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Given the complexity of inclusive business (IB) to combine social contribution and business sustainability, companies make strategic choices. One multinational corporation (MNC) avoided interconnections with villagers and used only market-based relations with stimulants and incentives in the market. Another one delegated management completely to local partners, succeeding in stimulating the poor’s self-initiated economic activities. MNCs seem to have difficulties in handling institutional interconnections. In such cases, market-based relations or delegating management to the local partners were found to be highly effective for covering missing capabilities. One foreign NGO, despite its well-developed institutional interconnections with the locals, is struggling to develop markets for its social enterprises. In contrast, one local trust successfully cooperated with many local partners, appealing to local institutions (values and beliefs). Also, poor farmers felt the social contributions of two local companies by being incorporated into the companies’ supply chains backed by their corporate social responsibility (CSR) orientations and activities. Hence, both foreign and domestic organizations seem to succeed in IB by embedding their projects to their original institutions and developing diverse mechanisms to compensate for missing capabilities. One exception is a local company which successfully coordinated MNCs’ CSR activities, local communities, and governments. However, its success is owing to governmental regulation for CSR contribution. In general, though restricted by institutional backgrounds and business orientations, each case tried to create a fit between business models and its contingencies, achieve scale (at the level of communities, nations, or the global market) and business sustainability, and generate socioeconomic effects.

Managing complexity within care ecosystems is an increasing universal challenge. In health, this is emphasised by recent calls for greater care integration to achieve service improvement as levels of comorbidity and frailty grow within populations. This research takes a service-dominant logic (SDL) stance in examining the sources, types and nature of complexity within a care ecosystem in the UK.

This illustrative case research focuses on a community care ecosystem. A multi-method approach is used combining semi-structured interviews, descriptive statistics and secondary data. The results were independently assessed and validated by participants through a second interview phase.

The findings from this research provide empirical support for the six complexities discussed in the supply chain literature. Identifying these complexities proffers the opportunity of applying manufacturing-derived complexity management strategies in care ecosystems. The conceptual model for institutional complexity, derived from the illustrative case study, showed that care professionals face additional complexity challenges in operating care ecosystems.

The management of complexity in care ecosystems requires professionals to be considerate of institutional arrangements when addressing the consequences of increasing levels of complexity. This necessitates the development of a balanced approach between reducing complexity while absorbing institutional arrangements which minimise risk.

Drawing on the supply chain complexity literature, the paper has developed a framework which guides care professionals facing increasing levels of complexity within the context of their institutional arrangements. As such, this research furthers our understanding of supply chain complexity effects in care ecosystems and provides a platform for future research.