The impact of dynamic capabilities and time-based competitive advantage on SME performance: The role of organisational structure and entrepreneurial orientation

The aim of this thesis is to examine how dynamic capabilities are used by small and medium-sized enterprises (SMEs) to increase performance. Specifically, it explores the mechanism by which the dynamic capabilities of SMEs affect firm performance through time-based competitive advantage. It also examines important factors that facilitate and enhance the deployment of SME dynamic capabilities, including organisational structure and entrepreneurial orientation. Data obtained from a sample that comprised 482 United Kingdom–based manufacturing and service SMEs were evaluated through a quantitative survey. Using partial least squares modelling, the analysis indicated the existence of a partial mediating effect of time-based competitive advantage on the dynamic capabilities and SME firm performance relationship. The analysis also identified a partial mediating effect of dynamic capabilities on the positive relationship between organisation structure (organicity) and time-based competitive advantage. An interesting finding was that, in the context of SMEs, an organisation structure that is more mechanistic in nature encourages greater time-based competitive advantage; however, in the presence of dynamic capabilities, an organic structure is preferred. This thesis discusses possible reasons for these results. Further, a partial mediating effect of dynamic capabilities on the positive entrepreneurial orientation and time-based competitive advantage relationship was also found. The moderating influence of organisation structure on the positive dynamic capabilities and time-based competitive advantage relationship was supported. However, the hypothesised moderating influence of entrepreneurial orientation on the positive dynamic capabilities and time-based competitive advantage relationship was not supported. This thesis has outlined the mechanism by which SMEs can develop dynamic capabilities and use them to generate greater time-based competitive advantage, as well as increase firm performance. It thus makes an empirical contribution to the emerging body of research on dynamic capabilities in the SME context. Several theoretical contributions and managerial contributions are also further outlined

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research