the distribution of final respondents across different strata and Medical-hubs.
Table 2. Respondents Profile Across Strata & Hubs
Medical-
Strata Medical-hub I Total Percentage
hub II
Hospitals 43 19 62 22.46
Hotels 32 12 44 15.94
Chemistry and Pharmaceuticals 28 39 67 24.28
Marketing/public relations 17 5 22 7.97
Medical Equipment
13 24 37 13.41
Manufacturers+ Surgical Suppliers
Food and Beverage Providers
17 11 28 10.14
(Restaurants)
Insurance 10 6 16 5.80
Total 160 116 276 100
The respondent characteristics were shown in Table 2. The composition of the final respondents
was: 22.46 % hospital managers (average experience > 8 years); 15.94 % hotel managers
(average experience > 12 years); 24.28 % pharma managers (mean experience of 9 years);7.97 %
marketing managers (mean experience of 6.75 years); 13.41 % managers in medical equipment
manufacturing (mean experience of 8.26 years); 10.14 % restaurant managers (average
experience > 7.53 years); 5.8 percent insurance managers (mean experience of 8 years).
To test the proposed relationships, the study employed SPSS 17 for Windows and Amos 17.0.
Appendix -1 show the final measurement items.

Non-response Bias
The study explored for differences between early and late responses (Armstrong and Overton,
1977). Results suggested absence of any dominant mean differences. Hence, non-response bias
is not a potential concern for the study.

Assessment of Measures
Exploratory factor analysis (principal component analysis) was executed initially before
checking the measurement model reliability and validity through confirmatory factor
analysis(CFA). Results showed items expected to come together are loading on a single factor.
Further, Barlett’s Test of Sphericity was significant with a KMO value of 0.717. Hence the null
hypothesis of correlation matrix has an identity matrix is rejected. Also, KMO > 0.5 suggested
presence of sufficient correlation and appropriateness for principal component analysis.
Subsequently, the study utilized CFA for assessment of measurement items. Through CFA, as
assessment of reliability and validity were made. Reliability refers to the internal consistency of
items measuring a particular factor (Hong and Cho, 2011) and were assessed through
standardized loadings, cronbach alpha and composite reliability. In Table 3, Cronbach alpha and
composite reliability estimates for every latent factor were > 0.7 ((Nunnally, 1978; Kline, 2013).
Also, standardized loadings for all items were > 0.7 (Kline, 2013). Hence measures demonstrated
sufficient reliability. The study further evaluated construct validity of the latent factors through
assessing uni-dimensionality, convergent, discriminant and nomological validity (Selnes, 2013).
Construct validity evaluates the agreement in the conceptualization of a latent factor and its scale
items (Bagozzi et al., 1991). CFA clearly showed items loadings on expected factors with
standardized loadings > 0.7 suggesting measures as uni-dimensional (Hong and Cho, 2011).
Table 3. Reliability and Uni-dimensionality

Construct Variable Std.Loadings t-value SMC CR Alpha Composite AVE
Reliability
Development Culture DC1 0.779 11.046 0.607 0.881 0.910 0.669

No. of Items=5 DC2 0.792 16.479 0.627
DC3 0.852 15.007 0.726
DC4 0.838 12.519 0.702

DC5 0.829 10.267 0.687
Group Culture GC1 0.814 14.079 0.663 0.856 0.889 0.666

No. of Items=4 GC2 0.794 11.374 0.630
GC3 0.818 9.237 0.669
GC4 0.839 16.279 0.704
Rational Culture RC1 0.844 10.281 0.712 0.879 0.909 0.714
No. of Items=4 RC2 0.861 11.319 0.741
RC3 0.835 15.021 0.697
RC4 0.841 13.229 0.707
Hierarchical Culture HC1 0.758 8.379 0.575 0.852 0.870 0.625
No. of Items=4 HC2 0.781 19.041 0.610
HC3 0.804 16.497 0.646
HC4 0.819 13.242 0.671
Technology Orientation TO1 0.881 13.927 0.776 0.892 0.926 0.714
No. of items=5 TO2 0.839 14.169 0.704
TO3 0.856 15.473 0.733
TO4 0.842 12.067 0.709
TO5 0.807 11.992 0.651
Healthcare SC Resilience (HCRES) RES1 0.777 12.554 0.604 0.873 0.902 0.647
No. of items=5 RES2 0.802 14.349 0.643
RES3 0.791 11.031 0.626
RES4 0.819 16.428 0.671
RES5 0.832 15.302 0.692
Further, convergent validity (i.e. agreement among different methodological attempts to
measure a construct) can be claimed to be achieved with critical ratios > 2, standardized loadings
> 0.5 and average variance extracted > 0.5 (Fornell and Larcker, 1981; Hair et al., 2006). Table 3
suggests the minimum critical ratio (=8.379) > 2; the minimum standardized loading (=0.758) >
0.5 and smallest AVE (=0.625) > 0.50 (Hair et al.,2006). Thus, convergent validity for the
measurement model is acceptable.
Discriminant validity was next assessed following Hair et al. (2006). This type of validity is
evidenced when the minimum AVE is greater than squares of between-construct correlation
coefficients (Hair et al., 2006). Table 4 showed largest correlation coefficient as 0.527 and that
the square of this number, 0.277, is not as large as 0.625, the minimum AVE.
Hence the measurement model had adequate discriminant validity.
Table 4. Correlation matrix of the constructs
Mea Std. x
Construct n Deviation x1 x2 x3 x4 x5 6 AVE
0.66
Development Culture (x1) 3.57 0.89 1 9
0.44 0.66
Group Culture (x2) 4.14 1.02 7 1 6
0.51 0.46 0.71
Rational Culture (x3) 4.71 0.91 9 1 1 4
0.52 0.49 0.44 0.62
Hierarchical Culture (x4) 4.33 0.79 7 2 1 1 5
Technology Orientation 0.34 0.35 0.39 0.47 0.71
(x5) 3.73 0.87 9 1 2 2 1 4
0.37 0.35 0.40 0.33 0.26 0.64
HCRES (x6) 4.18 0.76 1 9 8 9 1 1 7
Nomological validity refers the extent to which structural relationships among measured
constructs are consistent with other studies. The correlation coefficients were used for assessing
nomological validity. Some of the correlation coefficients were moderate for e.g. 0.527 between
development culture and hierarchical culture and hence a multicollinearity test was performed. If
variance inflation factors evaluate to 10 or less, then there exists no threat of multicollinearity
(Hair et al., 2006). Results showed VIF values from 2.873 to 5.119. This suggested that
multicollinearity is not a potential concern. It is concluded thereby that sufficient nomological
validity is present in the measurement model.
Table 5 showed the goodness of fit for the measurement model. Standardized Chi-Square was
obtained as 2.179 suggesting modest fit (Hu and Bentler,1999). Further, absolute fit indices,
SRMR, incremental fit indices were all within their prescribed limits (Hu and Bentler, 1999; Hair
et al., 2006). Goodness of fit index is slightly near to the threshold (Hu and Bentler, 1999).
Considering other fit indices; this value of GFI just near to threshold is acceptable. Hence the
measurement model was reasonably fitted to the data set (Hu and Bentler, 1999).
Table 5. Goodness of fit test

Goodness of fit test
Acceptable
Category Measure Values Value
Absolute Fit indices Chi-Square 673.311
d.f. 309
Chi-
Square/d.f. 1 to 3 2.179
GFI 0.90 or above 0.897
SRMR 0.080 or below 0.0583
Incremental Fit indices NFI 0.90 or above 0.908
RFI 0.90 or above 0.902
IFI 0.90 or above 0.911
TLI 0.90 or above 0.915
CFI 0.90 or above 0.921
Other Fit indices PNFI 0.60-0.90 0.779
RMSEA 0.050-0.080 0.051
Structural Model Results
The study utilized structural equation modeling using AMOS 17 to test the significance of the
proposed hypotheses. Table 6 summarizes the results of hypotheses testing. H5a, H5b, H5c
discussed a positive moderation of technology orientation on each of development culture, group
culture and rational culture with HCRES. For testing the above proposed moderation effects, the
following interaction terms (viz. development culture × technology orientation etc.) were created
and regressed on HCRES. Most of the corresponding coefficients were found to be positive and
significant as shown in Table 6. Figure 2 summarizes the hypotheses testing results in a
structural model. Figure 3, 4 and 5 subsequently shows the interaction effects. As shown, TO
enhances the contribution of development culture, group culture and rational culture on HCRES.
Table 6. Results of Hypotheses Testing

Std. C.R.(t- Supporte
Hypotheses Path coefficient value) d?

H1 Development Culture --> HCRES 0.326*** 5.642 Yes
H2 Group Culture --> HCRES 0.279** 4.293 Yes
H3 Rational Culture --> HCRES 0.331*** 4.832 Yes
H4 Hierarchical Culture --> HCRES -0.243** 3.997 Yes
Dev. Culture * Tech. Orientation -->
H5a HCRES 0.173** 2.531 Yes
Group Culture * Tech. Orientation -->
H5b HCRES 0.129* 2.119 Yes
Rational Culture * Tech. Orientation --
H5c > HCRES 0.155* 2.502 Yes
Hierar. Culture * Tech. Orientation -->
H5d HCRES 0.002 0.016 No
** p<0.05; *** p<0.01; *p<0.10
Figure 2 below shows the structural model.

Figure 2. Results of Hypotheses Testing ( Structural Model)

5
4.5
4
3.5
3 Low TO
HCRES
2.5 High TO
2
1.5
1
Low Development High Development

Culture Culture
Figure 3. Moderating effect of TO on Development Culture HCRES Linkage
5
4.5
4
HCRES
3.5
Low TO
3
High TO
2.5
2
1.5
1
Low Group Culture High Group Culture
Figure 4. Moderating effect of TO on Group Culture HCRES Linkage

5
4.5
4
3.5
Low TO
HCRES
3
High TO
2.5
2
1.5
1
Low Rational Culture High Rational Culture
Figure 5. Moderating effect of TO on Rational Culture HCRES Linkage

Discussion
The study is the foremost to adapt and develop the measurement instruments for development,
group, rational and hierarchical cultures for medical SCs. Further, the study conceptualized
resilience for medical SCs and also developed its measurment instrument. In terms of the
proposed research questions, the study has empirically established development, group and
rational cultures as dominant enablers of healthcare resilience. The study is also the foremost to
explore the concept of resilience in healthcare context. The importance of resilience in providing
uninterrupted services to patients is more profound as any failure in the same can be fatal. The
study found a negative but significant influence of hierarchical culture on HCRES supporting our
proposed hypothesis. The study also showed that technology orientation (TO) acts as a positive
moderator for development, group and rational cultures in their influence on HCRES. This
suggests that TO enhances the importance of development, group and rational cultures as
effective enablers of HCRES. However, TO does not show any significant moderation on
hierarchical culture HCRES linkage.
The study has contributed to extant literature by undersigning the importance of CVF view of
organizational culture in generating HCRES. A culture of change facilitates the development of
dynamic capabilities (Cameron and Quinn, 2006; Teece et al., 1997). While theoretical
arguments suggested CVF to have strong association with dynamic capabilities (Jones et al.,
2005); our empirical examination established CVF as a dominant enabler of dynamic capabilities
through its positive influences on HCRES. The study therefore advanced the association of CVF
view and dynamic capabilities.
In the current context, development culture focuses on providing uninterrupted services to
patients. This can be achieved through fostering high adaptability in exchanging information and
decision-making. Readiness for uncertainties can be easily achieved if healthcare entities are
ready to adapt to changing circumstances and willing to cooperate. Hence development culture
can be attributed as a positive enabler for HCRES, based on the dynamic capability view (Teece
et al., 1997). Group culture ensures that healthcare entities work in a collaborative manner for
developing business continuity plans. Effective training programs for possible disruption
mitigation should be developed for healthcare entities. Entities should be made well aware of the
possible disruptions and mitigation mechanisms through appropriate knowledge sharing.
Healthcare entities should be involved into joint planning and executions. Consequently, group
culture (as suggested by findings) can be enlisted as a positive enabler of HCRES, based on
dynamic capability view (Birkinshaw et al., 2016). As the hierarchical culture aims for stability
and control; the finding that it has a negative influence on HCRES holds relevance. Hierarchical
culture aims for maintaining stability of structure and control through informed decision making
and timely communication with entities. Hence, flexibility is compromised in such a culture. As
a result, healthcare entities fostering a hierarchical culture likely to suffer the negative
consequences of disruptions. Rational culture of CVF view suggests healthcare entities to focus
on providing uninterrupted healthcare services. While the focus would be on providing
healthcare services at the optimal cost; care must be taken that such services are not
delayed/disrupted. This can be achieved through collaborative planning and execution of
activities. Hence as suggested by the findings, rational culture can be attributes as a positive
enabler of HCRES. The findings indicated technology orientation to effectively enhance the
importance of development, group and rational culture as positive enablers of HCRES.
Theoretical Implications
Our study has several theoretical implications. Theoretically, our study enriched the literature of
resilience and organizational culture in multiple ways. First, the study has empirically
established the importance of several important dimensions of organizational culture viz.
development, group, rational and hierarchichal in enriching healthcare resilience. While
development, group and rational cultures contribute positively and significantly towards
healthcare resilience; hierarchical culture inhibits HCRES. So theoretically the study has
established that CVF view of organizational culture and its associated dimensions do contribute
significantly to HCRES. An important contribution of the study is the empirical validation of the
importance of development, group and rational cultures in enhancing HCRES.
Second, the study has added the CVF based dimensions of organizational culture as important
enablers of resilience in the supply chain risk management literature. Although extant studies
have considered several enablers (Juttner and Maklan, 2011; Wieland and Wallenburg, 2013;
Scholten and Schilder, 2015); our study added the importance of these three cultural dimensions
in developing resilience. Further, the study established that CVF view is a prominent
conceptualization of organizational culture and the same can be further used in healthcare for
subsequent empirical testing. In terms of construct development, our study has developed a
measurement instrument for healthcare resilience. In this context, the study has also contributed
in terms of constuct development through adapting and developing the measures for
development, group, rational and hierarchical cultures for healthcare SCs.

Studies have stressed the role of several relational attributes (Wieland and Wallenburg, 2013),
social capital based enablers (Johnston et al., 2013)etc. for resilience; however a robust empirical
evidence of the dominant role of organizational culture was lacking. The current study is the
foremost to fulfill this requirement in resilience literature. Further, using the first order
measurement items of resilience, researchers can further develop the resilience construct for
other service environments. Our study has undersigned TO as an essential contingent variable in
enriching the influence of three dimensions of organizational culture (viz. development, group
and rational)on HCRES. Earlier research have considered the contingent role of environmental
uncertainty (Srinivasan et al., 2011) etc on supply chain performance. Our study argued
practitioners to consider the dominant role of TO in enhancing SC capabilities and sustaining
performance in the event of disruptions.The study has also contributed to the usage of TO in
operations and SC empirical explorations with a special reference to healthcare (Lee et al., 2013;
Ho et al., 2016).
Managerial Implications
The study holds several implications for healthcare managers. Since our study has showed
development, group and rational cultures as dominent enablers of HCRES; managers therefore
must focus on enriching these specific cultures in their respective organizations for enhanced
HCRES. Increased operation restoration and protection being the key focus of managers;
healthcare firms must focus on overall sustainability (Dayan et al., 2016). Such a focus would
lead to modification of exising routines and procedures. Such remodifications are required for
innovation and development of dynamic capabilities e.g. HCRES (Teece et al., 1997; Ponomarov
and Holcomb, 2009). With a strong emphasis on reinforcing sustainabiliy issues, firms in
healthcare can create long term value (Koufteros et al., 2007). Hence using appropriate
dimensions of organizational culture; managers can create long term value for their respective
healthcare SCs (Büschgens et al., 2013).
Second, managers must encourage healthcare entities to work as cohesive groups for enhanced
coordination and cooperation. Synchronization of individual processes in real time may be
effectively achieved with cohesive group collaboration (Flynn et al., 2010). Such team efforts
would enable the effective integration of complex operations in the SC. With succesful
integration, healthcare SCs would be more prepared for fighting disruptions effectively. Third,
managers must urge their healthcare partners to realize the importance of joint problem solving
for the attainment of incentives (Naor et al., 2008). Incentives systems can be positive motivator
for employees to work together as a team and sustain competitive advantage (Braunscheidel et
al., 2010; Naor et al., 2008). However, healthcare entities must be ready for accepting change
and should have a proactive learning orientation. Such orientation is vital for embracing new
technologies and treatment procedures. These are further required for adapting to dynamic
environments and ensuring survival in the competition (Teece et al., 1997). Hence formal
structures and hierarchical systems may be required to be abolished. Stress must be on more
informal modes of communication across the healthcare SCs. These would also improve SC
relationships resulting in enhanced cooperation and collaboration (Scholten and Schilder, 2015).
While studies on supply chain management and healthcare systems acknowledged the dilution of
formal structures and informal communication modes as a pre-requisite for successful delivery of
services to patients (Zepeda et al., 2016); managers are yet to implement the same in practice,
especially in healthcare organizations (Kwon et al., 2016).

Third, managers must conduct training programs directed to clarify the importance of
organizational climate and its CVF based dimensions at the employee level. Different
dimensions of organizational climate has a different perspective. Managers must make their
employees realize the importance of working in groups for realizing long term benefits (Dayan et
al., 2016). While development culture emphasizes realizing a firm’s long term goals and
working for achieving the same; managers must argue their employees to extend cooperation for
realizing firm level objectives. Long term value can be created only when firm level objectives
are in tandem with that of other key entities (Dayan et al., 2016). Hence for healthcare SCs,
hospital managers must therefore focus on effective synchornization of their goals with those of
their key SC entities (Zepeda et al., 2016; Kwon et al., 2016). Our study suggested managers that
such developments and implementation if made effectively, the resultant healthcare SCs can
provide a positive response to disruptions.
Fourth, the study suggests managers to focus on making their healthcare entities realize the
importance of developing a collective orientation (i.e. group culture). Working in groups and
making joint plans and executions result in positive performance implications (Ramanthan and
Gunasekaran, 2014; Peterson, 2010). For a complex service supply chain e.g. healthcare SCs, the
importance of group culture is therefore all the more important for timely generation and
delivery of healthcare services (de Vries and Huijsman, 2012; Syahrir er al., 2015). Further,
managers in healthcare entities must plan for effective reward mechansims for employees for
achieving firm and SC level targets on a periodic basis. Such workplace culture have positive
implications for employee job satisfaction (Belias and Koustelios, 2014). Employees with higher
job satisfaction are more motivated for working in groups for realizing firm’s goals. This would
lead to the development of rational culture in the heathcare SC firms; resulting in more effective
sharing of knowledge among the SC participants. With rational culture in place; healthcare firm
employees would be positively motivated for achieving firm and SC level objectives. Hence,
group culture and rational culture would contribute greatly for synchronizing all key entities in
healthcare SCs for designing and delivering effective healthcare services (Wei et al., 2014).
Samaha et al. (2014) stressed group culture to result in effective relationships in global SCs.
Hence for healthcare SCs, working in groups and exchanging knowledge and ideas
complemented with an effective reward system would positively contribute for the development
of HCRES. Further, all such dimensions of organizational culture would also lead to innovative
practices in healthcare SCs (Büschgens et al., 2013; Zepeda et al., 2016).
Healthcare entities must focus on developing a positive orientation towards IT and upcoming
technologies in their firms. Such positive TO would further aid in enhancing the importance of
development, group and rational cultures in generating HCRES. Proactive orientation for
upcoming technologies paves the way for ensuring sustainability in the long run. Infrastructure
wise, all the entities in healthcare SCs would be at the leading edge in their respective industry
sector. This would further help to synchronize operations, work as a cohesive group and fight
disruptions.
Limitations and future research
Our study has several limitations. First, the study examined a cross sectional survey to explore
the influence of organizational culture on HCRES. With prime focus on facing disruptions
proacively and restoring operations rapidly; a longitudinal study of specific firms would
enunciate better picture of the actual contribution of organizational culture. Second, our study
has not explored the contribution of organizational culture dimensions on healthcare agility ( i.e.
the capability of fulfilling patient’s treatment requirements in a speedy manner). Future study
should utilize the first order measures developed to explore further on the development of such
agile capabilities in healthcare. Fulfilling patient’s treatment needs in a speedy manner can
seriously harness healthcare enities with competitive advantage ( Gligor and Holcomb, 2012;
Teece et al., 1997).
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Appendix -1
Final Measurement Items

Construct Items
Development Culture As a key HSC member, you pursue strategic programs for production capabilities in advance of needs
Adapted from Cao et al. (2015) As a key HSC member, you try to predict the potential of new procedures and technologies in the field of healthcare
As a key HSC member, your production units are always at the leading edge of new technology in your respective industry sector
As a key HSC member, you are in continous process of thinking and adopting next generation healthcare technologies
As a key HSC member, you are always mentally ready for embracing upcoming healthcare technologies
Group Culture As a key HSC member, you have supervisors who everytime motivate to work as a team
Adapted from Cao et al.(2015) As a key HSC member, you have seniors who encourage employees to exchange opinions and ideas about upcoming healthcare technologies
As a key HSC member, you have seniors who always encourage for group meetings for discussion and idea exchange
As a key HSC member, you have seniors who always encourages for enhancing collaboration
Rational Culture As a key HSC member, your incentive system strongly encourages to aggressively follow your firm's objectives
Adapted from Cao et al.(2015) As a key HSC member, your incentive system is fair in rewarding people who accomplish firm's objectives
As a key HSC member, your incentive system really recognizes the people who contribute the most to your firm's objectives
As a key HSC member, your incentive system strongly urges to fulfill firm's vision and mission.
Hierarchical Culture As a key HSC member, every small matter has to followed up with higher officials for permit
Adapted from Cao et al.(2015) As a key HSC member, every decision you make has to be sanctioned by your supervisor
As a key HSC member, you are not permitted to take any decision without your supervisor's approval
As a key HSC member, you and every employee has to depend on your supervisor's approval before executing any action
Technological Orientation You use advanced technologies in your every day operation
Adapted from Leng et al.(2015) You use updated technologies in your strategic operation
You normally refrain from using technologies that are outdated
You design your product/services always with the latest technologies
You readily accept proven technological innovation in your organization
Healthcare SC Resilience You and key HSC members can restore quickly healthcare supply chain operations in the face of any disruption
(HCRES) You and key HSC members is capable of providing uninterrupted healthcare services to your patients
(Newly Developed) You and key HSC members are well adept financially to proactively meet contingencies
You and key HSC members possess the capability to respond to disruptions in a positive manner
You and key HSC members are capable of providing suitable healthcare services even in the face of disruptions
*HSC= Healthcare Supply Chain

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Purpose: To explore the influence of dimensions of organizational culture viz. development

marketing/public relations/ promotion, medical equipment manufacturers and surgical suppliers,

is more important in healthcare services compared to manufacturing. This is because failure to

2016; Dobrzykowski et al., 2014; Harvey, 2016).

healthcare SC resilience (HCRES) as the capability of healthcare SC entities to work in a

Further, the importance of organizational culture in effective supply chain management is

Accomplishment of objectives often become a challenging task in the absence of a proper

organizational culture (Cao et al., 2015).

et al., 2015; de Vries and Huijsman, 2011).

the potential to reshape organizational capabilities through resource reconfiguration and

culture and hierarchical culture on HCRES.

would be an influential factor in determining the success of different organizational cultures in

rational and hierarchical culture on HCRES?

Resilience in Healthcare Supply Chains

With increased complexity in managing globalized operation in recent times, SC resilience is an

Different investigations have highlighted various enablers of SC resilience: viz. collaborative

(Scholten et al.,2014); and effective procurement (Pereira et al., 2014).

Further, collaborative activities (information-sharing, collaborative communication, joint

Kamalahmadi and Prast, 2016).

in a synchronized manner with an objective to provide uninterrupted medical services to patients

With increased complexity in managing globalized operation in recent times, SC resilience is an

Different investigations have highlighted various enablers of SC resilience: viz. collaborative

(Scholten et al.,2014); and effective procurement (Pereira et al., 2014).

Further, collaborative activities (information-sharing, collaborative communication, joint

Kamalahmadi and Prast, 2016).

in a synchronized manner with an objective to provide uninterrupted medical services to patients

healthcare services compared to manufacturing. This is because failure to provide timely

Dobrzykowski et al., 2014; Harvey, 2016).

Organizational culture and CVF

acquisition with market culture facilitating instrument information utilization.

assumptions, values and artefacts as essential constituents of organizational culture. While

employees of an organization. There has been different conceptualization of organizational

and Huang, 2010; Zu et al., 2010).

deemed to govern organizational behaviors (Howard, 1998). Subsequently, the Competing

Quinn et al., 1991).

development and implementation through cultivating adaptability and readiness, visionary

communication, and adaptable decision-making (Linnenluecke and Griffiths, 2010; Zammuto et

effective goal planning, instructional communication and centralized decision-making (Jones et

preferences (Quinn and Kimberly, 1984; Quinn et al., 1991).

Effects of Organizational Culture on HCRES

business (Barney,1986; Nahm et al., 2004). Organizational culture aids in execution of

Literature suggests presence of cooperation among SC entities as an essential precursor to effect

synchronize cross-functional processes allow SC firms to enhance their relational ties.

organizational culture would be a dominant enabler of HCRES.

Organizational culture is normally manifested in an organization’s norms, value and practices

environments; healthcare firms should be ready to respond to such environmental changes.

uncertainties therefore require a culture of change. Hence it requires an organizational culture

facilitating such change. As a dynamic capability, resilience requires appropriate resource

of dynamic capabilities through appropriate resource reconfiguration and deployment (Jones et

rational and hierarchical would be positively associated with HCRES.

Development Culture and HCRES

practicing development culture.

Development culture emphasizes on improving SC relationships based on trust and commitment

HCRES. Accordingly, the study hypothesizes that:

H1: Development culture is positively associated with HCRES.

Group Culture and HCRES

key to sustain in competition for such healthcare SCs.

enhanced collaboration; thereby resulting in enhanced HCRES (Papadopoulos et al., 2016;

H2: Group culture is positively associated with HCRES.

Rational Culture and HCRES

satisfy the objectives of an organization. This component of organizational culture stresses on