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.

This cumulative dissertation investigates the role and implications of top managers in firms. By building on two influential contemporary phenomena – internationalization and digitalization – and by examining top managers from a multitude of conceptional and methodological angles, the dissertation provides novel insights to upper echelons research. The first study examines the association between top management team (TMT) internationalization and firm innovativeness and argues that the accumulation of international knowledge and resources in the TMT benefits firm innovativeness. The second study analyzes the association between CEO internationalization and firms’ strategic risk-taking, paying particular attention to various governance mechanisms that may influence this relationship. The third study explores the role and facilitating actions of top managers in response to the digital transformation. Overall, this dissertation contributes toward a more fine-grained understanding of top managers and their individual characteristics. Given the contemporary relevance of the topics under consideration, the presented findings are of significant value for both theorists and practitioners.

With the ongoing globalization and changes in the economic environment, organizations need to be flexible and adaptable towards new situations and opportunities. In a context where firms strategically reach across national borders, firms are encountering differing cultural backgrounds. Multinational corporations (MNCs) are confronted with the question of how to fill executive positions. The need for employees with international expertise arises to reap the advantage of nationality diversity by matching the complexity of the global environment with the right level of board capital. Such firm managers must work in increasingly international contexts and cross-cultural environments. Scholars have regarded diversity as an essential element that helps organizations and their executives to deal with uncertainties arising from globalization. (Koles 2014). The top executives of an organization are regarded as an essential criterion for firm´s success. Top managers have considerable influence over the fate of the organizations they lead. These trends have led to increasing instability in classic employment relationships and show greater diversity and mobility within organizational and occupational boundaries (Dokko/Wilk/Rothbard 2009; Greenhaus/Callanan 2012; Biemann/Zacher/Feldman 2012; Koch et al. 2017). This dissertation further aims at advancing our empirical understanding of top managers diversity, internationalisation and their careers. The three research manuscripts that form the core of this thesis advance research on top managers in several ways and extend knowledge in the area of executive characteristics. All three manuscripts are anchored in the European context and address topics that are relevant yet underexplored in extant, mostly centred in the US and Western economies top management literature (Tosi/Greckhamer 2004; Carter et al. 2009; Boyd et al. 2012; Dauth 2012).

Heuristics are mental shortcuts applied, consciously, subconsciously or both, to save time and efforts at the expense of risking the accuracy of the outcome. Therefore, one might argue that it is just an accuracy-effort trade-off. Nonetheless, we ought to recognize the distinction between the circumstances of risk, where all choices, outcomes, and probabilities might be generally known, and the circumstances of uncertainty, where, at least some, are not. Traditional models like the Subjective Expected Utility (SEU) work best for decisions under risk but not under uncertainty, which portrays most situations people need to tackle. Uncertainty requires simple heuristics that are sufficient instead of perfect. In this dissertation, the notion of heuristics was researched through a comprehensive historical review that unfolded the heuristics-linked ideas of significant scholars. An explicit distinction between the deliberate and the automatic heuristics was stated with chronological categories of pre and post-introduction of the SEU theory; providing a new perspective and opening a discussion for future research to consider. Additionally, qualitative and quantitative studies were applied that produced an unsophisticated heuristic set that was used by entrepreneurs in the Middle East and Germany. Perhaps entrepreneurs, and people in general, do not always know or acknowledge their use of heuristics. But still, they use it extensively and may exchange heuristics among others. That may lead us to think that in a world where uncertainty prevails, the Homo heuristicus might become a real threat to the Homo economicus.