Abstract
Background Hospitals operate under simultaneous market, regulatory, technological, and resource pressures, yet evidence remains limited on how these conditions are associated with hospital performance through organizational agility. Methods A cross-sectional organizational survey was conducted among 173 hospital directors representing 173 hospital operating units in Indonesia. The model related 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 organizational agility–hospital performance relationship. Partial least squares structural equation modeling was performed in SmartPLS 4. All seven latent variables were estimated as reflective global constructs. Bootstrapping used 5,000 subsamples, two-tailed testing, α = 0.05, and percentile confidence intervals. Results Innovation ambidexterity (β = 0.338, p