Fostering Exploration and Exploitation among Hospital Wards: the role of Social Capital and Environmental Dynamism

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Nov 7, 2013 (4 years and 1 day ago)

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Fostering
Exploration and Exploitation

among Hospital Wards
:
the role of
Social Capital and Environmental Dynamism



AUTHORS


Matteo Mura
1
,
Giovanni Radaelli
2
*
,
Emanuele Lettieri
2
,
Nicola Spiller

2
, Mariolina
Longo
1



(
1
)
University of Bologna

Department
of Management

Via
Terracini, 28

40131 Bologna
, Italy


(
2
) Politecnico di Milano

Department of Management, Economics and Industrial Engineering

Via Lambruschini, 4/B

20156 Milan, Italy


* Contacting author

Mail:
giovanni.radaelli@polimi.it
;


Keywords:

Social Capital, Exploration, Exploitation, Environmental Dynamism, Healthcare


1.
Introduction

In a context of escalating expectations of quality improvement
s

and cost reduction, the innovation of
current
operations

is a
major

concern for both
hospital
managers and
healthcare
practitioners. Continuous improvement
of operations can be best achieved through
the
combination of

knowledge

exploitation

and knowledge
exploration

(Menor, Tatikonda and Sampson, 200
2; Brenner and Tushman, 2003;
O’Reilly and Tushman, 2008
;
Martini, Laugen, Gastaldi, Corso, 2013)
, since healthcare organizations are knowledge
-
intensive
.
Knowledge
exploitation, in particular, refers to hospitals’ capability
to recombine internal
knowledge assets into new ideas
and solutions
, while k
nowledge exploration refers to
the capability to
acquire and use external
knowledge
from
other organizations
.


Several studies have recently
questioned
the view that exploration and exploitation stand i
n a mutual trade
-
off, providing instead empirical evidence of the possibility to pursue
both capabilities

(
Birkinshaw and Gibson,
2004;
Rais
c
h et al., 2009)
.

Past
research

has
accordingly looked forward possible
antecedents
that could affect
both
explorati
on and exploitation (Fang

et al.
, 2010)
.
This
evidence has thus far mostly addressed
: (i)
environmental

factors such as exogenous shocks, competitive intensity and external dynamism;

(ii)
organi
z
ational

factors such as absorptive capacity, structure, cultu
re
,

and size;

and

(iii)

managerial

factors such
as risk aversion, past experience and ICT
(
Raisch and Birkinshaw, 2008
;
Mom et al., 2009
; Raisch et al., 2009;
Lavie et al., 2010).
Drawing upon these contributions, recent reviews ha
ve

indeed suggested that

the field
still

reveals
two relevant

empirical gaps
, i.e.

(i) having contrasting evidence on the role
played by

these factors
in
simultaneously
achiev
ing

both exploration and exploitation
and (ii) having
overlooked a whole set of
factors
that
could be pot
entially relevant for the
desired outcome.

In the present study, we
seek to
address the
latter gap,
investigat
ing

the role of Social Capital
on
an
organization’s
ability to exploit existing knowledge as well as exploring new knowledge
.

Social Capital
descr
ibes how an organization is connected with others in terms of density, strength and similarity of ties
(Nahapiet and Ghoshal, 1998)
.
Properties of

social capital exert a relevant
impact
on

organizations


innovation
capabilities (
Nahapiet and Ghoshal
, 1998; Landry, Amara, Lamari, 2002;
Maurer

et al.
, 2011)

and
, in particular,
on the capacity to access and use external knowledge

for innovation purpose


i.e. knowledge exploration
(e.g.
Yli
-
Renko, Autio and Sapienza, 2001; Tsai, 2001; Anand, Glick and M
anz, 2002). N
o
study

has however linked
social
capital
with both
exploitation

and
exploration
.

An exception is represented by
Kang and Snell’s (200
9
)
concep
t
u
al model which, however, suggested that exploration and exploitation
are
affected by two distinct
typologies of social capital architectures


i.e. entrepreneurial and cooperative
.
Moving from a different
perspective on Social Capital than Kang and Snell’s (200
9
), our
study empirically tests the
hypothesis that
structural, relational and cognitive dime
nsions
of
social capital are able to positively affect both
knowledge
exploration and exploitation
.


Our theoretical framework also takes into account
the
impact and
moderation of environmental dynamism.
Past research indicates
in fact
that organizations’
capacity to explore and exploit their knowledge

is not
indifferent to the context in which they are embedded (
Raisch et al., 2009; Lavie et al., 2010
).
O
rganizations
actively perceive the stability or turbulence of their environment and move accordingly by

providing stronger or
weaker stimuli to knowledge exploitation and exploration.
T
he nature and extent of this stimulus remains
however
ambiguous, since a few studies have
indicated that

knowledge exploitation has more

chances
to occur
in stable environments,
and knowledge exploration in
turbulent
ones

(Hannan and Freeman, 1984; Sidhu et al.,
2004)
,
while
others have also shown how
environmental turbulence
could
undermine

exploration efforts (Kim
and Ree, 2009; Levinthal and Posen, 2009)
.

Our study seeks to provide further evidence on the role of
environmental dynamism by investigating its
direct and
moderating
role on

knowledge exploration/exploitation.

Differently from most exploration/exploitation studies, our work investigates the lin
k in the context of
healthcare organizations


and, more precisely,
the
hospital

ward

represents our unit of analysis
. Hospital
s

are
in
fact
knowledge
-
intensive organizations whose

continuous improvements depend

extensively on the capacity to
exploit
the
e
xpert knowledge
produced by its
clinicians
as well as
to explore knowledge opportunities that are
produced in other hospitals, research
cent
r
e
s and professional communities

(
Djellal and Gallouj, 2005;
Kennedy
and Fiss, 2009
; Martini et al., 2013
)
.
Hospital
s are professional contexts whose knowledge is not only located at
the bottom, but also protected by clinicians to maintain their autonomy (
Abbott, 1988; Freidson, 1988
). As such,
hospitals have proven
to be
less affected by
organizational structure and ma
nagerial control, and more by
individual decision
-
making (Ferlie et al., 2005) and by the nature of the social network which professionals,
wards and organizations had developed over time (Addicott et al, 2006; Mascia and Cicchetti, 2011)
. Hospitals
thus r
epresent exemplary context
s

to appreciate the role of social capital for knowledg
e exploration and
exploitation, and will also provide the opportunity to
transfer results on environmental dynamism
.


2.
Research Framework

Our conceptual model is presented in

Figure 1 (control variables are not displayed).



Figure
1
: Conceptual model


Our model will test a direct relationship between
social capital and knowledge exploration and exploitati
o
n
.
Specifically,
we will distinguish
three

di
mensions of social capital
(Nahapiet and Ghoshal, 1998; Tsai and
Ghoshal, 1998)
: the “structural capital” which illustrates how the network of acquaintances is configured (e.g.
number of ties, network density)
;
the “
relational

capital” which, instead, desc
ribes th
e strength of ties (e.g. trust)
and, the “cognitive capital” which describes
the
mutual understanding between individuals that is achieved
through shared codes, language and narratives
.
Furthermore, the model will test the moderation operated by
en
vironmental dynamism on each link. Henceforth, we will briefly outline the hypotheses supporting the
conceptual model

2.1 Direct impact of
social capital

on
knowledge exploration


Social capital
represents

the aggregate of resources embedded within,
available through and derived from
the network of relationships possessed by an organization
” (Inkpen and Tsang, 2005, p. 151).

Each dimension of social capital describes a property that characterizes the relationship of an organization
with others.
Struc
tural social capital indicates to which extent an organization is connected with many other
organizations. An organization with higher structural social capital than other
s

might have stronger opportunity
for knowledge exploration because it has access to
a wider range of information and “stimuli” in the network of
acquaintances

(
Nahapiet and Ghoshal, 1998;
Yli
-
Renko et al.,

2001
)
. Differently, relational social capital
indicates to which extent an organization has strong relationships with other organizati
ons
-

in terms, for
instance, of reciprocal trust. An organization with higher relational social capital than others might
then
have
stronger possibility for knowledge exploration because the strength of the tie allows having access to external
knowledge m
ore rapidly and more effectively (
Nahapiet and Ghoshal, 1998
; Inkpen and Tsang, 2005
). Cognitive
social capital provides a further support for knowledge exploration. It indicates, in fact, to which extent
the

organization has

consonant


goals, ‘visions’ a
nd norm with
the others. Knowledge produced in ‘consonant’

realities can be easier and more relevant to acquire and translate in the new context


because it has been
produced
for similar purposes and with similar perspective (
Nahapiet and Ghoshal, 1998
)
.

As such,
it can be
expected that an organization with higher cognitive social capital might have a stronger capacity for knowledge
exploration. Consistently with these ideas, we propose that social capital can positively affect knowledge
exploration becaus
e it provides a combination of
stimuli

and facilitation in the acquisition and use of knowledge

from external sources
:

Hp 1:
Social capital is positiv
ely related to knowledge explor
ation
.

Hp 1(a):
Structural

Social capital is positively related to
knowledge explo
r
ation
.

Hp 1(b):
Relational

Social capital is positively related to knowledge explo
r
ation
.

Hp 1(c):
Cognitive

Social capital is positively related to knowledge explo
r
ation
.

2.
2

Direct impact of
social capital

on
knowledge exploitation

In the

present study, we also propose that s
ocial capital affect
s

organizations’
opportunities and possibility to
exploit internal knowledge.
As observed earlier, professional organizations can engage in k
nowledge
explo
it
ation
if they are able to mobilize expert

knowledge that resides
at the bottom. Such knowledge is typically
protected from external (e.g. managerial) sight by professionals
in order to
preserve
their
autonomy
. As such, the
possibility
to explo
it

internal knowledge does not depend primarily on a m
anagerial possibility to control
behaviors at the bottom
, but rather
on a capacity to engage professionals in sharing their expert knowledge with
the community for a common purpose (Hansen et al., 2000; Radaelli et al., 2011)
.
Past research provides in fac
t
different suggestions that organizations in tight networks of acquaintances are exposed to social influences and
stimuli that translate in superior learning performances (
Powell et al., 1996; McEvily and Marcus, 2005;
Boschma and ter Wal, 2007
).
Beyond
the notion that these learning mechanisms support the exploitation of
external knowledge (Yli
-
Renko et al., 2001)


we also propose the notion that organization use them to exploit
their own, internal, knowledge. Two reasons can be advanced. First, access
to a

dense and tight
network
exposes
organizations to
different and
alternative uses of knowledge assets
they possess


different purposes that can
be
endorsed and ‘translated’ for innovation purposes (
Perry
-
Smith and Shalley, 2005)
. Second,
the experience
s of
close and strong ties might help organizations to have a better understanding of relevant knowledge that has
remained ‘hidden’ at the bottom of the organization


for different reasons. We
propose
that these two reasons
can coalesce in an overarching
hypothesis suggesting that close, tight and consonant ties with other realities
might help organizations to spot relevant (and, maybe, underappreciated) knowledge that has remained ‘hidden’
and translate it into new uses. As such, we propose the following
hypotheses.


Hp
2
:
Social capital is positively related to knowledge exploitation
.

Hp 2(a):
Structural

Social capital is positively related to knowledge exploitation
.

Hp 2(b):
Relational

Social capital is positively related to knowledge exploitation
.

Hp 2(
c):
Cognitive

Social capital is positively related to knowledge exploitation
.


2.
3

The
r
ole of environmental dynamism on exploration and exploitation

Organizations’ possibility and propensity for knowledge exploration and exploitation is affected by the
env
ironment in which they are embedded. As we observed earlier, environmental dynamism has been already
investigated as a predictor of knowledge exploration and exploitation


prompting
however conflicting findings.

On
the
one hand,
past research suggests that dynamic environments represent a
strong

condition for
change
.
Stable environments, in fact, might legitimate the establishment and persistence of
routines
, while e
nvironmental
changes
push instead
organization into searching for

new knowledge both outside and inside

(Becker, 2004;
Sidhu et al., 2004)


i.e. pursuing both exploration and exploitation to advance its processes and products.

This
appears especially true in
service
organizations such as hospitals which have a
(
righteo
us
)

tendency to preserve
,
rather than challenge,

the practice


since
the continuity of care is a key antecedent for hospital effectiveness and
safety (
Bloom, 1988
)
.
As such, in conditions of environmental stability, hospitals have shown limited propensity

toward


and, often, active resistance against
-

practice change (
Kellogg et al., 2006; Kellogg, 2010
). In this
scenario, e
nvironmental stimul
i

were able to challenge the status quo, and
provide a
much needed stimulus
to
search and implement new ideas
bot
h outside
and inside
the organization
.
Past research has indeed dedicated
most attention
to
the role of environmental dynamism as a trigger for knowledge exploration
and observed
that
organizations
need to ‘
look somewhere else


when

they have to generate r
adically
new ideas and knowledge
(
Ahuja, 2000; McEvily and Marcus, 2005; Yli
-
Renko et al., 2001
).
Posen and Levinthal (2012) balance
d

this
view suggesting that organizations
, in times of environmental turbulence,
rely primarily on knowledge
exploitation. The authors indicated in fact
that there is also “
the possibility that the reward to generating new
knowledge may itself be eroded if

change is an on
-
going property of the environment. This observation in turn
sugg
ests that environmental change

is not a self
-
evident call for strategies of greater exploration. Indeed, under
some conditions the appropriate

response to environmental change is a renewed focus on exploiting existing
knowledge and opportunities
” (p. 587).


Drawing upon this evidence, the following two hypotheses can be advanced:

Hp
3
:
Environmental dynamism
is positively related to knowledge explo
r
ation
.

Hp
4
:
Environmental dynamism
is positively related to knowledge exploitation
.


The previous quote from
Posen and Levinthal (2012)
hints to a possibly
negative
effect
of environmental
dynamism
on
the link between social capital and exploration/exploitation efforts.
Th
is

work

is
indeed
one
in a
line of
recent studies that
recogniz
e downsizes of
turbulent
environments

in terms of reliance on external
networks to access

knowledge
.
It has been argued, in fact, that turbulent environments might
soften the
role of
external
influences
because others’ experience appear
s

outdated
,
problematic
or unreliable
(Kim an
d Ree, 2009;
Levinthal and Posen, 2009)
.
T
his does not mean that organizations stop relying on exploration for continuous
improvement in turbulent environments
,
but rather that
the strength, density and consonance of the social ties
become less significant

for
knowledge exploration and exploitation. For instance, cognitive assonance
might
become

less
conducive of collaboration

in turbulent environments

because
organizations’
goals, missions and
norms are
evolving and under
question

as the
organization
is
search
ing for

new stability
. As a whole,
the
hypotheses are as follow:

Hp
5
:
Environmental dynamism negatively moderates the link between social capital and
knowledge explo
r
ation
.


Hp
5(a)
:
Environmental dynamism negatively moderates the link between
Struct
ural Social
capital and
knowledge explo
r
ation
.

Hp
5(b)
:
Environmental dynamism negatively moderates the link between
Relational Social
capital and
knowledge explo
r
ation
.

Hp
5(c)
:
Environmental dynamism negatively moderates the link between
Cognitive Social

capital and
knowledge explo
r
ation
.


Hp
6
:
Environmental dynamism negatively moderates the link between social capital and
knowledge
exploitation
.

Hp
6(a)
:
Environmental dynamism negatively moderates the link between
Structural Social
capital and
knowledge

explo
it
ation
.

Hp
6(b)
:
Environmental dynamism negatively moderates the link between
Relational Social
capital and
knowledge explo
it
ation
.

Hp
6(c)
:
Environmental dynamism negatively moderates the link between
Cognitive Social
capital and
knowledge explo
it
ation
.


3.
Method

3.1
Sample

We tested

the proposed hypotheses
by
collect
ing

survey data on hospital wards belonging to large public
sector Italian hospitals.

As we observed earlier, h
ospitals represent a rewarding context for studying the
link
between soc
ial capital and knowledge exploration/exploitation. Hospitals are in fact professional organizations
characterized by
expert knowledge that resides at and is protected by front
-
line employees


i.e. professionals
(
Abbott, 1988; Freidson, 1988
).
Innovation
in hospital context typically occurs
through processes of

knowledge
accumulation
and recombination that involve the coordination of different
professional expertise



with an
increasing reliance on teamwork and network to achieve multi
-
disciplinarity
.
Therefore, social ties within and
outside the organization
play a critical role in enhancing the performance of healthcare organizations

and, in
particular, innovation and knowledge management (
Greenhalgh et al., 2004
)
.

Also,
hospital
s are
embedded in a de
manding environment that calls for a constant update of

products and
delivery systems in (possibly conflicting) terms of higher quality and lower costs, higher medical specialization
and lower clinical variance (
Frist, 2005
).
As such, hospitals also repres
ent an appropriate context to appreciate
the impact of environmental dynamism



and, even, turbulence


on the rate of knowledge exploration and
exploitation, as well as on the role of social capital.

We chose
hospital
ward
s

as unit of analysis
for

at lea
st t
wo

reasons.
First, hospital wards are

the reference
unit
for

know
ledge accumulation and creation. Since most practice is managed within wards, in fact,
most
innovations
also
occur at

and depend on

this level
as they require the coordination of their ph
ysicians and nurses
around a common clinical or operational problem. Second
, hospital ward
s

are

relatively autonomous
entities
in
terms of decision making and resources allocation (e.g. both physical and financial resources), and
thus

its
behaviors
can be
compared to
those of an
organization.
Accordingly, we believe that
our
ward
-
related
findings
can
be extended to other organizational context outsi
de the healthcare system.




3.2
Data collection

We surveyed
hospital wards by administering a
structured
questionnaire

to the
head physician
of the ward
.
Therefore, based on previous studies, we gathered information on hospital ward by directly asking to the
head
physician
of the ward, considered as an informed actor that could provide relevant information on

the overall
ward. The questionnaire was sent by email to
857 ward
’s head physicians
belonging to large public sector
hospital located in the
n
orthern part of Italy.
The final dataset consists of 174
usable observations
, collected from
February to October
2012
, for a
20,4
% response rate
.


A copy of the questionnaire was delivered to each respondent.

The survey consisted o
f

multiple item Likert
-
type scales on knowledge exploration, knowledge exploitation
, social capital and environmental dynamism
.

All
constructs were measured using multiple
-
item scales that were adapted from previous related studies. To
enhance our understanding of the context in
which the constructs were being investigated we conducted a series
of face
-
to
-
face with personnel from o
ne of the
organizations

involved. This allowed us to adjust and refine the
wording of our questions.
We pilot tested our model on a
small

hospital of about 250 beds and 35 wards located
in the northern part of Italy.
The final questionnaire included
6
scal
es, for a total of
24
items measured on a 7
-
point Likert scale anchored at 1 (I totally disagree) and 7 (I totally agree). We also included
control variables
,
namely:

type of ward and number


of physicians.
.

Scales for each construct were derived from exta
nt literature
, with minor
modifications
introduced

to adapt
measures to
our context

of

investigation
.
Specifically, we measured
knowledge exploration

in terms of
acquisition of new knowledge
, and we adapted the measurement scale from
Jansen et al. (2005)
. We measured
knowledge exploitation
, instead, in terms of
the
transformation and application of existing knowledge
, and we
adapted the measurement scale from
Jansen et al. (2005)
.
With regard to
social capital
, we measured (i) the
structural dimension

in
terms of
density

and frequency of in
-
work social interactions,
adapting the measurement
scale from
Kang et al., (2007)
; (ii) the relational

dimension

in terms of
mutual trust and strength of the
relationships

adapting the measurement scale from
Kang et al
., (2007)
; (iii) the cognitive

dimension

in terms of
common narratives and language,

adapting the measurement scale from
Kang et al., (2007)
. Finally, we
measured
environmental dynamism

in terms of
the extent to which
frequent changes occurred within the l
ast 5
years in terms of technology, provided services and market regulations,

adapting the measurement scale from
Volberda and Van Bruggen, 1997



3.3
Data analysis

Collected data were analyzed using Seemingly Unrelated Regression techniques.
Prior to the
testing of the
focal hypotheses, a set of

CFA analyses were conducted, and indicate
d

adequate
psychometric properties of
model constructs.
D
iscriminant
validity of all factors
was

assessed by performing a number of chi
-
square tests

contrasting the hypothes
ized measurement model with models where, in turn, each interconstruct correlation was
constrained to be equal to 1
;
additionally, all constructs were inspected for relevant cross
-
loading and AVEs
were calculated for each factor to assess convergent validi
ty. Finally, a
ll scales display
ed

Composite reliabilities
above the 0.7 threshold.
Table 1 describes the
zero
-
order
correlations
and the measurement statistics
among the
model constructs.



Table 1. Correlations among model constructs




01

02

03

04

05

06

01.Exploration

0.94






02.

E
xploitation

0
.
71

0.93





03.

C
ognitive

SC

0
.
52

0
.
56

0.77




04.

R
elational

SC

0
.
52

0
.
58

0
.
59

0.88



05.
S
tructural

SC

0
.
42

0
.
51

0
.
42

0
.
58

0.88


06. Dynamism

0.30

0.38

0.19

0.16

0.18

0.89

Note: On the diagonal Composite reliability coefficients

4
.
Results

Table 4 shows the
results from two regressions, i.e. one
with knowledge exploration as dependent variable
and the other with knowledge exploitation
.
The control variables used in this study d
id

not show significant
relations, and are therefore not reported.


Table 2. Regression Analysis results

Dependent Variab
le:
Exploitation


Dependent Variable:
Exploration


01.Structural SC (SSC)

.18*

01.Structural SC (SSC)

.20**

02.Relational SC (RSC)

.37***

02.Relational SC (RSC)

.33***

03. Cognitive SC (CSC)

.11*

03. Cognitive SC (CSC)

.16*

04. Dynamisms (DIN)

.25***

04. Dynamisms (DIN)

.24***

04.SSCxDIN

-
.07

04.SSCxDIN

-
.09*

05. RSCxDIN

.02

05. RSCxDIN

.15*

06. CSCxDIN

.05

06. CSCxDIN

-
.08

R
2
=0.41

R
2
=0.43

Note: * p<.05; **p<.01;***p<.001


With regard to knowledge exploration, our r
esults
indicate that Hypothesis 1 is fully supported. Each
dimension of social capital, in fact,
positively and significantly affects knowledge
exploration. Relational Social
Capital, in particular, emerged as the most relevant antecedent of knowledge exploration

(β = 0.
33
, p < 0.0
01)
vis
-
à
-
vis Structural Social Capital
(β = 0.
20
, p < 0.0
1) and Cognitive Social Capital
(β = 0.
16
, p < 0.0
5).
The
results also indicate that Hypothesis 3 is fully supported since environmental dynamism
positively and
significantly affe
cts knowledge
exploration
(β = 0.
24
, p < 0.0
01). Hypothesis 5 is instead only partially
supported. Only Hypothesis 5(a) is in fact supported, with environmental dynamics negatively moderating the
link between structural social capital and knowledge explora
tion
(β =
-
0.
09
, p < 0.0
5). Hypothesis 5(b) is not
supported. Contrary to our expectations, environmental dynamics positively moderates the link between
relational social capital and knowledge exploration. Finally, Hypothesis 5(c) is not supported. Contrar
y to our
expectations, environmental dynamics does not moderate the link between cognitive social capital and
knowledge exploration.

With regard to knowledge explo
ita
tion, our r
esults
indicate that Hypothesis
2

is fully supported. Each
dimension of social
capital, in fact,
positively and significantly affects knowledge
exploration.
Similarly to the
case of knowledge exploration,
Relational Social Capital emerged as the most relevant antecedent of knowledge
explo
it
ation
(β = 0.
37
, p < 0.0
01) vis
-
à
-
vis Struct
ural Social Capital
(β = 0.
18
, p < 0.0
5
) and Cognitive Social
Capital
(β = 0.
11
, p < 0.0
5). The results also indicate that Hypothesis
4

is fully supported since environmental
dynamism
positively and significantly affects knowledge
explo
it
ation
(β = 0.
2
5
, p

< 0.0
01).
Finally,
Hypothesis
6

is
not supported, since environmental dynamism does not support any link

between social capital and

knowledge exploitation. Contrary to our expectations, in fact, tests of
Hypothes
e
s
6
(a)
, 6(b) and 6(c) were not
statistical
ly significant (
p
>

0.0
5).

5.
Discussion

The
study
highlights four main results
:

(i) social capital


in all its dimensions


is a positive and significant
antecedent of both exploration and exploitation efforts; (ii) environmental dynamism is a positive
and significant
antecedent of both exploration and exploitation efforts; (iii) the strength of the link between social capital and
knowledge exploration is affected by environmental dynamism


specifically, dynamic (or turbulent)
environments increase the
role of relational capital and debase the role of structural capital; (iv) environmental
dynamism does not affect the link between social capital and knowledge exploitation.

With regard to the role of social capital
,
the results
provide empirical evidence

that all three dimensions exert
a positive and significant on both
knowledge exploration and exploitation.
O
ur results indicate that having a
dense network (i.e. strong structural capital) of close ties (i.e. strong relational capital) populated with memb
ers
that share common vision and goals (i.e. strong cognitive capital) represents a condition for
effectively push
exploration.
Dense and strong ties, in fact, provide wards with the opportunity to access a wider network of
acquaintances as well as the possibility to identify and use external knowledge.
Likewise, all three dimensions of
social capital have a positive impact on know
ledge exploitation


which is consistent with the notion that the
wards are exposed to others’ experiences and stimuli and might learn from them to recognize relevant
knowledge assets and recombine them into new assets.

With regard to environmental dynamis
m
, the results
provide a composite role on its role on
exploration and
exploitation. As we observed earlier,
previous studies provide
conflicting evidence on whether turbulent
environment were supportive of exploration and/or exploitation.
Our study
addres
sed this issue in the context of
healthcare organizations and
the results indicate that both
knowledge exploration and exploitation increased with
environmental dynamism. This evidence is consistent with the notion that, in a situation of environmental
sta
bility, wards might not be stimulate to engage in knowledge exploration and exploitation because of a natural
tendency to preserve the routine. Conversely, turbulent environments


which might be higher pressures to
improve care effectiveness or sustainabi
lity


provide an appropriate stimulus to engage in exploration or
exploitation efforts. At the same time, it is worth noticing how environmental dynamism has a relevant
moderation effect on the
relationship

between social capital and exploration. The resu
lts indicate that, in a
context of turbulent environment, wards are less affected by the density of their network and more by the
strength of the tie. This suggests that, in turbulent environments, wards become more selective when they access
external know
ledge, as they tend to
focus
on
fewer, but stronger,

ties


arguably because strong ties allow for
more durable and reliable relationships.
Notably no significant moderation emerged with knowledge
exploitation.
This result
indicates that the social influen
ces of dense and strong ties are perceived as relevant for
knowledge exploitation, regardless of the overarching environment dynamism. This is consistent with the notion
that social networks provide opportunities for knowledge use and recombination that wa
rds decide to endorse in
any environmental condition because


unlike exploration


it deals with knowledge that the ward already own
and does not involve any external exposure, or relational investment or risk.


6.
Conclusions

This research adds to our un
derstanding of the antecedents of exploitation and exploration by providing
evidence of the role played by the structural
,

relational
and cognitive
dimensions of social capital. These findings
add to a literature which has thus far concentrated on contextu
al factors (e.g. culture, organizational identity) and
on units’ properties (e.g. size, functions). Cohesive and strong ties emerge as highly instrumental for units in
gaining access to external knowledge assets and to stimuli to recombine the knowledge al
ready available within
the unit.

Furthermore, the results also
provide further evidence on
environmental dynamism


an antecedent which
has catalyzed conflicting results in the literature. Our results indicate that environmental dynamism
exerts a
direct positive impact on exploitation and exploration;
and represents a relevant moderator for knowledge
exploration
. In hospitals, these results
only partially support
the notion that environmental turbulence activates
increasing levels of atten
tion among professionals


as the moderation to exploitation is non
-
significant. It
appears, in fact, more appropriate to claim that higher level of environmental dynamism limit the natural
tendency to
preserve
existing
routine
s
.

In terms of practical
implication, we hope that our study

can
support hospital managers
or head physicians
(i.e. ward leaders)
in designing initiatives that
could
recognize the centrality of network ties


in terms of both
cohesiveness and strength


for strategies of continuou
s improvement. Social networks represent the locus in
which hospital units can identify and acquire knowledge from outside (supporting an explorative capability) as
well as the locus in which knowledge can be shared, recombined and turned into novel soluti
ons (supporting an
explorative capability). The findings primarily imply that managers should encourage initiatives that support
systematic connections among units and facilitate knowledge exchange


and diverse interventions can be put in
place, from syst
ematic plenary meetings to more sophisticated ones such as

boundary spanning


tools (e.g., ICT
solutions) and roles (e.g., knowledge brokers).

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