Innovation in healthcare is a central way of coping with the changes affecting the healthcare system through the megatrends of demographic change, digitalization as well as the opportunities in the life-sciences sector and the “-omics” subjects. Due to the multiple facets of the topic, research on innovation in healthcare is diverse and draws insights from systems theory, management theory, human resources, innovation and change management. While the literature on innovation in healthcare has grown steadily in the last 20 years and publications on pharmaceutical and medical device innovation, health technology assessment strategies, or digital innovations have increased significantly, other areas such as sectoral health innovation systems, the creation and implementation of innovation in hospitals still remain fairly uncharted. Applying established concepts such as systems of innovation theory, mass customization theory or management of employee involvement in innovation activities to the healthcare sector provides new insights into a field that is often considered a “blackbox”. This thesis adds to the topic in three essays, each focusing on a different aspect and depth level ranging from a macro perspective on healthcare innovation on a global scale to a meso level perspective on the implementation of personalized medicine in one country and putting a micro lens on innovation activities of hospital staff. The aim of this thesis is to provide an overview for researchers, policy makers and healthcare stakeholders about current developments, propose tools for measuring innovation and allow for benchmarking the current status quo in healthcare in order to foster new and innovative developments.

Small, new or foreign firms inherently have a lower likelihood of surviving in the market. Frequently, this is due to the existence of resource constraints, such as the liabilities of smallness, newness or foreignness. Consequently, to survive in the market, small, new or foreign firms need to find efficient ways to use their resources. Multiple ways to alleviate these problems have been discussed in the literature, which include digitalization, internationalization, or outsourcing relationships. The usage of digital technologies, entering foreign markets or partnering with established organizations have been found to have compelling advantages and, thus, are promising practices for small, new and foreign firms in overcoming those constraints. It is, however, surprising that little is known about relevant aspects of these practices. For instance, research has just begun to investigate the influence of digital technologies on small and new firms, misses to investigate the success factors in the internationalization of small, new and foreign e-commerce firms, or has not fully investigated methods to improve performance of small firms in outsourcing relationships. Drawing on extant research on digitalization, internationalization, and outsourcing this cumulative dissertation presents four research papers. Each paper contributes to fill existing research gaps in the respective literature. All papers investigate a particular type of small firm and examine potential ways to handle scare resources. Beyond the theoretical and practical contributions of each research paper, this dissertation in its entirety presents several implications for practitioners in small, new and foreign firms that will help them to overcome resource constraints. Furthermore, the thesis discusses implications for theory, limitations, and avenues for further research.