Abstract
Amid the global shift toward sustainable supply chains, SMEs in China’s medical device industry face mounting pressure from centralized procurement policies and compliance requirements. Drawing on paradox theory and a multi-case study of nine SMEs across five regions in China, this study integrates semi-structured interviews and secondary data to examine dynamic tensions and adaptive strategies in sustainable supply chain management. The findings identify four interrelated tensions: institutional embeddedness, survival ethics, innovation stagnation, and sustainability fragmentation. In response, SMEs adopt composite strategies centered on cultural adaptation, institutional embedding, and resource reallocation.
The study contributes by introducing the notion of Confucian pragmatism to reinterpret paradox theory within the Chinese context and by conceptualizing dynamic tension–strategy interactions. It highlights the need for more flexible policy design, transparent governance mechanisms, and adaptive resource optimization pathways to support SME transformation. The research offers a culturally grounded framework for understanding sustainable transformation in emerging economies.