Background <p>China’s public hospitals operate in an increasingly turbulent environment shaped by demographic transition, payment reform, and rising patient expectations, making the determinants of hospital performance a question of both managerial urgency and theoretical importance. The Resource-Based View (RBV) explains performance through the possession of valuable resources, while Dynamic Capabilities Theory (DCT) emphasizes the ability to reconfigure resources under environmental change, and empirical evidence integrating the two within healthcare remains scarce. The aim of this study was to investigate which configurations of resources and dynamic capabilities lead Chinese tertiary public hospitals to high performance.</p> Methods <p>Building on an integrated RBV–DCT framework, we collected combined cross-sectional and longitudinal data for all tertiary public hospitals in a Chinese province (2017–2018). Fuzzy-set qualitative comparative analysis (fsQCA) was employed to examine the configurational pathways that lead to high and low performance.</p> Results <p>No single condition was necessary or sufficient for high performance. Three configurations led to high performance: (1) abundant human resources combined with strong learning capability and weak integration capability; (2) abundant human resources combined with strong perception and learning capabilities; and (3) strong perception, learning, and integration capabilities combined with limited financial resources. Low performance was primarily driven by the absence of learning capability coupled with weak perception or integration capability.</p> Conclusions <p>Hospital performance arises from configurational rather than additive effects of resources and dynamic capabilities, demonstrating equifinality. The findings extend RBV–DCT integration into the healthcare domain and provide policy makers and hospital administrators with concrete configurational targets for performance improvement under environmental volatility.</p>