The impact of organizational culture and leadership climate on organizational attractiveness and innovative behavior: a study of Norwegian hospital employees

Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
https://doi.org/10.1186/s12913-022-08042-x
RESEARCH
T he impac t ofor ganizational cultur e
andleadership climat e onor ganizational
attr ac tiveness andinno va tiv e behavior: astudy
ofNor w egian hospital emplo y ees
Barbara Rebecca M uton yi 1* , T erje Slåtten 2 , Gudbrand Lien 2 and Manel González‑Piñer o 3,4
Abstr ac t
Backgr ound: In the domain of health ser vices, little resear ch has f ocused on how organizational cultur e, specifically
internal mark et‑or iented cultur es (IMOCs), are associated with or ganizational climate resour ces, support for autonom y
(SA), and whether and how IMOCs and SA are either individually or in combination r elated to emplo yee perceptions
of the attractiveness of the organization and their level of innovativ e behavior . These k nowledge gaps in previous
resear ch motivated this study .
Methods: A conceptual model was tested on a sample ( N = 1008) of hospital employees. P ar tial least‑squares struc‑
tural equation modeling (PLS–SEM) was employed t o test the conceptual models, using the SmartPLS 3 sof tware.
T o test the mediator eff ect, a bootstrapping test was used to determine whether the direct and indirect effects wer e
statistically significant, and when combining two tests , to determine the type of mediator effect.
Results: The results can be summarized as f our k ey findings: i) organizational culture (r eferring to an IMOC ) was posi‑
tively and dir ec tly relat ed to SA ( β = 0.87) and organizational attractiveness ( β = 0.45); ii) SA was positively and dir ectly
relat ed to both organizational attractiveness ( β = 0.22) and employee individual inno vative behavior ( β = 0.37); iii)
The relationships between an IMOC, SA, and employ ee innovative behavior w ere all mediated thr ough organizational
attractiveness; and iv) SA mediated the relationship between the IMOC and or ganizational attrac tiveness as w ell as
that between the IMOC and employee innovativ e behavior .
Conclusions: Organizational cultur e, IMOC, organizational climat e resour ces, and SA wer e highly correlated and
necessar y drivers of employee perceptions of or ganizational attractiveness and their innovative behavior . M anag‑
ers of hospitals should consider IMOC and SA as two organizational resour ces that are pot entially manageable and
controllable . Consequently , managers should ac tively in vest in these resour ces. Such in vestments will lead to r esource
capitalization that will improv e both employee per ceptions of organizational attractiveness as well as their innovativ e
behavior .
Keywor ds: Organizational cultur e, Organizational climat e, Internal mar ket‑ oriented culture , Suppor t for autonom y ,
Organizational attractiveness, Innovative beha vior , Hospital employees
© The Author(s) 2022. Open A ccess This ar ticle is licensed under a Creative Commons A ttribution 4.0 I nternational License, which
permits use, sharing, adaptation, distribution and repr oduction in any medium or format, as long as you give appr opriate credit to the
original author(s) and the source, pr ovide a link to the Creativ e Commons licence, and indicate if changes wer e made. The images or
other third part y material in this article are included in the ar ticle’ s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the ar ticle ’ s Creative Commons licence and your int ended use is not permitted by statutor y
regulation or exceeds the permitted use , you will need to obtain permission directly from the copyright holder . T o view a copy of this
licence, visit http:// creat iv eco mmons. org/ licen ses/ by/4. 0/ . The Creative Commons P ublic Domain Dedication waiver ( http:// creat iveco
mmons. org/ publi cdoma in/ z ero/1. 0/ ) applies to the data made available in this article, unless other wise stated in a credit line to the data.
Backgr ound
O wing to the fa st - pace d grow th of demands for health-
care and the advancements of health technolog y , hospi-
tal organiz ations now face increas ed demand s for health
Open Ac cess
*Correspondence:  Barbararebecca.Muton yi@k ristiania.no
1 School of Economics, Innovation and T echnology, Kristiania University
College, Oslo , Nor way
F ull list of author information is available at the end of the article
P age 2 of 19
Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
ser vices [ 1 ], w ith im provements in area s such as value,
efficienc y , and innovative thinking [ 1 – 3 ]. Increa se d
patient need s and demand for care are pushing health
organiz ations t o ke ep pace with the increa singly chal -
lenging he alth industr y and the comple xity of offering
quality healthcare [ 1 , 4 ]. Employee innovativeness i s not
only be coming essential for addressing patient need s
and demands [ 5 ], but also indi spensable for a con tinued
expansion and adoption of nove l idea s in resp onse to
current environmen tal and market changes [ 6 , 7 ].
W ith “healthcare’ s comple x environment and its
diverse communities of practice (CoP s)” [ 5 ], the role of
hospital employe es in all categories and their innov ative
behavior is a ke y strategic tool in resp onding to the a b ove
challenges [ 1 ]. The impor tance of hospital employee s is
their knowledge-b ase d patient -or iented ex p ertis e [ 8 ].
As ho spital employees st and at the fron t line of patient
care, their diverse CoPs r e quire an or gani zational culture
and climat e that is conducive to em ployee innov ativeness
[ 1 , 5 , 9 ] to impr ove organiz ational performance, ser v ice
quality deliver y , and patient care [ 9 ]. Consequently , given
their employees cr itical role, health organiz ations should
strive to promote a cultur e and climate t hat fosters
employee innovation at work , here termed “individual
innovative behavior (IIB)” [ 10 ].
This paper explores whether and how hospitals c ulti -
vate an organizational culture and climat e that enc our -
ages and de velops innovative b eha vior by employee s .
Organiz ational cultur e and climate c oncern how organi -
zational par ticipants ob ser ve, exper ience, and make
sense of their work environment [ 11 ]. A positive and
healthy in terpl ay between organi zational culture and
climat e may ha ve practic al implications f or the manage -
ment of effective organiz ations . While “ climat e” refers to
experiential desc riptions or p erc eptions of e vents , c ul -
ture he lps to define why they happen [ 12 – 14 ]. Culture
represents an e volve d con text embedde d in sy stems. It
is more stable than clima te, has strong root s in histor y ,
is collectively held, and is resist ant t o manipulation [ 15 ,
16 ]. Climate resides within individual p erceptions of the
organiz ational c ontex t , and when these p erc eptions are
shared across indiv iduals , a higher-level so cial construct
emerges [ 17 , 18 ]. On the other hand, culture is the prop -
erty of the collec tive [ 19 ], reflecting de ep er phenomena
ba sed on s ymb olic [ 20 ] and shared meaning s about core
values , beliefs , and underly ing ideolog ies and a ssump -
tions [ 15 , 21 ].
Hewko [ 5 ] recently argued that while encouraging
employee innovation remains an ongoing challenge,
“without engag ing in critic al or creative thinking , hospi -
tal employee s may find it difficult to iden tif y what, where,
and how ne w ways of working (i.e., innovations) can b e
introduced. ” T o this end, this study focus es on concepts
that ar e seldom rese arched in the domain of healthcare
ser vice research, to examine and demonstra te IIB a s an
indisp ensable ingredient in improving patien t care, hos -
pital efficienc y , s er vice quality , ser v ice de liver y , and other
asp ec ts [ 5 , 22 , 23 ].
In this study , organiz ational culture is reflecte d in the
concept of “ internal market -oriented c ulture” (IMOC ),
which is purp osely or intentionally dir e cted toward
employees [ 24 ]. Pre viou s research reve als that IMOCs
are re lated to concepts such as employe e job satisfaction,
turnover inten tion, work engagement, and organi zational
attractiveness [ 10 , 24 ]. Howe ver , regarding the ne wness
of the conc ept , Slåtten et al. noted, “there is a nee d for
additional research into several a sp ect s relat e d to the
concept of IMOC , ” [ 10 ] suggesting that future rese arch
should re late IMO Cs to clima tic conditions such as lead -
ership styles in hospital organi zations . This study follows
this recommendation and examines how IMO Cs are
relat ed to le adership suppor t for a utonomy (SA) in hos -
pital organiz ations . SA reflect s employee p erc eptions of
the int erp ersonal climate betwe en themselves and their
nearest le ader and the a utonomy-supp ortive le adership.
An IMO C and SA represent the culture as oppo se d to
the clima te of an organiz ation and shar e the following
featur es : (i) a fo cus on organiz ational help and support
for employees and (ii) consideration for t hem as organi -
zational resources , reflec ting that both the IMOC and
SA are generally under management c ontrol and t here -
fore manageable. This lat ter asp e ct assume s the potential
to capitalize on IMO C and SA to achie ve desirable out -
comes for the hospital organiz ation.
This study examines two typ es of c apitalization on
IMO Cs and SA , motivated by pre vious work by Slåt -
ten et al. [ 10 , 24 ]. Ac cording t o them, an IMO C should
spe cific ally re late to hospital employee s’ perceptions of
organiz ational a ttractiveness (OA) [ 10 ] and employee
IIB [ 24 ]. In t he ca se of OA , T r yb ou et al. [ 25 ] note d that
“hospital attractiveness is of major impor tance. ” Regard -
ing IIB, pre vious res earch has found p ositive innovative
attit udes and b eha viors to b e a vital s ource of c ompeti -
tive advantage through pe ople [ 26 , 27 ]. Communities
of pe ople e volve, and the roles of the actors within are
undergoing change [ 28 ]. Colla b oration c ould b e formal
(work groups or proje ct teams) or informal (such as com -
munities of practitioners or informal network s). T o day ,
research and innovation practices are under w ay in t he
practitioner community [ 29 , 30 ], generating advances
and breakthroughs in science, technolog y , and innova -
tion, opening up opp ortunities for ne w interdisciplinar y
combina tions [ 28 , 31 , 32 ]. This le vel of formality in work
groups explains why t his study refers to t he concept of
IIB instead of innov ative work beha vior (I WB), g iven
that IWB refers to more f ormal work group s and IIB to
P age 3 of 19
Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
less formal ones . Therefor e, it is v ital that em ploye es can
communica te and implement nove l idea s through formal
and informal means . Thi s study c ontributes to research
on IMO Cs and SA in health organiz ations as antecedents
to employee IIB. A s Oppi e t al. [ 3 ] noted, “ studies inves -
tigating factors that sha pe innov ative behaviour at wor k
are scarce, ” espe cially in he alth or gani zations [ 5 , 33 ].
This paper pro cee ds as follows . The first p art provide s
the conc eptual mo del of the st udy . Se cond, there is a
desc ription and definition of each concept, followe d by
a discu ssion in which re lationships b etween concept s are
hypothesi ze d. Third, a description of the metho dolog y
and findings from the empirical study is presented. The
paper clos es with a dis cussion of the findings , including
se veral propo sals for future research, as well as an overall
conclusion of this study .
C onceptual model ofthestudy
The concept ual mo del of this study is represented in
F ig . 1 . As s een on the left side of the fig ure, marked
with a dotted line, IMO C and SA represent two distinc -
tive but interre lated ty pe s of “ organiz ational resources. ”
Spe cifically , an IMO C repres ents an organiz ational cul -
ture r es ource, wher ea s SA is an organiz ational clima te
resource. Notably , the term “resource” describ es four
common characteristics relev ant to both IMO Cs and
SA . First, b oth constit ute rela tively intangible organi -
zational resources . S econd, neither IMO Cs nor SA are
static resources but rat her are dynamic and subje ct
to change ( either p ositive or neg ative) as time pa sses .
Third, the t erm “resource” signals a p otential t o capi -
talize on IMO C and SA , which thus have t he p oten tial
to con tribute to com p etitive advantage of one ho spi -
tal over others . This latter vie w is consistent with t he
resource-base d v iew (R BV ) the or y [ 34 ], which assume s
that t he constella tion of resources is b oth idiosy n -
cratic and heterogeneously distr ibuted across fir ms .
F our th, bas ed on the se cond characteristic , the term
“r es ource” implies the po ssibility of a hospital organi -
zation managing and exerting a deg ree of contr ol over
the two resources (IMO C and SA), proving an oppor tu -
nity to in vest in them. Thus , on this ba sis and as show n
in F ig . 1 , the following logic i s assume d: If a hospital
organiz ation undertakes a “resource in vestment” in
IMO C and SA , the outc ome may be capitali zation man -
ifested in p ositive g rowth in both employee s’ percep -
tions of OA as well as their IIB. Therefore, O A and IIB
in F ig . 1 are terme d “r esource capitali zation ” b ec ause
they b oth stem from and reflect an outcome of the two
organiz ational resourc es of IMO C and SA .
Above, it is propo se d that both IMOCs and SA are
directly and indirec tly re lated to two ty pe s of resource
capitaliz ation: (i) hospital employee p erceptions of OA
and (ii) hospital employe es’ le vels of IIB. In the follow -
ing se ctions , the conc ept s and linkage s betwe en the
concepts in F ig . 1 are elaborated in det ail.
Fig . 1 Conceptual model of the study of the r elationship between organisational resour ces and resource capitalisation
P age 4 of 19
Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
Conc eptual framew ork
As de picted in Fig. 1 , the conceptual model of this study
propos es two organiz ational resources , IMO C and SA ,
that fall under the r es ource ca tegorie s of organiz ational
culture and organizational climate. Hist oric ally , the con -
struc t of clima te precede d that of culture [ 35 ], c limate
being w idely studied as a result of it s demonstrable influ -
ence on or gani zational effec tiveness [ 36 – 38 ], a s well as
its relationship to individual motivation and behavior [ 39 ,
40 ]. However , there has b een considerable debat e about
the similarities and differences be tween the two terms
[ 13 , 16 , 41 ]. A ma jor difference lies in the c onten tion
that t he climate of an or ganiz ation consists ess entially of
shared perceptions , wherea s the culture of an or gani za -
tion is made up of shared a ssumptions [ 42 ]. In a similar
vein, Moran and V olkwein [ 43 ] have suggested that cli -
mate c onsist s of at titudes and value s alone, whereas
culture exists as a colle ction of ba sic assumptions , in
addition to at titudes and value s . Recently , scholars have
gone a step fur ther , focusing on how and why the two
construct s can b e linked to provide a more compr ehen -
sive and parsimonious v iew of the higher-or der so cial
struc tur e of an organiz ation [ 12 , 44 , 45 ]. This study has
focu sed on the SA a s an organiz ational clima te resource,
and an IMO C as an organi zational culture resource. In
line with F ig . 1 , the two resources are fur ther elaborated
below .
Suppor t forautonomy (SA)
A utonom y in a work cont ext “has be en consistent ly ass o-
ciated w ith individual innovativeness in the workplace”
[ 5 ]. Prev ious health ser v ices research has re veale d the
import ance of leadership styles and their importance for
encouraging innovation at work [ 23 , 46 ]. Thus , this study
has fo cuse d on a sp ecific ty p e of autonom y provided by
leaders in a workplace, namely SA .
The concept of SA re lates to the in terp ersonal work
cont ext in or gani zations . As show n in F ig . 1 , SA i s con -
sidered to be a climatic resource within the or gani zation,
assume d to be under management contr ol and therefor e
relative ly manageable. Spe cifically , SA concerns employ -
ee s’ perceptions of “how things are done here” in the
hospital organi zation. SA embraces whether the int er -
pers onal con text is “ … autonom y- suppor tive when man-
agers provide a meaning ful rationale for doing the task s ,
emphasize choice rather t han contr ol, and acknowle dge
employees’ fe elings and persp e ctive” [ 47 ]. SA reflect s
employees’ p erceptions of a positive and go o d leader -
ship style, referring to the r elationship betwe en employ-
ee s and their direct leader and whe ther they p erceive t his
interpersonal contex t to be encouraging , motivating , and
stimulating.
SA orig inally rela ted to idea s within the domain of self-
determination theor y (SDT) [ 48 ]. Prev ious rese arch has
emphasize d SDT as a highly relev ant and a ppropriate
frame work for studying asp ec ts of motiv ations in wor k
context s [ 49 ]. In SDT , there are two typ es of motivation,
labele d (i) aut onomous and (ii) controlled motivation.
A utonomous motivation is an inner or self-dr iven typ e of
motivation whereby “ the person b ehaves with a full sens e
of volition and choice” [ 47 ]. By c ontrast , contr olle d moti -
vation is diametr ically opp ose d to autonomous moti-
vation. I t is a non- self-determine d typ e of motiv ation
impose d f rom without, me aning “t hat the person engage s
in an activity w ith an ex p erience of pressure and con trol”
[ 47 ]. This study limits it s focu s to a utonomous motiva -
tion. There are f our rea sons for this persp e ctive in the
study of SA . First, and most f undamentally , under SDT as
a guiding the oretical frame work , SA is closely a ssoc iated
with the aut onomous motiv ation of a person [ 47 , 50 ].
Se cond, in work con tex ts (a s in this study), many em ploy -
ee s consider a utonomy to be a desirable and a prefera ble
condition tha t they of ten actively se ek in their wor k role.
In line with this , Amundsen states , “individuals who s eek
autonom y at work ar e often se arching for inner motiva -
tional environments and situations t hat provide them the
oppor tunity for self-determination, initiative and c hoice”
[ 51 ]. Third, aut onomous motiv ation is descr ibe d as the
“highest quality of reg ulation ” [ 47 ] and is a sso ciated
with po sitive outcomes . F our th, SA is esp eci ally effective
when individual s per form com plex ta sks . “Com plex task s
require creativity , de ep processing of information, and
information int eg ration ” [ 52 ]. This latter aspe ct , a ssoc i -
ated with SA , i s esp eci ally relevant considering the focu s
on IIB in this pap er .
Internal mark et‑ oriented cultures (IMOCs)
Prev ious health ser v ices research on organiz ational cul-
ture r e veal the multifaceted nature of the c oncept of
organiz ational cultur e, which collectively have “be en
ext ensively studied in relation t o individu al innovative -
ness” [ 5 ]. This is b e cause culture is commonly found to
be ke y in supp orting , encourag ing , and fostering employ -
ee s’ IIB at work [ 7 , 53 ]. None the less , s cholars in health
ser vices rese arch ha ve calle d for fur ther studies to e xtend
our current understanding of the multifaceted concept of
organiz ational cultur e and it s role in encouraging indi -
vidual innov ation at wor k [ 1 , 4 , 54 – 57 ]. F or example, in
examining 331 Chinese nurses , Jing et al. [ 56 ] found that
organiz ational cultur e, studied a s workplace fun, w as
po sitively corre lated w ith IIB. As such, this study has
focu sed on a sp e cific ty pe of organiz ational culture a tten -
tive to employees , namely IMO C .
The IMO C concept is vie we d as an “ organi zational
culture purp osely or inten tionally direc ted toward
P age 5 of 19
Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
employees in the organiz ation ” [ 10 ]. Spe cifically , in this
study , an IMO C i s presented in F ig . 1 a s an organiz a -
tional culture resource. An IMOC fo cuse s on employ-
ee s and whether there e xist s a culture of suppor tiveness
within the hospital organiz ation. There are five r ea sons
for focusing on a supp ortive organi zational culture, here
termed an IMO C . F irst , culture has prev iously be en
vie we d as an e ssential part of any organiz ation [ 58 , 59 ],
and as such, a supp ortive organiz ational culture em pha -
sizes v alues that are in ternal and employee fo cuse d [ 10 ,
60 , 61 ]. S econd, organiz ational culture is a key fac tor in
be tter understanding and sustaining “the obser v able
norm-ba se d behavior that c onstitutes organiz ational cul -
ture” [ 24 ]. Thir d, organiz ational culture managemen t in
health organiz ations, e spe cially IMO Cs , is p erceived
as an indisp ensable par t of health system reform [ 58 ].
F our th, organiz ational cultur e has b e en linked to be t -
ter performance and terme d a power ful de terminant of
long-ter m organizational success [ 58 ]. This is ow ing to its
“ ability to create a sense of identity and rule s” [ 58 ], which
aids organiz ations , espe ci ally health organiz ations, to
achieve their goal s . F ifth, hospit al employees’ k nowledge
about their organiz ational cultur e is an effe ctive coping
mechanism in this c urrent fast -changing environment,
be cause k nowledge c an offer insights and solutions into
the problems health or gani zations now face [ 60 ].
Prev ious studies show that health or gani zations that
focu s on their or gani zational culture have derived p osi -
tive outcomes, such a s overall quality improvement and
po sitive employee behaviors and attit udes [ 60 , 62 ]. In
addition, prev ious studies foc using on IMO Cs among
frontline em ploye es in healthcare found that t he y have
a po sitive influence on overall job satisfaction [ 10 ] and
employee engagement [ 24 ]. Therefor e, pre vious res earch
has prop ose d that or gani zational culture is vital for he alth
organiz ations [ 24 , 60 ]. A suppor tive organiz ational cul -
ture r elates to its tang ible and visible characteri stics . In
this study , the IMO C reflec ts ho spital employees’ expe -
riences , b eliefs , and expect ations regarding their or gani-
zational culture. The IMO C focu ses on the relations hip
be tween the organiz ation and its employee s , and whether
employees identif y the overall conditions of t heir organi -
zation to be motiv ating , inspiring , and encouraging .
Organizational attractiveness ( OA)
In this study , the concept of O A centers on whet her p eo-
ple perceive the hospital organiz ation to be a great place
to work . Ac cording to T r yb ou et al. [ 25 ] “ho spital attrac -
tiveness [is] … of major impor tance. ” In a similar vein, Y an
and K ung [ 63 ] des crib e OA as “the c ore values … e spe -
cially for the labor -intensive healthcare industr y . ” Orig i-
nally , O A stems from and within the domain of employer
branding [ 64 ]. However , much of prev ious rese arch on
OA has narrowed it s foc us to ex ternal a spe ct s rela ted to
recr uitment [ 65 ] and how com panies communicate to
prospe ctive applicants that “ our ” organiz ation is a desira -
ble place to work . I t is impor tant to appear attractive and
actively “ sell” the hospital organiz ation as an attractive
organiz ation t o work for to potential new c andidates . On
the other hand, some would sa y that an even more fund a -
mentally import ant criterion for O A is the p erception of
hospital employe es that t he hospit al organiz ation is gen -
uinely at tractive, which is the focu s of this study . Studies
have f ound that those ( cur ren t employee s) who perceive
their organization to be attractive, which is synonymou s
with the term “ a g reat place to work , ” are f our times more
willing to de vote ex tra effort to their work role [ 66 ].
Therefor e, and in contrast to the dominan t foc us in pre -
vious res earch, the em pha sis is on OA from an int ernal
and current employee persp e ctive. In line with pre vious
research taking this c urrent employee persp ec tive, OA
is considered to be an attitudinal c onstr uct [ 24 ]. Spe cifi -
cally , OA re lates to current employees’ overall attit ude
concerning whether their or gani zation is an attractive
employer [ 24 ]. I t i s notable tha t the concept of O A poten -
tially contains or embraces both cognitive and affec tive
asp ec ts of employe es’ perceptions when considering the
attractiveness of their hospital organiz ation. A ccordingly ,
OA r efle cts c urrent employees’ overall cumulative at ti -
tudes and whether they are “v ie wing the [hospital] organ-
iz ation as a desirable entity ” [ 67 ].
Individual innov ative behavior (IIB)
Ac cording to H ult e t al. [ 68 ] innov ation in an or gani za-
tion can b e manifested in a diversity of w a ys and pl aces in
the organization such as a “ne w product or ser v ice, a new
production pro cess , or a ne w structure or administrative
system. ” Institutions are for ced to innovate at a faster rate
to maintain their c ompetitivene ss in the mark et . How -
e ver , innovation in this study is limited in its s cope and
persp e ctive in three ways . First, it focu ses on innov ation
ass oci at e d with and direc ted toward employees in the
hospital organi zation. This means it i s mainly initiated
and driven by employee s . Se cond, manifestation of inno -
vation is relat e d to work r oles . Third, innov ation is stud-
ied at the individual employe e level. Thes e three asp e cts
collectively encompass IIB.
IIB refers to the use of novel ideas and solutions by
employees to solve problems at work [ 69 ]. I t com -
pris es problem detec tion, promotion of new ide as , and
the actual application of nove l idea s or solutions [ 70 ].
Therefor e, II B is closely relat e d to ever yday practices
and employees’ refle ctions on how things are done and
their capability to pr op ose ide as to improve wor k p erfor -
mance. A ccordingly , II B embraces or functions a s a form
of “learning and k nowledge c reation, in teg rat e d into daily

P age 6 of 19
Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
work practices” [ 46 ]. As such, these innov ative practices
take place in the practitioners’ comm unity [ 29 , 30 ], gen -
erating advances and breakthroughs in real science, tech-
nologie s , and daily practice [ 28 , 32 ]. CoPs ar e promoted
in the healthcare se ctor as a me ans of generating and
sharing knowle dge, improving organizational p erfor -
mance [ 9 ], and designing f ramework s for systematic ev al-
uations of the CoP s’ effectivene ss in improving practice
and sustaining improvement [ 71 , 72 ].
CoPs c onnec t with what we understand to be informal
as opp ose d to formal collaboration (formal work groups
or projec t teams). This le vel of formality in work groups
explains t he us e of the IIB concept instead of IW B, con -
sidering that IWB refers to more formal work groups
and IIB to less formal one s . IW B is define d as deliberate
introduction and solicit ation of ideas (whether b etwe en
individual s , groups , or organi zation as a whole), pro -
cesses , pro ducts , or procedures that are re latively new
to the unit of adoption, and in tended to benefit g reatly
the individuals , g roups , or organiz ation [ 73 ]. The number
of paten t s/inven tions in a countr y can be inc reas ed by
employee I WB [ 74 ]. Thus , IIB app ears to be a more “ sp e -
cific form of change-oriented activ ity ” [ 75 ] that reflect s
employees’ applications of ne w and usef ul idea s in their
hospital work role.
Theor etical relationships betweenc oncepts
As shown in Fig . 1 , SA is a ssumed to have a direct impact
on IIB. Pre vious res earch has shown that SA is a ssoc iated
with different type s of positive outcomes , including job
per formance [ 52 , 76 ]. F or example, in a study by Kana t -
Maymon and Reizer [ 52 ], the authors f ound that super v i -
sors’ autonom y- suppor tive manageri al style wa s , among
other factors , po sitively asso ciated w ith job per formance
in a sample of sport s analyst s [ 52 ]. Similarly , in a study
undert aken in a healthcare setting , Gillet e tal. [ 76 ] found
that super v isor autonom y supp ort w as indire ctly re lated
to nurses’ job per formance. Gillet et al. [ 76 ] defined job
per formance as nurses’ p erception of their t eam ’ s quality
of work . In this study , job per formance refers t o employ -
ee s’ IIB. II B embraces both (implicitly) a person ’ s cogni-
tion (that is, thinking or c reativity) as well a s the e xplicit
manifestation of a person ’ s b eha vior (ac tually tr y ing out
ne w idea s in practice).
IIB is demanding and c an be characteri ze d as a com -
plex task . Prev ious rese arch suggests that a neces -
sar y foundation for perfor ming such c omplex task s
is autonom y . Kanat -Maymon and Reizer [ 52 ] st at e,
“ comple x ta sks … tend to require a higher deg ree of …
autonom y . ” A ccording t o SDT , SA is “p osited to fac ili -
tate the need s for a utonomy ” [ 47 ]. On this ba sis , it is
assume d that when em ploye es experience SA from
their direct leader it should rais e their IIB. Res earch
has ye t to e xamine this linkage in a he althcare con tex t .
However , pre vious res earch suppor ts a p ositive link age
be tween SA and employee s’ creative per formance [ 77 ].
F ur thermore, there is empirical e vidence that em ployee
autonom y is ass oc iated with characteristic s such as
innovative behavior [ 78 ], creative work in volvement
[ 79 ], creative self-efficac y , and innov ative activities [ 80 ] .
F ur thermore, a link be tween SA and I IB is als o sup -
por ted by the L MX (leader –memb er –exchange) t he or y .
LMX the or y builds on s oc ial ex change theor y [ 81 , 82 ] .
Ac cording to LMX theor y , a leader ha s a unique rela -
tionship with each member of the organiz ation [ 79 ].
I t has b e en suggested that a high-quality relationship
be tween le aders and members in an organiz ation has
se veral po sitive outcomes , such as improved job p er -
formance. Consequently , bas ed on L MX theor y , when
employees p erceive a high-quality SA rela tionship with
their direct leader , it i s reas onable t o a ssume that t his
constitut es a ne cessar y foundation and func tions as a
promoting factor for employee IIB. Naturally , there is
probably variation in employee s’ perceptions of SA ,
ranging f rom low to high. H owe ver , in this study , it is
expecte d that t he more SA a direct le ader provides to
employees , the more it will incre ase employe e IIB. This
rela tionship is stated formally in this hyp othesis :
Hypothesis 1: SA is p ositively re lated to employee
IIB.
As prop ose d in F ig . 1 , this study propose s two links
that in terc onne ct to form a chain. The first link in the
chain is a direct relationship betwe en SA and OA . The
study propose s tha t employee s’ perception of leadership
style (referring to SA) is ass oci ated with their at titude
toward the a ttractiveness of the organiz ation. However ,
this spe cific relationship is yet to be explor e d, and the
literat ure provides empirical e v idence and documents
the finding tha t leadership style and p erformance of the
leadership role are strongly asso ciated with the employ -
ee s’ perception of their organization. F or exam ple, pre -
vious res earch in healthcare has re veale d a sig nificant
link from the per formance of managemen t ta sks and
leadership style to employee attit udes . Their attitudes
are reflected in me asures such a s job satisfaction [ 83 ] ,
work engagement [ 84 ], t urnover intentions [ 85 ], and a
range of other work - and organiz ation-rela ted f actors .
In this study , employee- p erceived OA is defined as
an attit ude. Conse quently , the “list” of employee atti -
tudes influenced by leadership in organiz ations should
also include OA . Therefore, t here are goo d reas ons to
assume a dire ct relations hip b etwe en SA and O A . This
vie w is formulated a s the following hypothesi s:
Hypothesis 2: SA is p ositively re lated to O A .
P age 7 of 19
Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
As mentioned ab ove, the first propose d link is the
relations hip be tween SA and OA . When this first link
(SA–O A) is est ablished, it should lead to the second
link , which is b etwe en OA and IIB. Therefor e, a s shown
in F ig . 1 , this study also suggest s that t he relations hip
be tween SA and II B is me diated through O A . This rela -
tionship represents an additional and complemen tar y
“r oute” through which SA pr omotes II B as propo se d
in the first h y pothesi s . Ac cordingly , SA of le aders is
“ a coherent cluster of super v isor y behaviors that col -
lec tively create t hat int erp ersonal tone of supp ort and
understanding ” [ 86 ]. Cons equently , when employe es
perceive the SA of the leader to be favorable and posi -
tive, this should strengthen employees’ attitudes toward
the at tractiveness of the organiz ation tha t employs them.
This p ositive attit ude of employees reg arding SA could
be manifeste d in OA e xpressions such as : “this is a great
place to work” or this is a “ g reat em ployer . ” Similar to the
relations hip be tween SA and OA , s cant prev ious rese arch
has examine d the spec ific ass oci ation betwe en OA and
IIB a s a typ e of job p erformance. Howe ver , the lit era -
ture support s the vie w that O A is linked to job p erfor -
mance. F or example, in a st udy under taken in healthcare
settings , Sl åt ten et al. [ 24 ] found that O A wa s po sitively
signific ant ly a ssoc iated with job p erformance. Job per -
formance in this study was reflec ted in the quality of
ser vice provide d to hospital patients and employee work
engagement [ 24 ]. Moreover , F or tune 100’ s Be st Compa -
nies to W ork F or also sugge sts a link b etwe en O A and job
per formance, stating , “ employees who say they have a
great place to work [ or what t his study labels OA] were
four times more likely t o say they ’ re willing to give extra
to get the job done” [ 66 ]. So cial cog nitive theor y (SC T )
also provide s theoretical supp or t for the assumption of
an ass oci ation betwe en OA and IIB. SC T suggest s that
“ … beliefs and motiv ations ar e forme d on valuable judg -
ments” [ 87 ]. Ba se d on this SC T a ssumption, ther e are
goo d rea sons to ex p ec t tha t when employee s judge O A
more positively , it should strengthen their motivation for
IIB. The dis cussion above sugge sts that O A f unctions as
a link or a medi at or b etwe en SA and IIB. Spe cific ally , it
means p ositive p erceptions of leader SA should lead to
more positive attitudes toward employee OA . Next, when
OA increase s , this should strengthen employees’ motiva -
tion to use their capability to ex per iment with novel ideas
and find creative solutions in their work , thus increasing
their IIB. This chain of link s can formally b e stated in the
following hyp othesis :
Hypothesis 3: OA mediates the re lationship betwe en
SA and employee IIB.
F igure 1 als o suggests that an IMO C has a dire ct
impact on SA . Simultane ously , SA is a ssumed to func tion
as a me diator betwe en IMO C and b oth O A and IIB. The
idea for both of these relationships assume s some fun -
damental conditions tha t cultiv ate and pr omote SA and
in the nex t round may ha ve an impact on both p erceived
OA and em ployee I IB. This “ eng ine” or prerequisite that
triggers and initiates this domino effec t is suggested to
be an IMO C . An IMO C , as mentioned ab ove, is define d
and desc ribe d a s a typ e of organiz ational culture. Pr e -
vious res earch has well doc umented and emphasize d
the fundamental impor tance and role of organizational
culture. Organizational culture is said to “per v ade all
asp ec ts of organi zational life” [ 59 ]. When focusing on
culture in organizations , one lo oks at “more fundamen -
tal characteristic s of organiz ation ” [ 88 ]. The import ance
of organiz ational cultur e lies in it s propo sition as a “ cr iti -
cal first step toward creating a satisfactor y work en v iron-
ment” [ 59 ]. F or example, organizational culture “provides
the rules for b eha vior w ithin organizations” [ 83 ]. Thes e
“rules , ” stemming from organiz ational cultur e, are trans -
ferred to all organiz ational members . The transmission
is not limited to employee s . I t also extends to managers
and leaders of the organiz ation and ser ves a s a guide to
appropriat e b eha vior and work practices . There is a link
be tween organi zational culture and leadership behavior .
As B anasz ak -Holl et al. [ 59 ] stated, “ organi zational cul -
ture pr ovide s a key me chanism by which top manage-
ment in teg rat e manageri al actions . ” Prev ious rese arch
provides go od supp or t for the view that there is a posi -
tive ass oci ation betwe en organiz ational cultur e and lead-
ership behavior . Thi s po sitive rela tionship is als o found
in healthcare rese arch [ 83 , 89 ]. Cons equently , p arallel
to findings in prev ious rese arch, ther e are goo d rea sons
to ex pe ct organi zational culture in this study t o repre -
sent the conc ept of IMO Cs , which is p ositively ass oci -
ated with the SA of leaders . This le ads to the following
hypothesi s :
Hypothesis 4: The IMO C is p ositively re lated to SA .
As mentioned ab ove, an IMO C in an organiz ation
provides dire ction and behavioral code s of conduct for
the SA of organization leaders . Cons equently , when an
IMO C po sitively increas es their SA , this should also
increa se both employee s’ perceived OA and their IIB in
an organiz ation. S p ec ifically , in this study , it is expe cted
that t he stronger the IMO C of an organization is , the
more it drives the SA of leaders and sub sequently both
the O A and IIB of employe es . Acc ordingly , an IMO C ini -
tially f unctions to promote O A as p erceived by employ-
ee s and their IIB, which work thr ough the me chanism
derive d from leader SA . Conse quently , it is expe cte d tha t
SA has a me diating role betwe en IMO C and b oth O A
and IIB. B as ed on the above dis cussion, the following two
hypothes es are propos ed:
P age 8 of 19
Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
Hypothesis 5: SA me diates the r ela tionship b etween
an IMO C and OA .
Hypothesis 6: SA me diates the r ela tionship b etween
an IMO C and employee IIB.
Ac cording to F ig . 1 , IMO C i s assume d to ha ve a direc t
impact on IIB. Pre viou s research has indic ated that in
health organiz ations with a suppor tive organiz ational
culture for em ploye es , it can b e a source of com pe titive
advantage [ 90 ]. S cot t et al. [ 91 ] argue d that “ str uctural
changes alone do not deliver anticipat e d improvemen ts
in quality and p erformance in health care. ” Conse quent ly ,
organiz ational cultur e should be ke y to improvemen ts
in quality and p erformance for health organizations .
F or example, Hogan and Coote [ 92 ] explored the role of
organiz ational cultur e in professional ser vice firms and
found it to be a key v ariable in fostering II B at work . Sim -
ilarly , Hombur g and Pfless er [ 88 ] found or gani zational
culture to be directly relat e d to employee per formance.
In this study , p erformance refers to em ployee s’ IIB, which
encompasses b oth the production and implementa -
tion of novel ideas in a sp e cific work role. Consequently ,
there ar e go od rea sons to assume that an organiz ational
culture tha t suppor t s new ide as or ne w w ays of acc om -
plishing a work task have the potential to f oster employee
IIB dire ctly . On this b asis , the following hy pothesis i s
suggested:
Hypothesis 7: An IMO C is p ositively re lated to
employee IIB.
F ur thermore, it is also a ssume d tha t the relations hip
be tween IMO C and I IB is me diated through O A . As
se en in F ig . 1 , this rela tionship represents an indire ct and
supplementar y route of links for IMO Cs promoting IIB
compared with that pr op ose d in Hypothesi s 7. There are
two links in this chain. The first link a ssumes that IMO C
has a dire ct impact on OA . A s mentioned above, the con -
cept of OA r efers to em ploye es’ attit udes and whe ther
they p erceive the hospital organization to be an attractive
organiz ation in which t o work . It is reasonable to assume
that or ganiz ational culture, in this study r efle cted in the
IMO C , has a sig nificant impact on employee p erceptions
of OA . Ac cording to Chhabra and Sharma [ 93 ], or gani -
zational culture is one of the most preferred organiz a-
tional attributes. Pre v ious research supp ort s the vie w
that em ployee p erceptions of organiz ational cultur e are
relat ed to employee s’ at titudes [ 4 , 60 , 94 , 95 ]. A pre vi -
ous study using the conc ept of IMO C in a he althcare set -
ting has shown that IMO C is dire ctly linked to hospital
employee p erc eptions of OA [ 24 ] as well as to employee
satisfaction [ 10 ]. Conse quently , in line w ith previou s
research on the impact of organiz ational culture, and
esp eci ally those using the IMO C construc t, there are
goo d rea sons to ex p ec t tha t IMO C is related to OA . This
leads to the following hyp othesis :
Hypothesis 8: An IMO C is p ositively re lated to O A .
F ur thermore, and this leads to the se cond link betwe en
IMO C , OA , and IIB, when employe es perceive the organ -
iz ation to be attractive, be cause of the IMO C , it is also
reas onable to assume tha t this p ositive attit ude (reflec ted
in OA) will motivate and engage employees to de vote
both more time, more of their men tal or physical c apac -
ity , and generally more willingness to work to benefit the
inter est s of their hospital organiz ation. This idea and
logic are analogou s to wha t w as suggeste d in Hypothe sis
3 regarding the impact of SA on OA and IIB. Spec ifically ,
ba sed on S C T [ 87 ], an IMO C (similar to SA) can b oo st
employee p erc eptions of OA and strengthen their moti -
vation for IIB. T o the authors’ knowledge, no pre viou s
research has examine d this exact rela tionship in health
ser vices rese arch. However , prev ious rese arch in hospital
settings ha s identified OA as a me diator betwe en IMO Cs
and asp ec ts of work role per formance such as employee
engagement and ser v ice quality [ 24 ]. Conse quent ly , in
line with this rese arch, it is assumed that OA functions a s
a medi at or b etwe en IMO C and IIB. This le ads to the fol -
lowing final hyp othesis :
Hypothesis 9: OA mediates the re lationship betwe en
an IMO C and employee IIB.
All the suggested hyp otheses g uiding this study are
summari zed in T able 1 .
Methods
Study design andsettings
This study aims to examine t he relations hip b etwe en an
IMO C , SA , OA , and I IB, and is par t of a larger research
projec t. In F ebruar y 2020, data were gathered from one
of the largest health ex p ert communities in Nor w ay , in
T able 1 Hypotheses leading this study
Note : SA Support for Autonom y , IIB Individual I nnovativ e Behavior , OA
Organizational Attr activeness, IMOC Internal Market-Or iented C ulture
Hypothesized relationships
H1 SA is positively relat ed to employee IIB .
H2 SA is positively relat ed to OA.
H3 OA mediates the r elationship between SA and employee IIB.
H4 The IMOC is positively r elated to SA.
H5 SA mediates the relationship between an IMOC and O A.
H6 SA mediates the relationship between an IMOC and employ ee IIB.
H7 An IMOC is positively relat ed to employee IIB .
H8 An IMOC is positively relat ed to OA.
H9 OA mediates the r elationship between an IMOC and employee IIB.
P age 9 of 19
Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
the Inland Nor w ay r eg ion, ext ending over 40 sites with
over 10,000 employees . W ith over 10 div isions , the hos -
pitals offer var ious ser vices in relation to psychiatric and
somatic illnesses . Initially , the health expert community
in the Inland Nor w ay r eg ion wa s invited to par ticipate in
the study . Howe ver , follow ing the decisions of the Direc -
tor of Research (D OR), Human Resources Managemen t
(HR M) office, division managers , and dep artment man -
agers , we were granted access to a total of 2000 hospital
employees drawn f rom seven st aff units and 10 ho spital
divisions . Initi al con tac t , and all con tact w ith the hospi -
tal, wa s sought through the D OR . The D OR w as g iven
a pitch on t he rese arch project , along with it s aim, esti -
mated time, and essential resources . The D OR encour -
aged and motiv ated the hospital administration to
provide access and oppor tunities for the hospit al employ -
ee s to particip ate in t he rese arch pr oje ct . In addition, the
D OR suppor ted the diss emination of inf ormation about
the research projec t and the online questionnaire link .
Information about the research projec t cover e d its pur -
po se, par ticipants’ r ights , time allotted to the question-
naire, a link to t he questionnaire and the contact details
of the research projec t leader(s). All contact with the
hospital, H RM, div ision managers , and staff unit s went
through the DOR . Spe cific ally , the DOR for warde d any
information to division managers , who for w arded it and
the sur ve y to their em ploye es . This w as in line w ith the
hospital s’ HR M polic y and employe e protection p olic y .
Study par ticipants
In this study , a ho spital employee is understo od to be
any individual employed by a hospit al whose s er vices
or labor are provide d to a hospital, for which com p en -
sation is reflecte d in the hospital payroll records . As
mentioned above, a total of 2000 ho spital employees
were in v ited to partic ipate in the st udy . Out of thes e
and through con venience sam pling , a total of 1008 ho s -
pital employee s partic ipated in the sur ve y , resulting in
a respons e rat e of 50.4%. A s shown in T able 2 , 73% of
respondents were female. The high number correlates
well with the Nor weg ian cont ext, where more than 80%
of employees of he alth organizations are women [ 96 ].
Moreover , 37.3% were under the age of 45 years , and
77.5% were full- time workers. In addition, over 55% of
the particip ants had amass ed sub stantial work ex per i -
ence be cause the y had be en with the organiz ation for
more than 10 ye ars . While there were minor diff erences
among divisions , it i s import ant to not e that this st udy
focu sed on indiv idual b eha vior and not div ision-le vel
differenc es . In addition, the study sought to examine all
hospital employe es regardless of their work roles , so it
did not focus on minor differences be tween st aff roles ,
such as those b etwe en nurses and do ctors . Therefor e,
this study offers new insights into issues related to IIB
among individual ho spital employee s .
Instruments
The study use d four established instr uments to mea sure
the conc eptual mo del of the st udy (F ig . 1 ): IMO C , SA ,
OA , and IIB. All items in the sur ve y require d par tici -
pants to respond u sing a se ven-p oint Likert resp onse
scale (1 = str ongly disag ree to 7 = strongly agre e). In
addition to the sur ve y statemen ts show n in T able 2 , the
questionnaire included p ersonal characteristic s such as
age, sex , typ e of employment, and work role. T o ensure
quality in the overall research desig n, two expert s in the
field, with 34 randomly selecte d hospital employe es ,
completed a pre-test . In addition, the sur ve y wa s con -
ducted in the Nor weg ian lang uage. F or this rea son, s ev -
eral workshops w ith academic expert s and employees
were held t o verif y the back - translation. Note t hat as
mentioned above, the sur ve y u sed in this study is p art
of a larger sur ve y rese arch pr oje ct foc using on var ious
asp e cts of employe e re lations in health organiz ations .
The statemen t s use d in this study are a ppende d (se e
Additional file 1 : A pp endix1).
The IMO C wa s mea sured using eig ht it ems f rom Slåt -
ten et al. [ 24 ]. SA wa s mea sured using five items from
Amundsen [ 51 ]. OA was mea sured u sing two items
from T r yb ou et al. [ 25 ]. IIB w as me asure d using five
items from Janssen [ 97 ] and Scott and Bruce [ 74 ]. I t is
import ant to not e that the it ems use d in this study were
adjusted to the cont ext of hospital employees in Inl and
Nor w ay . All items use d in this study are summarize d in
T able 3 .
T able 2 P ersonal characteristics of the study sample ( N = 1008)
%
Sex F emale 73.0
Male 27.0
Staff role: Nurse 33.0
Doctor 8.7
Others (admin. Staff, other health
prof essionals, etc .) 58.3
Employed: less than 5 years 26.9
between 6 and 10 years 18.0
between 11 and 20 years 30.3
more than 20 years 24.8
P ar t‑time or full‑time: par t‑time job 22.5
full‑time job 77.5
Age: younger than 45 years 37.3
between 46 and 55 years 32.2
older than 55 years 30.5
P age 16 of 19
Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
resource capitaliz ation manifested in both improved
employee p erc eptions of OA as well as their II B.
In conclusion, this study c ontributes ne w knowl -
edge reg arding how or gani zational culture, IMO Cs ,
and organiz ational clima te, SA , f unction as two ty p es of
organiz ational r es ources, a s well as their relation t o OA
and IIB. The study found SA to corre late with hospital
employees’ OA and IIB, in addition to having an indirect
effect . In addition, the study reve aled IMO Cs to corre -
late with SA and O A , with indirec t effect s on IIB. Thus ,
the findings of this study highlight the significance of
investment in both IMO Cs and SA by hospital managers .
Ba se d on these findings , hospital managers should make
resource in vestments in IMO C and SA , a s the payoff or
resource capitaliz ation will be manifeste d in both p osi -
tive grow th in employees’ perceptions of OA as well as
employees’ le vel of innovative behavior . These are desir -
able outc omes for hospit al managers and organizations
that seek sustainable ways to use employee s’ IIB at work .
Limitations andfuture r esearch
There are several opp ortunities for f uture r es earch bas ed
on the limitations of this st udy . The following four area s
of study are r e commended.
F irst , this study is limited by its c ross- se ctional desig n.
F or inst ance, the em pirical d ata in this study wer e col -
lec ted at one point in time from a single he alth or gani za-
tion. Conse quent ly , the results of this study should not be
generalize d to other health or gani zations . Reg ardless , the
results c an ser ve a s a stepping-stone to future rese arch
including variou s health organiz ations, including testing
causal and revers ed c asu al rela tionships . This w as done to
minimize metho d bia s . In addition, the limitations linked
to online sur ve ys are known to include self- selection and
shared respons e bia s , owing to the nat ure of self-repor t
mea sures . Conse quently , as sugge sted by Hair etal. [ 100 ],
these limitations may reveal that future studies should
employ a time lag in data gathering .
Se cond, this study is limited to the use of an IMO C to
represent the or gani zational culture resource. However ,
future research should examine other type s of poten -
tial cultural resources in hospital organi zations . F or
exam ple, one could include those culture typ es men -
tioned in the frame work of C ameron and Quinn [ 117 ].
In their frame work , the authors pr op ose four ty pe s of
organiz ational cultur e that could e xist or dominate
organiz ations: clan, adho crac y , market , and hierarch y .
T o the authors’ knowledge, fe w health ser vices stud -
ies have examined their role. Ther efore, it is highly
recommended that future research focu s on culture
typ es in the Cameron and Q uinn [ 117 ] frame work and
examine how they either individually or e ventually col -
lec tively can achieve de sirable objective s for hospital
organiz ations. In addition to the ne w IMO Cs , this
study recommends tha t f uture r es earch ex pand cur rent
knowle dge and understanding of the com plex nat ure of
hospital environments , and the advantage s of cultures
that f o cus on employee s .
Third, this study was als o limited to SA to repre -
sent organizational climatic resources . As mentioned
above, the domain of organiz ational clima te as a concept
requires the study of organizations ba se d on the perspe c -
tive of “how things are done here. ” On this ba sis , there
are numer ous opp ortunities to include other clima tic
resources in hospital organi zations in future rese arch.
Spe cifically , studying climatic conditions from a leader -
ship persp ec tive could include leadership styles such as
empowering le adership, transformational leadership,
ambidextr ous le adership, transactional leadership, char -
ismatic leadership, and so forth. F urthermore, f rom an
employee p erspe ctive, f uture r es earch could e xamine
climatic aspe ct s such as coop erative clima tes , commu -
nication climat es , le arning climates , suppor tive climat es ,
trusting climates , humorous clima tes , and so for th. These
asp ec ts of organi zational climat e, like ty pes of organi za -
tional culture, could be studied individu ally or in combi-
nation. Paralle l to this study , it would als o be p ossible for
future research to examine how or gani zational cultures
such as IMO Cs thrive under CoPs to assess their impact
on improving hospital employee s’ OA , IIB, and overall
healthcare practices [ 118 ].
F our th, as note d throughout t his p aper , there is lit -
tle research on the two typ es of resource capitaliz ation
included in this study (OA and IIB). Considering the
import ance of O A and IIB for hospit al organiz ations,
there is a nee d to include both of these factors in f uture
health ser vices res earch. However , in addition to includ -
ing OA and IIB, other typ es of resource capitaliz ation
could be included. F or example, c onsidering the se emingly
growing competition among ho spitals (e.g ., public ver -
sus priv ate hospitals) in many coun tries , future research
could include t he concept of com p etitive power . The
concept of c ompe titive power foc use s on “ a company ’ s
relative adv antage in the mar ketplace in com par ison to
its mo st relevant competitors” [ 119 ]. Competitive p ower
is reflec ted such as by b eing “the first t o introduce new
ser vices into the mar ket , having more satisfied customers
and hard for c ompetitors to imitate firms’ ser vice offer -
ings” [ 119 ]. Organiz ational culture is propose d a s a poten -
tial source of com p etitive advantage [ 120 ]. Including the
concept of c ompe titive power in he alth ser vices res earch
will re veal what typ e of organiz ational culture and assoc i -
ated organiz ational c limate best explain the com p etitive -
ness of hospit als . Conse quently , foc using on these and
se veral other options offers the potential f or ne w knowl -
edge and insig hts , both theoretic al and practic al.

P age 17 of 19
Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
Abbrevia tions
CoP s: Communities of practice; RB V: Resour ce ‑based view ; SDT : Self‑
determination theor y ; LMX: Leader–member – exchange; SC T: Social
cognitive theory ; DOR: Director of research; IIB: Individual innovative
behavior; SA: Suppor t for autonomy; IMOC: I nternal market‑ oriented
culture; O A: Organizational attractiveness; PLS–SEM: P ar tial least‑squares
structural equation modeling; A VE: Av erage variance ex tracted; HTMT :
Heterotrait –monotrait; VIF: V ariance inflation factor ; NSD: The Nor wegian
Centre f or Research Data; HRM: Human resour ce management; DPO:
Data Pr otection O ffice.
Supplementary Information
The online version contains supplementary material available at https:// doi.
org/ 10. 1186/ s12913‑ 022‑ 08042‑x .
Additional file1: Appendix1. Questionnair e developed for this study .
Acknowledgements
The authors express their g ratitude to the respondents for their participation
in this research.
Authors ’ contributions
BRM led the development of the questionnaire , data collection, and
drafting of the manuscript. TS led the development and mainly drafted
this manuscript. GL contributed to the development of the questionnaire,
statistical analysis, interpretation of data, and general input r egarding the
manuscript. MGP contributed general input regarding the manuscript, in
addition to being mainly responsible f or revisions. All f our authors read
and approv ed the final draft.
F unding
Not applicable.
A vailability of data and materials
The datasets used and/or analyzed during the current study are a vailable from
the corresponding author on a reasonable r equest.
Declarations
Ethics approv al and consent to participate
This study was approv ed by the Nor wegian Social Science Data Ser vices
(NSD) (project No. 239029). The NSD is a resour ce center and ethics com ‑
mittee for academic r esearch in Norway. The study was also approv ed by
the Data Pr otection O ffice of the hospital organization in this study . I n
accordance with the P ersonal Data Act §§2–7 and 8 No. 1, the participants
were g iven written information about the project. Informed consent was
obtained from all subjects and/or their legal guardians, prior to com ‑
mencement of the study .
Consent f or publication
Not applicable.
Competing int erests
The authors declare that they hav e no competing interests.
Author details
1 School of Economics, Innovation and T echnology , Kristiania Universit y
College, Oslo , Nor way . 2 Inland S chool of Business and Social Science, Inland
Nor way University of Applied Sciences, Lillehammer , Nor way . 3 Depar tment
of Economics, F aculty of Economics and Business, University of Barcelona,
Barcelona, Spain. 4 Research Centre f or Biomedical Engineering, T echnical
University of Catalonia, Barcelona, Spain.
Received: 27 A ugust 2021   Accepted: 27 A pril 2022
Referenc es
1. Mutonyi BR, Slåtten T , Lien G. Fostering innovativ e behavior in health
organizations: a PLS‑SEM analysis of Norwegian hospital employees.
BMC Health Ser v Res. 2021;21(1):470.
2. Y an D , Wen F , Li X, Zhang Y . The relationship between psychological
capital and innovation behaviour in Chinese nurses. J Nurs Manag .
2020;28(3):471–9.
3. Oppi C, Bagheri A, V agnoni E. Antecedents of innovative w ork behav‑
iour in healthcare: does efficacy play a role? Int J Public Sect Manag.
2019;33(1):45–61.
4. T sai Y . Relationship bet ween organizational cultur e, leadership behavior
and job satisfaction. BMC Health Ser v Res. 2011;11(1):98.
5. Hewko SJ. Individual‑level fac tors ar e significantly more predictive
of employee innovativ eness than job ‑specific or organization‑level
factors: results from a quantitativ e study of health professionals . Health
Ser v Insights. 2022;15:11786329221080039.
6. Vivona R, Demircioglu M A, Raghavan A. Innovation and innovative ‑
ness for the public servant of the future: what, why , how, wher e, and
when. In: Sullivan H, Dick inson H, Henderson H, editors. The P algrave
handbook of the public ser vant. Switzerland: P algrave Macmillan; 2021.
p. 1–22.
7. Usmanova K, W ang D, Y ounas A. Leader ’ s strategy to encourage
employee ’ s innovative work behavior in multicultural w ork place: do
suppor tive colleagues matter? Chin Manag Stud. 2021;16(2):274–92.
8. Glover W , Nissinboim N, Naveh E. Examining innovation in hospital
units: a complex adaptive systems appr oach. BMC Health Ser v Res.
2020;20(554):1–26.
9. Ranmuthugala G, Plumb JJ, Cunningham FC, Georg iou A, W estbrook JI,
Braithwaite J . How and why ar e communities of practice established in
the healthcare sector? A systematic r eview of the literature. BMC Health
Ser v Res. 2011;11(1):273.
10. Slåtten T , Lien G, Lupina E, Gravingen KA. P romoting an internal
market‑ oriented culture (IMOC) in healthcare ser vices. J Ser v Sci Res.
2019;11(2):157–82.
11. Schneider B, Ehrhar t MG, Macey WH. Organizational climate resear ch:
achievement and the road ahead . I n: Ashkanasy NM, Wilderom CPM,
P eterson MF , editors. The handbook of organizational cultur e and
climate. 2nd ed . Thousand Oaks: Sage; 2011. p . 29–49.
12. Schneider B, Ehrhar t MG, Macey WH. Perspectives on organizational
climate and culture . In: Zedeck S, editor . Handbook of industr ial and
organizational psychology . Washingt on, DC: American Psychological
Association; 2011. p . 373–414.
13. Schein EH. Sense and nonsense about culture and climate. In: Ashka‑
nasy NM, Wilderom CP , P eterson MF , editors. Handbook of organiza‑
tional culture and climate . Thousand Oaks: Sage; 1999. p . xxii–xx.
14. Schneider B, Ehrhar t MG, Macey WH. Organizational climate and cul‑
ture. Annu Rev P sychol. 2013;64:361–88.
15. Schein EH. Organizational culture and leadership . San F ransisco: Wiley ;
2010.
16. Denison DR. What is the difference between or ganizational culture
and organizational climate? A native ’ s point of view on a decade of
paradigm wars. A cad Manag Rev. 1996;21(3):619–54.
17. James LR, Choi CC, Ko C‑HE, McNeil PK , Minton MK , Wright MA, et al .
Organizational and psycholog ical climate: a review of theor y and
research. E ur J Work Or gan Psychol . 2008;17(1):5–32.
18. Allen JB, Shaw S. Women coaches ’ perceptions of their spor t organiza‑
tions’ social environment: supporting coaches’ psychological needs?
Spor t P sychol. 2009;23(3):346–66.
19. Mar tin J. Organizational cultur e: mapping the terrain. Thousand Oaks:
Sage; 2001.
20. Hatch MJ. Material and meaning in the dynamics of organizational
culture and identity with implications for the leadership of or ganiza‑
tional change. In: Ashk anasy NM, Wilderom CP , Pet erson MF , editors.
Handbook of organizational culture and climat e. 2nd ed. Thousand
Oaks: Sage; 2011. p. 341–58.
21. T r ice HM, Beyer JM. The cultures of work organizations: P rentice‑Hall
Inc; 1993.
22. F arruk h M, Ansari NY , Raza A, M eng F , W ang H. H igh‑per formance
work practices do much, but H.E.R.O does more: an empirical
P age 18 of 19
Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
investigation of employ ees’ innovative behavior fr om the hospitality
industr y . Eur J Innov Manag. 2021; (In press).
23. Slåtten T , Mutonyi BR, Lien G. The impact of individual creativity, psy cho ‑
logical capital, and leadership aut onomy suppor t on hospital employees ’
innovative behaviour . BMC Health Ser v Res. 2020;20(1):1096.
24. Slåtten T , Lien G, Svenkerud P J. The role of or ganizational attrac ‑
tiveness in an internal market‑ oriented culture (IMOC): a study of
hospital frontline employ ees. BMC Health Ser v Res. 2019;19(1):307.
25. T r ybou J, Gemmel P , V an V aerenbergh Y , Annemans L. Hospital–physi ‑
cian relations: the relativ e impor tance of economic, relational and
prof essional attributes to organizational attractiveness. BMC Health
Ser v Res. 2014;14(1):232.
26. Y an D , Wen F , Li X, Zhang Y . The relationship between psychological
capital and innovation behavior in Chinese nurses. J Nurs Manag .
2020;28(3):471–9.
27. Slåtten T , Lien G, Horn CMF , P edersen E. The links between psycho ‑
logical capital, social capital , and work‑relat ed per formance —a
study of ser vice sales representativ es. T otal Qual Manag Bus Excell.
2019;30(sup1):S195–209.
28. González‑Piñer o M, P áez‑Avilés C, Juanola‑F eliu E, Samitier J. Cr oss‑
fertilization of k nowledge and technologies in collaborative r esearch
projects. J Knowl Manag. 2021;25(11):34–59.
29. Starke y K, M adan P . Bridging the relevance gap: aligning stakeholders
in the future of management resear ch. Br J Manag. 2001;12:S3–S26.
30. Søraa RA, Ingeborgrud L, Subotick i I, Solbu G. Communities of peer
practitioners. Experiences from an academic writing group . Nord J
Sci T ech Stud. 2017;5(1):30–7.
31. P áez‑Avilés C, Van Rijnsoever F J, Juanola‑F eliu E, Samitier J. Multi‑
disciplinarity breeds diversity : the influence of innovation project
characteristics on diversity creation in nanotechnology . J T echnol
T ransf. 2018;43(2):458–81.
32. Juanola‑F eliu E, Colomer‑F arrarons J, Miribel‑Català P , Samitier J, V alls‑
P asola J. Market challenges facing academic research in commer ‑
cializing nano‑ enabled implantable devices for in‑vivo biomedical
analysis. T echnovation. 2012;32(3–4):193–204.
33. Mutonyi BR, Slåtten T , Lien G. Fostering innovativ e behavior in health
organizations—a PLS‑SEM. Analysis of Norwegian Hospital Employ ‑
ees. 2020.
34. W erner felt B. A resour ce ‑based view of the firm. Strateg Manag J.
1984;5(2):171–80.
35. Ostroff C, Kinick i AJ, Muhammad RS. Organizational culture and
climate. In: W einer IB, Schmitt NW , H ighhouse S, editors. Handbook
of psychology : industrial and organizational psychology . 12. 2nd ed.
Hoboken: Wiley ; 2013. p. 643–76.
36. Liker t R. The human organization: its management and values . 1st ed.
New Y or k: M cGraw‑Hill; 1967.
37. K anter RM. The change masters: innovations for pr oductivit y in the
American corporation. New Y ork : Simon and Schuster; 1983.
38. Mudrack PE. Defining group cohesiveness: a legacy of confusion?
Small Group Behav . 1989;20(1):37–49.
39. Bower S, Bow er G. Asser ting yourself : a practical guide for positive
change. Reading: Addison Wesley ; 1976.
40. P anuwatwanich K , Al‑Haadir S, Stewar t RA. Influence of safety
motivation and climate on safety behaviour and outcomes: evidence
from the Saudi Arabian construction industr y . Int J Occup Saf Ergon.
2017;23(1):60–75.
41. P ayne M. The politics of case management and social work . Int J S oc
W elf . 2000;9(2):82–91.
42. Ashf or th BE, Mael F . Social identity theor y and the organization. Acad
Manag Rev. 1989;14(1):20–39.
43. Moran E T , V olk wein JF . T he cultural approach to the f ormation of
organizational climate . Hum Relat. 1992;45(1):19–47.
44. Zohar DM, Hofmann D A. Organizational culture and climate . In:
Kozlowski SW , editor . T he Oxford handbook of or ganizational psy ‑
chology . 1st ed. New Y ork : Oxford Univ ersity Press; 2012. p . 643–66.
45. Hofmann DA, Burke MJ, Z ohar D. 100 y ears of occupational safety
research: fr om basic protections and work analysis to a multilevel view
of work place safety and risk. J Appl Psychol . 2017;102(3):375.
46. Avby G, Kjellstr öm S. LearnOvation: an inter vention to f oster explora‑
tion and exploitation behaviour in health care management in daily
practice. BMC Health Ser v Res. 2019;19(1):319.
47. Gillet N, Gagné M, Sauvagère S, F ouquereau E. The role of supervisor
autonomy support, organizational suppor t, and autonomous and con‑
trolled motivation in predicting employ ees’ satisfac tion and turnover
intentions. Eur J Work Organ P sychol. 2013;22(4):450–60.
48. Deci EL, R yan RM. F acilitating optimal motivation and psychological
well‑being across lif e ’ s domains. Can P sychol/Psy chologie Canadienne.
2008;49(1):14.
49. Gagné M, Deci EL. Self‑ determination theor y and work motivation. J
Organ Behav . 2005;26(4):331–62.
50. Ryan RM, D eci EL. Over view of self‑ determination theor y : an organis‑
mic dialectical perspective. In: D eci EL, Ryan RM, editors. Handbook of
self‑determination research. 1st ed. Rochester: University of Rochester
Pr ess; 2002. p. 3–33.
51. Amundsen S. Empowerment i arbeidslivet ‑ et myndiggjøringsper‑
spektiv på ledelse, selvledelse og medarbeidersk ap [empowerment
in work ing life ‑ an empo werment perspective on management,
self‑management and employeeship]. 1st ed . Oslo: Cappelen Damm
Ak ademisk; 2019.
52. K anat‑Maymon Y , Reizer A. Super visors’ autonomy suppor t as a
predictor of job per formance trajectories. Appl P sychol Int Rev.
2017;66(3):468–86.
53. Li W , Bhutto T A, Nasiri AR, Shaik h HA, Samo F A. Organizational innova‑
tion: the role of leadership and organizational cultur e. Int J Public L ead.
2018;14(1):33–47.
54. Cho Y J, Song HJ . How to facilitate innovative beha vior and organiza‑
tional citizenship behavior: evidence from public employees in Korea.
Public P ers M anage. 2021;50(4):509–37.
55. Ding H, Lin X, Su W . Employee strengths use and innovative beha vior : a
moderated mediation model. Chin Manag Stud. 2021;15(2):350–62.
56. Jing J, Niyomsilp E, Li R, Gao F . E ffect of workplace fun on Chinese nurse
innovative behaviour: the intermediar y function of affective commit‑
ment. J Nurs Manag. 2021;29(7):2250–9.
57. Chang L ‑C, Liu C‑H. Employee empowerment, innovative behavior and
job productivity of public health nurses: a cross‑sectional questionnaire
sur vey . Int J Nurs Stud. 2008;45(10):1442–8.
58. Mesfin D, Woldie M, A damu A, Bekele F . P erceived organizational
culture and its relationship with job satisfaction in primar y hospitals of
Jimma zone and Jimma town administration, corr elational study . BMC
Health Ser v Res. 2020;20(1):438.
59. Banaszak‑Holl J , Castle NG, Lin MK , Shrivastwa N, Spreitzer G. The role
of organizational culture in r etaining nursing workfor ce. Gerontologist.
2015;55(3):462–71.
60. Zachariadou T , Zannetos S, Pa vlak is A. Organizational culture in the pri‑
mar y healthcare setting of Cyprus . BMC Health Ser v Res. 2013;13(1):1–8.
61. Dastmalchian A, Lee S, Ng I. The interplay between organizational and
national cultures: a comparison of organizational practices in Canada
and South Korea using the competing values framework . Int J Hum
Resour . 2000;11(2):388–412.
62. Chow CW , Harrison GL, McK innon JL, Wu A. The organizational culture
of public accounting firms: evidence from T aiwanese local and US affili‑
ated firms. Acc Or gan Soc. 2002;27(4–5):347–60.
63. Y an Y , Kung C. Hospital image and compensation/benefit system on
organizational attractiveness. P ublic Health. 2017;2(1):33–41.
64. Ber thon P , Ewing M, Hah LL. Captivating company: dimensions of
attractiveness in employer branding. Int J Adv er t. 2005;24(2):151–72.
65. Theurer CP , T umasjan A, W elpe IM, Lievens F . Employer branding: a
brand equity‑based literature review and resear ch agenda. Int J M anag
Rev . 2018;20(1):155–79.
66. Benioff M. Fortune 100 best companies to work for; 2018. Available from:
https:// www. g reat place towork. com/ best‑ workp laces/ 100‑ best/ 2018
67. Aiman‑Smith L, Bauer TN, Cable DM. Are you attracted? Do you
intend to pursue? A r ecruiting polic y‑captur ing study . J Bus P sychol.
2001;16(2):219–37.
68. Hult GTM, Hurley RF , Knight GA. I nnovativeness: its antecedents and impact
on business per formance. Ind Mark M anag. 2004;33(5):429–38.
69. Mutonyi BR, Slåtten T , Lien G. Empowering leadership, work group cohesiv e ‑
ness, individual learning orientation and individual innovative behaviour
in the public sector : empirical evidence from Nor way . I nt J Public L ead.
2020;6(2):175–97.
70. Mutonyi BR, Slåtten T , Lien G. Organizational climate and cr eative per for ‑
mance in the public sector . Eur Bus Re v . 2020;32(4):615–31.
P age 19 of 19
Mutonyi etal . BMC Health Ser vices Research          (2022) 22:637
71. Braithwaite J , W estbrook JI, Ranmuthugala G, Cunningham F , Plumb J , Wiley
J, et al . The development, design, t esting, refinement, simulation and
application of an evaluation framework for communities of practice and
social–prof essional networks. BMC Health Ser v Res. 2009;9(1):162.
72. Ranmuthugala G, Cunningham FC, Plumb JJ , Long J , Georgiou A, W estbrook
JI, et al. A realist evaluation of the r ole of communities of practice in
changing healthcare practice. Implement Sci. 2011;6(1):49.
73. West MA, F ar r JL. Innovation and creativity at work : psychological and or gani ‑
zational strategies . Chichester: W iley ; 1990.
74. Scott SG, Bruce RA. Determinants of innovative behavior: a path
model of individual innovation in the workplace. Acad Manag J.
1994;37(3):580–607.
75. Battistelli A, Montani F , Odoardi C, V andenberghe C, P icci P . Employees’
concerns about change and commitment to change among I talian
organizations: the moderating role of inno vative work behavior . J Hum
Resour Manag. 2014;25(7):951–78.
76. Gillet N, Colombat P , M ichinov E, P ronost AM, F ouquereau E. Pr ocedural jus ‑
tice, supervisor autonomy suppor t, work satisfaction, organizational iden ‑
tification and job per formance: the mediating role of need satisfaction
and perceived or ganizational suppor t. J Adv Nurs. 2013;69(11):2560–71.
77. Hocine Z, Zhang J. A utonomy support: explaining the path from leadership
to employee cr eative per formance. Open J Soc Sci. 2014;2(6):417–23.
78. Slåtten T , Mehmetoglu M. Antecedents and effects of engaged frontline
employees—a study fr om the hospitality industr y . Manag Ser v Qual: I nt J.
2011;21(1):88–107.
79. Graen GB , Uhl‑Bien M. Relationship ‑based approach to leadership: dev elop ‑
ment of leader–member exchange (LMX) theory of leadership over
25 years: applying a multi‑level multi‑domain perspective. Leadersh Q .
1995;6(2):219–47.
80. Slåtten T . Determinants and effects of employee ’ s creative self‑efficac y on
innovative activities. Int J Qual Ser v Sci. 2014;6(4):326–47.
81. Blau PM. Exchange and pow er in social life. New Y ork : Wiley ; 1964.
82. Gouldner A W . The norm of reciprocity : a preliminar y statement. Am Sociol
Rev . 1960;25(2):161–78.
83. T sai Y . Relationship bet ween organizational cultur e, leadership behavior and
job satisfaction. BMC Health Ser v R es. 2011;11:1–9.
84. García‑Sierra R, Fernández‑Castro J . Relationships between leadership,
structural empowerment, and engagement in nurses. J Adv Nurs .
2018;74(12):2809–19.
85. Moloney W , Boxall P , P arsons M, Cheung G. F ac tors predicting reg istered
nurses’ intentions to leav e their organization and prof ession: a job
demands‑resources framew ork . J Adv Nurs. 2018;74(4):864–75.
86. Reeve J. Giving and summoning autonom y suppor t in hierarchical relation ‑
ships. Soc P ersonal Psy chol Compass. 2015;9(8):406–18.
87. Aloustani S, Atashzadeh‑Shoorideh F , Zagheri‑ T afreshi M, Nasiri M,
Bark hordari‑Sharifabad M, Sker rett V . Association between ethical leader ‑
ship, ethical climat e and organizational citizenship behavior fr om nurses’
perspective: a descriptive correlational study . BMC Nurs. 2020;19(15):1–8.
88. Homburg C, Pflesser C. A multiple ‑layer model of market‑or iented organi ‑
zational culture: measurement issues and performance outcomes. J Mark
Res. 2000;37(4):449–62.
89. Casida JJ, P into‑Zipp G. Leadership– organizational culture r elationship in
nursing units of acute care hospitals . Nurs Econ. 2008;26(1):7–15.
90. Har tnell CA, Ou A Y , K inicki A. Organizational culture and organizational
effectiveness: a meta‑analytic inv estigation of the competing val ‑
ues framework ’ s theoretical suppositions. American P sychol Assoc.
2011;96(4):677–94.
91. Scott T , Mannion R, Davies H, Marshall M. The quantitative measur ement of
organizational culture in health car e: a review of the available instruments.
Health Ser v Res. 2003;38(3):923–45.
92. Hogan SJ, Coot e L V . Organizational culture , innovation, and per formance: a
test of Schein ’ s model. J Bus Res. 2014;67(8):1609–21.
93. Chhabra NL, Sharma S. Employer branding: strat egy for impro ving employer
attractiveness. Int J Organ Anal. 2014;22(1):48‑60.
94. O’Reilly C, Chatman J. Culture as social contr ol: corporations, cults, and com ‑
mitment. Res Organ Behav . 1996;18:157–200.
95. Slåtten T , Lien G, Svensson G. The value of cultivating norms for market orien ‑
tation in prof essional ser vice firms. Int J Qual S er v Sci. 2018;10(3):316–30.
96. Jensen RS, Øistad BS. D et kjønnsdelte arbeidsmarkedet på vir ksomhetsnivå.
In: The gender‑segr egated labour market at the wor kplace level. Oslo:
F afo‑rappor t; 2019.
97. Janssen O. Job demands, per ceptions of effort‑reward fairness and innova ‑
tive work behaviour . J Occup Organ Psy chol. 2000;73(3):287–302.
98. Ringle CM, W ende S, Beck er J‑M. Smar tPLS 3; 2015. Available fr om: https://
www. smart pls. com/
99. Zhao X, Lynch JG Jr , Chen Q . Reconsidering baron and Kenny : myths and
truths about mediation analysis. J Consum Res . 2010;37(2):197–206.
100. Hair JF , Sarstedt M, Ringle CM, Gudergan SP . Advanced issues in partial least
squares structural equation modeling. L ondon: SAGE; 2018.
101. Hair JF , Hult GTM, R ingle C, Sarstedt M. A primer on par tial least squares
structural equation modeling (PLS‑SEM). 2nd ed. London: SA GE; 2017.
102. Hair JF , Hult GTM, R ingle CM, Sarstedt M. A primer on par tial least squares
structural equation modeling (PLS‑SEM). 3rd ed: Sage publications; 2021.
103. Hair JF , R isher JJ, Sarstedt M, Ringle CM. When to use and how to report the
results of PLS‑SEM. Eur Bus Rev . 2019;31(1):2–24.
104. Carlucci D , Schiuma G. Organizational climate as per formance driver:
health care workers’ perception in a large hospital . J Health Manag.
2014;16(4):583–94.
105. Mutonyi BR. Employ ees’ psychological capital and innovative beha vior in
higher education. Int J Qual Ser v S ci. 2021;13(2):198–215.
106. W enger E. Communities of practice: learning, meaning, and identity . New
Y ork : Cambridge University Pr ess; 1999.
107. Carlucci D , Mura M, Schiuma G. Fost ering employees’ innovative
work behavior in healthcare or ganizations. Int J I nnov Manag.
2020;24(02):2050014–1‑28.
108. D eci EL, Eghrari H, P atrick BC, Leone DR. F acilitating internalization: the self‑
determination theor y perspective. J P ers. 1994;62(1):119–42.
109. G agné M. The role of autonomy support and autonomy orientation in proso ‑
cial behavior engagement. Motiv Emot. 2003;27(3):199–223.
110. Gagne M, Koestner R, Zuckerman M. F acilitating acceptance of organiza ‑
tional change: the impor tance of self‑determination 1. J Appl S oc P sychol.
2000;30(9):1843–52.
111. Williams GG, Gagné M, Ryan RM, Deci EL. F acilitating autonomous motiva ‑
tion for smoking cessation. Health Psychol . 2002;21(1):40.
112. Slemp GR, Kern ML, Patrick K J, Ryan RM. Leader autonomy support in the
work place: a meta‑analytic review . M otiv Emot. 2018;42(5):706–24.
113. Koeslag‑K reunen M, Van den Bossche P , Hov en M, Van der Klink M, Gijselaers
W . When leadership po wers team learning: a meta‑analysis. Small Group
Res. 2018;49(4):475–513.
114. Staw BM, Sandelands LE, Dutton JE. Threat rigidity effects in organizational
behavior: a multilevel analysis. Adm Sci Q . 1981;26(4):501–24.
115. Har vey J‑F , Leblanc P ‑M, Cronin MA. Beyond separate emer gence: a systems
view of team learning climate. F ront Psychol . 2019;10.
116. Har vey J‑F , Cohendet P , Simon L, Dubois L ‑E. Another cog in the machine:
designing communities of practice in prof essional bureaucracies. Eur
Manag J. 2013;31(1):27–40.
117. Cameron KS, Quinn RE. Diag nosing and changing organizational culture:
based on the competing values framework: W iley ; 2011.
118. Wenger E, McDermott RA, Snyder W . Cultivating communities of practice: a
guide to managing knowledge. Boston: Harvard Business Pr ess; 2002.
119. Make E J, Slåtten T . How can entrepreneurial orientation be promoted in
ser vice firms and what are the potential eff ects? An empir ical study of
frontline employ ees. Int J Multidiscip Bus S ci. 2020;6(9):13–22.
120. Barney JB. Organizational cultur e: can it be a source of sustained competitive
advantage? Acad Manag Rev . 1986;11(3):656–65.
Publisher’ s Note
Springer Nature remains neutral with r egard to jurisdictional claims in pub‑
lished maps and institutional affiliations.