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The integration of industry 4.0 has become a priority for many organizations. However, not all organizations are suitable and capable of implementing industry 4.0 because it requires a dynamic and flexible implementation strategy. The implementation of industry 4.0 often involves overcoming several tensions between internal and external stakeholders. This paper aims to explore the paradoxical tensions that arise for health-care organizations when integrating industry 4.0. Moreover, it discusses how a paradox lens can support the conceptualization and proposes techniques for handling tensions during the integration of industry 4.0.

This qualitative and in-depth study draws upon 32 semi-structured interviews. The empirical case concerns how two health-care organizations handle paradoxical tensions during the integration of industry 4.0.

The exploration resulted in six recurring technology tensions: technology invention (modularized design vs. flexible design), technology collaboration (automation vs. human augmentation), technology-driven patient experience (control vs. autonomy), technology uncertainty (short-term experimentation vs. long-term planning), technology invention and diffusion through collaborative efforts among stakeholders (selective vs. intensive collaboration) and technological innovation (market maintenance vs. disruption).

A paradox theory-informed conceptual model is proposed for how to handle tensions during the integration of industry 4.0. To the best of the authors’ knowledge, this is the first paper to introduce paradox theory for quality management, including lean and Six Sigma.

This paper shows how the interplay between organisational resilience and environmental complexity justifies the existence of differentiated yet successful approaches to digital transformation.

A multi-case method is applied to test our research hypotheses by contrasting the digital transformation of three Italian companies in the valves industry.

Different combinations of technological and organisational tools, hence diversified digital transformations, can be successful, provided that they are supported by a coherent set of resilience factors and allow for the implementation of strategic approaches aligned with the resilience capacity of the firm.

Awareness that resilience capacity shapes digital transformation and the strategies available to engage with external complexity should focus managers to invest in the alignment and the reinforcement of the factors underlying organisational resilience.

Most literature so far focused on the antecedents to digital transformation. In contrast, this paper focuses on the transformation process and highlights how the resilience capacity of the firm affects the unfolding of digital transformation and the emergence of diversified yet successful paths. In addition, in contrast with a dichotomous approach to external complexity this paper shows that digital transformation involves a mix of complexity reduction and complexity absorption strategies.

This study aims to extend ambidexterity theory from the perspective of organisational learning and examine how process ambidexterity, which comprises operational flexibility and operational routine, responds to environmental uncertainty and ultimately reduces organisational risks.

This study tests the hypotheses by analysing 464 annual reports of 115 listed companies in the Chinese agricultural and food industry using content and secondary data analyses. Four case studies are also provided.

The results show that (1) environmental uncertainty has a positive effect on either operational flexibility or operational routine; (2) both operational flexibility and operational routine have negative effects on organisational risks, supporting the view that process ambidexterity mediates the relationship between environmental uncertainty and organisational risks; and (3) organisational slack plays the role of “double-edged sword” by negatively moderating the effect of environmental uncertainty on operational flexibility and positively moderating the effect of environmental uncertainty on operational routine.

In an uncertain environment, companies are exposed to greater risk. This study contributes to risk management in three ways: first, it extends ambidexterity theory to process management and proposes how process ambidexterity balances operational flexibility and routines. Second, it distinguishes between the different conditions under which flexibility or routines are superior. Third, it explains the mechanisms related to how organisations can resolve environmental uncertainty into risk through process ambidexterity.