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Several studies have advocated for the value of co-evolutionary approaches to business-IT alignment in healthcare settings because they would be better suited to deal with complexity. However, empirical evidence supporting this premise is scarce and mainly based on qualitative works. We address this research gap by performing a survey among 85 Dutch healthcare organizations, looking into the effects of co-evolutionary information systems alignment (COISA) on organizational performance and the role of dynamic capabilities in this value path. We combine Necessary Condition Analysis and Partial Least Squares Modeling to see which aspects are indispensable and help further develop dynamic capabilities and performance. Our results confirm that COISA indeed positively influences healthcare organizations’ organizational performance through dynamic capabilities. Furthermore, we demonstrate that alignment motivation and interconnections between heterogeneous IS stakeholders are indispensable, and show the seemingly higher importance of the operational and orchestrational alignment competencies and the sensing dimension of dynamic capabilities.



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