PurposeThis 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. Design/methodology/approachThe 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. FindingsThe 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. Research limitations/implicationsThe 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). Practical implicationsManagers 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. Originality/valueThe 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.