Healthcare is considered a value that is particularly important from the point of view of an individual, but also in a wider context, as a category of social good that is important for the development of societies and economic well-being. Healthcare organizations and their employees play a special role in meeting health needs. These organizations must provide high-quality services that are accessible to patients who need them and be competitive at the same time. Managing these organizations is particularly difficult, because achieving organizational goals economically and efficiently should simultaneously meet the changing needs of patients.
Therefore, one of the desirable features of modern healthcare organizations is organizational agility and the implementation of innovations. Organizational agility is a necessary skill that enables companies to quickly react to changes in the operating environment that appear on the market [1]. Organizational agility makes it easier for organizations to respond to environmental changes [2] and, at the same time, may constitute a potential for innovative processes and activities. The implementation of innovative solutions is becoming an inevitable trend in improving the quality of services provided and improving medical productivity [3]. As a result of innovations in the nursing field work of nurses, it is currently possible to improve efficiency and introduce new solutions. The source of innovative processes in healthcare organization is primarily employees [4,5]. Nurses that provide up to 80% of primary health care [6] and their managers are a special group of people, whose behavior and abilities can influence the creation and implementation of healthcare innovations. The research conducted so far highlights the role of innovative behaviors of nurses [7,8] in the innovation process. Moreover, they emphasize the essence of an innovation-friendly organizational climate, to which employees are willing to transform their creative ideas into innovative products [9]. Job satisfaction is of particular importance in motivating nurses and their managers to undertake innovative activities. Knowledge, experience, and teamwork of healthcare professionals are catalysts to develop the necessary innovative solutions for many global health problems, while also serving as a source of job satisfaction in the healthcare industry.
Expectation States Theory (EST) is not only considered one of the interactive theories relating to cooperative activities and job satisfaction in social groups, but also used as a framework to develop an understanding of the relationship between organizational agility and the innovation process in healthcare organizations [10,11]. The main assumption of this theory is that actors/employees are in a task relationship with each other, and based on the available information, their expectations are formulated about the actions of others in relation to specific tasks [12]. In line with the EST, nurses trust in managers, regarding organizational agility in responding to changes, as well as the implementation of future innovative tasks, perfectly fits into the dynamics of such relationships.
Due to the enormous benefits of implementing innovations in this critical sector, the area of healthcare innovation is a subject of much research. However, there is a lack of sufficient studies that assessed the relationship between organizational agility and the innovation process in healthcare organizations. Thus, the current study aims to examine the relationship between organizational agility and the innovation process in healthcare organizations and mediating role of job satisfaction in this relationship.
Organizational agility and innovation process
Organizational efficiency is defined as the company's ability to react quickly to both expected and unexpected changes occurring in its internal and external business environment. The organizational agility model for business developed by Sharifi & Zhang [1, 13] has four main elements: i) responsiveness, ii) flexibility, iii) quickness, and iv) competency. These are used to determine whether the company is organizationally agile or not.
Various initiatives to achieve continuous transformation and agility in healthcare industry have led to changes at many levels of healthcare organizations, including structure, leadership skills and interpersonal relationships of co-workers carrying out such agile mission [14]. This allows organizational agility to provide the framework necessary for the innovation process. Putting agility in the foreground of innovation supports not only the ability to respond quickly and flexibly to changes in the business environment, but also the ability to proactively generate change, whether technology or customer driven [15]. Research conducted in other industries indicates that organizational agility increases the efficiency of radical innovations both in a specific situation and in an environment with technological turbulence [16]. Therefore, we hypothesized that
H1: There is a positive relationship between nursing managers' perceptions of organizational agility and innovation process.
Organizational agility and job satisfaction
Agility suggests to managing an organization creates the conditions / climate necessary to create innovation. These include openness to new ideas, technologies and solutions resulting from the market needs or the interests of the organization. The innovative climate has a positive impact on job satisfaction [17]. The motivators of job satisfaction include relations with colleagues and leaders and the nurse's work environment [18,19]. Formulating by managers and nurse’s expectations regarding actions to improve the implementation of various processes based on new information will increase job satisfaction. Therefore, we hypothesized that
H2: There is a positive relationship between organizational agility and job satisfaction of managers of nurses in healthcare institutions.
Job satisfaction and innovation process
Studies to date show that job satisfaction is a key indicator of well-being and mental health in the workplace [20, 21]. Satisfaction with work affects commitment, achieving better results and creativity [17]. Moreover, job satisfaction positively influences individual innovative behavior of employees [22, 23]. Due to the fact that the innovative climate stimulates initiative behavior [20] and encourages to be active, promotes innovation, we hypothesized
H3: There is a positive relationship between job satisfaction of nurse’s managers and innovation process in healthcare institutions
Job satisfaction, organizational agility and innovation process in healthcare organization
The literature emphasizes that nurses are of fundamental importance for high-quality in healthcare [24], as well as for the implementation of new innovative solutions and practices [6,7]. Nursing managers, on the other hand, are the frontline leaders who manage wards and influence the staff's ability to deliver quality care [25,26]. Research emphasizes the role of employees in creating innovation [27], because it turns out that most innovations are created inside the organization by employees. Thus, it is so important to learn about the factors supporting employees in being innovative. Work satisfaction is the determination of creativity [28] and openness to change [29]. Moreover, job satisfaction, with reference to the immediate superior and the workplace, can greatly influence employees' engagement in innovation [30]. Formulating specific expectations regarding tasks by nursing managers, depending on the changing conditions of functioning, increases, in accordance with EST, job satisfaction. Furthermore, the basis for a safe and stable work environment can be organizational agility [31]. Accordingly, we hypothesized
H4: Job satisfaction of nursing managers has mediating role between organizational agility and innovation process in healthcare institutions.
The hypothesis model is presented in Figure 1.