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This study aims to explain the effects of different types of innovations on organizational performance in terms of firms’ external effectiveness and internal efficiency. The study examines the interrelationship of technical and nontechnical innovations in complex services and the mediating effect of customer participation on the relationship between innovation type and organizational performance.

The study draws on a neo-Schumpeterian model for innovation to examine the complex service setting of healthcare provision. Data from Statistics Sweden, containing 38 hospitals and 242 primary care units in Sweden, provided the study's results.

The findings show the importance of combining different types of innovations in complex services, demonstrating a mediating effect of nontechnical innovation on both the relationship between technical innovations and external effectiveness and internal efficiency. Moreover, the results show that customer participation has a positive mediating effect for technical innovation and nontechnical innovation on external effectiveness. However, there is no such significant effect on internal efficiency.

The findings are based on self-assessment data, which has inherent limitations. The innovation data used were cross-sectional, which may lack reliability (although self-assessed data counter this risk to some extent).

Managers should pursue both technical and nontechnical innovations for gains in external effectiveness and internal efficiency. However, complex services call for technical innovations to be accompanied by nontechnical innovations to support positive effects. The results cause a dilemma for managing customer participation in complex services. As the results show customer participation resulting in external effectiveness, they also fail to establish an effect on internal efficiency.

The primary contribution is to add to the knowledge of different types of innovation in complex services by demonstrating their interdependent effects on both external effectiveness and internal efficiency. Furthermore, the study tests and advances the mediating effect of customer participation in complex services on organizational performance.

Advanced education is often thought to respond to the demands of the economy, market forces create new occupations, and then universities respond with new degrees and curricula aimed at training future workers with specific new skills. Presented here is comparative research on an underappreciated, yet growing, concurrent alternative process: universities, with their global growth in numbers and enrollments, in concert with expanding research capacity, create and privilege knowledge and skills, legitimate new degrees that then become monetized and even required in private and public sectors of economies. A process referred to as academization of occupations has far-reaching implications for understanding the transformation of capitalism, new dimensions of social inequality, and resulting stratification among occupations. Academization is also eclipsing the more limited professionalization processes in occupations. Additionally, it fuels further expansion of advanced education and contributes to a new culture of work in the 21st century. Commissioned detailed German and US case studies of the university origins and influence on workplace consequences of seven selected occupations and associated knowledge, skills, and degrees investigate the academization process. And to demonstrate how universal this could become, the cases contrast the more open and less-restrictive education and occupation system in the US with the centralized and state-controlled education system in Germany. With expected variation, both economies and their occupational systems show evidence of robust academization. Importantly too is evidence of academic transformations of understandings about approaches to job tasks and use of authoritative knowledge in occupational activities.