The assumption that generativity engenders unbounded growth has acquired an almost taken-for-granted position in information systems and management literature. Against this premise, we examine the relationship between generativity and user base growth in the context of a digital platform. To do this, we synthesize the literature on generativity into two views, social interaction (expansion of ecosystem boundaries) and product view (expansion of product boundaries), that jointly and individually relate to user base growth. Both views help us explain how opening a platform relates to the emergence and resolution of conflicting expectations in a platform ecosystem that result in new functions and expanded use. We adopt a panel vector autoregressive approach combining data from six large transaction platforms that engaged with open-source developer communities. We found that the dominant narrative of generativity engendering growth, although generally supported by our analysis, obscures the fact that the inverse is also true; that is, growth can lead to expansion of product boundaries (inverse generativity) and that generativity can be bounded; that is, growth can stabilize ecosystem boundaries (bounded generativity). Against this background, we propose an extended generativity theory that presents generativity and growth in an integrative view and raises awareness about the limitations of the “unbounded growth” claim. We conclude that there is value in separating the two views of generativity conceptually and analytically, along with their relationship to user base growth, and we call for research on the pathways through which generativity produces growth. History: Ola Henfridsson, Senior Editor; Robert Wayne Gregory, Associate Editor. Supplemental Material: The online appendix is available at https://doi.org/10.1287/isre.2023.1209 .

Aim The purpose of this paper is to investigate the implementation of value-based care principles in the context of frailty in the perioperative process, highlighting the importance of an integrative perspective considering medical and patient-centric outcomes as well as costs. Subject and methods This mixed-methods study employs a sequential design. Qualitative observational data were used to identify needs and barriers for implementing value-based principles, and quantitative methods were subsequently used to demonstrate the value of employing such an approach using data gathered from n = 952 patients. Propensity score matching was applied to identify the frailty-associated costs of the inpatient setting for n = 381 non-frail and n = 381 (pre-)frail patients, in particular considering patient-centric outcomes. Results The qualitative analysis identified three main challenges when implementing value-based principles in the context of perioperative care and frailty, namely challenges related to the cost, patient-centric, and integrative perspectives. In addressing these shortcomings, a quantitative analysis of a propensity score-matched sample of patients undergoing surgery shows additional frailty-associated costs of 3583.01 [1654.92; 5511.04] EUR for (pre-)frail patients and the influence of individual patient-centric attributes. Effect size Cohen’s d was 0.26. Conclusion The results demonstrate that frailty should be considered from an integrative perspective, taking cost, patient-centered outcomes, and medical outcomes into account simultaneously. The results also show the value of a research design which uses qualitative data for the identification of needs and barriers, as well as quantitative data for demonstrating the usefulness of the conceived value-based approach to perioperative care delivery.

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