Purpose The purpose of this paper is to explore how middle managers attempt to enhance internal innovation processes with digital usages. To do so, this research aims to open up an internal innovation process improvement ‘black box’ by looking not only at issues related to digital delivery but also at elements related to innovation culture and leadership. Design/method/approach To fulfill this purpose, this qualitative research develops a case study employing the lenses of middle managers to generate empirical data based on an interpretative approach and an in-depth semi-structured interview methodology. Findings Middle managers' attempt to enhance internal innovation processes with digital usages involves major elements related to influencing people’s mindset, motivating and embracing ideation, as well as collaboration across units leveraged by digital usages. Nonetheless, the core element of the attempt stands for the ability to root the digital tool usages not only at the individual or team level but also at the innovation process level. Contributions This study mainly contributes to theory extension by putting the individual at the heart of the organization's innovativeness culture and enlightening the leadership role of middle managers to influence innovative behaviors to embrace digital tools in the line of the organization’s strategy with major demands for change management. Originality/value By integrating the perspective of middle managers to the conceptual, this case study brings an additional piece to the puzzle of how digital tools nurture the internal innovation processes.

Leaders in the healthcare setting are challenged with competing responsibilities as they seek to provide high-quality services, ensure the implementation of safety measures, and engage in workforce maintenance. Many researchers have described innovation as a strategic approach to organizational concerns and have noted a failure to implement innovative measures in healthcare. This study was an investigation of the impact of ambidexterity in healthcare leaders on innovation. The purpose of this quantitative study, guided by the ambidexterity theory of leadership for innovation, was to analyze the extent to which ambidextrous leadership characteristics of healthcare executives and chief nursing officers (CNOs) influence the innovative performance of CNOs in the healthcare setting. The research question addressed which ambidextrous leadership behaviors or combination of behaviors, including open and closed behaviors of healthcare executives and exploration and exploitation actions of CNOs in healthcare settings, explain a statistically significant portion of the variance in innovative performance of CNOs. The research design involved the administration of a cross-sectional quantitative survey to 126 CNOs from across the nation. Each participant was employed by an acute-care hospital, held an active nursing license in the state employed, and had been in the role of CNO or chief nursing executive (CNE) for over a year, reporting directly to executive leadership. A linear multiple regression analyzed the correlation between ambidextrous factors and the effect on performance innovation. Findings suggest that a combination of ambidextrous behaviors had more impact on innovation performance than each set of behaviors alone. The results of the study may be used for the development of nursing leadership and supporting efforts for overall improvement in healthcare.