Organizing Hospital Wards for Continuous Innovation: Determinants of Exploration, Exploitation and Ambidexterity

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ORGANIZING HOSPITAL WARDS FOR CONTINUOUS INNOVATION:
DETERMINANTS OF EXPLORATION, EXPLOITATION AND AMBIDEXTERITY
Luca Gastaldia*, Emanuela Fogliab, Emanuele Lettieria,
Emanuele Porazzib, Lucrezia Ferrariob, Marta Salia, Antonella Maffia
a Politecnico di Milano, Italy
b Carlo Cattaneo – LIUC University, Italy
*
Corresponding author: luca.gastaldi@polimi.it
ABSTRACT
This paper deepens the determinants of exploration, exploitation and ambidex-
terity within the Italian hospital wards. Data were collected from 80 head cli-
nicians by means of an ad hoc questionnaire developed in accordance with ex-
isting scales. Results show that opening leadership, organisational creativity
and environmental dynamism are antecedents of exploration while exploita-
tion is well explained by closing leadership and organisational creativity.
Since ambidexterity was defined as the sum of exploration and exploitation, it
emerged that both opening and closing leadership as well as organisational
creativity were required to achieve ambidextrous behaviour within the
healthcare setting.
Keywords: Healthcare, Exploration, Exploitation, Ambidexterity, Innovation.
1. INTRODUCTION
Hospitals worldwide are experimenting new organizational designs aimed at improving
their capability to manage the tension between high-quality and safe delivery of care
and cost containment (Gilmartin and D’Aunno, 2007). The complexity of attaining this
twofold goal lies in the contradiction between the efforts underlining the two objectives.
While improving quality and safety would require “exploration” efforts, cost contain-
ment would require “exploitation” efforts (Gastaldi and Corso, 2012).
These efforts compete for the same resources (Holmqvist, 2004) in an environment
whose attitude is preserving the status quo (Søresen and Stuart, 2000). This peculiar
context emphasises the tensions between exploratory and exploitatory behaviours
(Lavie et al., 2010). The combined effect of these forces tends to open up the gap be-
tween exploratory and exploitatory activities, acting as two opposing attractors between
which an effective balance arises only if persistent and on-going efforts are put in place
(Martini et al., 2013). Research on continuous innovation focuses on how it is possible
to maintain this unstable and paradoxical balance during time (Martini et al., 2012),
leading to what have been called ambidextrous organisations (Turner et al., 2013).
2. RESEARCH OBJECTIVES AND HYPOTHESES
Despite the fundamental role of exploration and exploitation in healthcare (Gastaldi and
Corso, 2012), very little is known about: (i) quantitative indicators useful for their
measurement in this field; (ii) ambidextrous activities in the clinical practice; and (iii)
the relative constructs.

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From this viewpoint, hospital wards represent the best unit of analysis for at least four
reasons: (i) specific internal dynamics; (ii) attitude to research and innovation activities;
(iii) autonomy in the decision-making and resources allocation processes, and (iv) need
of a high level of coordination among different professionals to be efficient.
Coherently to these premises, the study addressed the following research questions:
• What should a ward improve to acquire new knowledge (exploration)?
• What should a ward improve to be more efficient (exploitation)?
• Which drivers a ward should have to achieve ambidextrous behaviours?
The analysis of the above mentioned research questions is related to the investigation of
different skills, and their relation with exploration, exploitation and ambidexterity, in
particular: (i) opening and closing leadership, (ii) perceived organizational support, (iii)
organizational creativity and (iv) environmental dynamism. The four skills will be
deepened in the next sub-paragraphs.
2.1 OPENING AND CLOSING LEADERSHIP
Leadership has been defined as “a process of social influence in which a person can en-
list the aid and support of others in the accomplishment of a common task” (Chemers,
1997). Ambidextrous leadership is defined as “the ability to foster both explorative and
exploitative behaviours in followers, by increasing or reducing variance in their behav-
iour and flexibly switching between those behaviours” (Rosing et al., 2011). A good
balance between exploration and exploitation is a necessary but not sufficient factor: the
integration of exploration and exploitation, and the ability to switch between the two, as
the situation requires, is the determinant of success.
The role of leadership could be distinguished in two factors (Rosing et al, 2011):
• Opening leader behaviour: which includes encouraging doing things differently and
experimenting, giving room for independent thinking and acting, and supporting at-
tempts to challenge established approaches.
• Closing leader behaviour: which includes taking corrective action, setting specific
guidelines, and monitoring goal achievement.
In the healthcare sector, it should be noted that typical behaviours are: i) the clinicians’
resistance to reinforce the work autonomy not accepting the role of the leader, ii) the
lack of support for those individuals undertaking the leadership role (Ham, 2003). A
Hospital ward, in order to be well managed, needs the coexistence of both opening and
closing leadership, to gain exploration and exploitation mechanisms.
According to this, the following hypothesis were displayed:
• H1.A: opening leadership has a positive impact on exploration.
• H1.B: closing leadership has a positive impact on exploitation.
• H1.C: both opening and closing leadership have a positive impact on ambidexterity.
2.2 PERCEIVED ORGANIZATIONAL SUPPORT
Perceived organizational support (POS) is considered an organizational warranty: it is
helpful in case of stressful situations and to effectively execute jobs activities (Eisen-
berger et al., 2001). In healthcare, there is still limited empirical support on POS theo-
ries, but organizational conditions and social support are predictors of job satisfaction

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(Sumathi et al., 2013) or intention to leave the work place (Acker, 2004), and could be
different considering clinicians age, role, work experiences (Sumathi et al., 2014), and
public or private provenance.
With regard to POS, the following hypothesis are defined:
• H2.A: POS has a positive impact on exploration.
• H2.B: POS has a positive impact on exploitation.
• H2.C: POS has a positive impact on ambidexterity.
2.3 ORGANIZATIONAL CREATIVITY
The organizational creativity could be considered as the capability to develop novel and
potentially useful ideas (Woodman et al., 1993). In the healthcare field, the desire to
suggest new and creative solutions is often linked with high risks and unknown effects.
Therefore, it is necessary a good trade-off among clinicians’ requirements, quality of
care, the need of constant learning, and innovation (Strating et al., 2010).
The social control in the healthcare sector could affect attitudes and behaviours related
to innovation, because of the poor tolerance to adverse events and mistakes. The con-
cept of error could be more disputed, due to safety reasons, than in other sectors, and
this factor could contribute to reduce the level of creativity (Strating et al., 2010).
The following hypothesis were formulated concerning creativity:
• H3.A: organizational creativity has a positive impact on exploration.
• H3.B: organizational creativity has a positive impact on exploitation.
• H3.C: organizational creativity has a positive impact on ambidexterity.
2.4 ENVIRONMENTAL DYNAMISM
Environmental dynamism is defined as the degree of change and level of unbalance in
the external context (Dess and Beard, 1984). Environmental dynamism present different
impacts on exploratory and exploitative innovations, thereby on ambidexterity (Lewin
et al., 1999). In the healthcare field, the concept of environmental dynamism as predic-
tor of innovation is particularly effective. Literature demonstrates that exploration and
exploitation have a positive relationship with environmental dynamism, since turbu-
lence and pressures towards the improvements of cares should stimulate innovation
(Mura et al., 2014). In a stabile context, instead, hospital wards should not be encour-
aged to pursue exploration or exploitation due to the natural trend in perceiving existing
routines.
Thus, the following hypotheses were proposed:
• H4.A: environmental dynamism has a positive impact on exploration.
• H4.B: environmental dynamism has a positive impact on exploitation.
• H4.C: environmental dynamism has a positive impact on ambidexterity.
Environmental dynamism could be conceived also as moderator of exploration and ex-
ploitation. In accordance to that, this variable could behave as moderator of the above
described independent variables (opening/closing leadership, POS and organisational
creativity). Turbulent context could mitigate the effect on outcomes because other expe-
riences appear to be more problematic or unreliable. Hospital wards could become more
precise in selecting external knowledge to acquire, focusing on the strength of the rela-
tion to foster long-term relationship (Mura et al., 2014).

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According to that, the following hypotheses were developed, considering all the three
frameworks analyzed:
• H5.A; H5.B; H5.C: environmental dynamism acts as moderator on the relationship be-
tween closing/opening leadership and the dependent variables.
• H6.A; H6.B; H6.C: environmental dynamism acts as moderator on the relationship be-
tween POS and the dependent variables.
• H7.A; H7.B; H7.C: environmental dynamism acts as moderator on the relationship be-
tween organizational creativity and the dependent variables.
2.5 SYNTHESIS OF THE RESEARCH FRAMEWORK
A synthesis of the research frameworks developed is proposed in Figure 1, 2 and 3.
Figure 1: Conceptual framework for exploration
Figure 2: Conceptual framework for exploration
Opening
leadership
POS
Organizational
creativity
Exploration
Environmental
dynamism
Closing
leadership
POS
Organizational
creativity
Exploitation
Environmental
dynamism
Closing
leadership
POS
Organizational
creativity
Ambidexterity
Opening
leadership
Environmental
dynamism
(A)
(B)
(C)
H1.A
H2.A
H3.A
H7.A H6.A H5.A H4.A
H1.B
H2.B
H3.B
H7.B H6.B H5.B H4.B
H1.C
H1.C
H2.C
H3.C
H7.C
H5.C
H4.C
H6.C
H5.C
Opening
leadership
POS
Organizational
creativity
Exploration
Environmental
dynamism
Closing
leadership
POS
Organizational
creativity
Exploitation
Environmental
dynamism
Closing
leadership
POS
Organizational
creativity
Ambidexterity
Opening
leadership
Environmental
dynamism
(A)
(B)
(C)
H1.A
H2.A
H3.A
H7.A H6.A H5.A H4.A
H1.B
H2.B
H3.B
H7.B H6.B H5.B H4.B
H1.C
H1.C
H2.C
H3.C
H7.C
H5.C
H4.C
H6.C
H5.C

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Figure 3: Conceptual framework for ambidexterity
3. RESEARCH METHODOLOGY
A study design, consisting of three distinct logical phases, was constructed as follows.
3.1 ADAPTATION OF EXISTING SCALES TO THE HEALTHCARE DOMAIN
A questionnaire was developed and administered in Italian language in order to avoid compre-
hension issues. All the scales useful to test the hypotheses related to the above mentioned varia-
bles, have been selected because of their validation in previous literature of the industrial sector
(Rosing et al., 2011; Eisenberg et al. 1986; Zhou and George, 2001; Volberda and Van Bruggen
1997, Jansen et al., 2005). In this view, it emerged that the main objective of the first research
phase was to create survey items that adequately represented the constructs of interest in a lan-
guage that respondents could understand, by keeping questions simple and specific.
An Exploratory Factor Analysis (EFA) was first carried out to establish if changes introduced in
the adaptation process for healthcare sector affected the structure of the scales, thus proving the
validity of each construct in order to establish their internal consistency. In particular, all the
items presenting a factor loading higher than 0.3 were included in the definition of the variables,
because of the maximisation of the variance of each construct along one dimension, thus most
clearly representing the content domain of the underlying construct.
Furthermore, to assure their reliability, the assessment of Cronbach’s alpha was applied, in or-
der to investigate how well the items measured the same constructs (Price and Mueller, 1986),
allowing the replicability of the scale within future research activities. As result, a value greater
than 0.7 (providing an indication of strong item covariance) was assumed to test items and cre-
ate the new variables (Nunnally, 1978), useful to verify the study hypotheses.
3.2 DATA COLLECTION
The sample of the study was composed by 80 head-physicians afferent to Italian hospital wards.
In October 2015, all the professionals involved in the study completed the self-reported ques-
tionnaire previously defined, using a specific online survey tool (Survey Monkey). The ano-
nymity of respondent was maintained, not requiring name and surname, because they would be
more honest concerning organization of reference.
Opening
leadership
POS
Organizational
creativity
Exploration
Environmental
dynamism
Closing
leadership
POS
Organizational
creativity
Exploitation
Environmental
dynamism
Closing
leadership
POS
Organizational
creativity
Ambidexterity
Opening
leadership
Environmental
dynamism
(A)
(B)
(C)
H1.A
H2.A
H3.A
H7.A H6.A H5.A H4.A
H1.B
H2.B
H3.B
H7.B H6.B H5.B H4.B
H1.C
H1.C
H2.C
H3.C
H7.C
H5.C
H4.C
H6.C
H5.C

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In particular, the questionnaire aimed at getting their insight concerning: i) influence of chief
ward towards innovation and efficiency; ii) hospital commitment; iii) trust within a working
team; iv) attitudes and behaviours in favour of innovation; v) degree of change and level of un-
balance in the external context; vi) wards exploratory and exploitatory behaviours, useful for the
definition of ambidexterity as the sum between exploration and exploitation (Lubatkin et al.,
2006; Cao et al., 2009).
Besides the above mentioned qualitative data concerning the professionals’ perceptions with re-
gard their ward, other quantitative information was gathered, such as i) number of projects
joined; ii) number of patents; iii) number of publications and iv) the related Impact Factor Index,
in relation to the activity of the hospital ward.
The quantitative data were collected considering a 36-month time horizon, in order to estimate a
good temporal proxy of ongoing innovation (He and Wong, 2004).
3.3 DATA ANALYSIS
Since the study involved only one representative per ward (in general the ward’s head clinician,
or subjects presenting comparable roles or managers of second level), the problem of Common-
Method Variance (CMV) was firstly considered.
One of the potential source for common method bias is related to the fact that a single respond-
ent answers the questions concerning both input variables and outcome (Podsakoff et al., 2003).
In this view, at first, the Harman’s single-factor test was conducted for the investigation of am-
bidexterity measures, in order to assure the validity of the sample, thus solving the CMV prob-
lem, verifying an acceptable level of bias (variance explained from the EFA is less than 50%).
In this view, all the investigated variables were loaded into an exploratory factor analysis
through an unrotated factor solution (Podsakoff et al., 2003).
Once the CMV problem was defined, qualitative and quantitative data derived from the ques-
tionnaire were analysed considering descriptive statistics, frequencies and distributions. The
principal statistical indicators as mean, standard deviation, skewness and kurtosis were comput-
ed in order to have a wide comprehension of the distribution of the variables, evaluating if some
of them should be discarded in case of abnormal behaviours.
Preliminary analyses were performed to ensure no violation of the assumptions of normality,
linearity and homoscedasticity. Furthermore, inferential analyses were conducted. In particular,
relationships between variables were investigated using the person product-moment correlation
coefficient to test the existence of small (from 0.10 to 0.29), medium (from 0.3 to 0.49) or large
(from 0.5 to 1) (Cohen, 1988) correlations among them.
A final investigation of the relationship among variables, using a hierarchical sequential linear
regression model (with enter methodology), was implemented to test the hypotheses, defining
the predictors of exploration, exploitation and ambidexterity.
4. FINDINGS
The present study involved 80 healthcare professionals, referring to different Italian hospital
wards, of which most part from Northern Italy (96%). The sample was composed predominately
by males (64%), with an average of 52.6 years (ranging from a minimum of 32 years and a
maximum of 65 years). Stratifying the target population by the professional role of the individ-
uals involved in the study, it emerged that 54% were head of physicians, followed by other hos-
pital managers of second level (34%) and clinicians having comparable functions (12%). Pro-
fessionals were affiliated to public (91%) and private (9%) hospitals, most of them without a de-
fined research orientation (82% versus 18%). With regard to the specific ward’s strategy, results
showed that 40% of the wards presented a clinical excellence, followed by profit maximisation
(33%) and technological orientation (27%).

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4.1 RELIABILITY OF THE VARIABLES
As previously described, it was necessary to test the reliability of the scales and the related con-
structs derived from literature evidence, using the Cronbach’s coefficient alpha, thus proving
the freedom of the scale from the random error. Detailed information are shown in Table 1. All
scales have been accepted since they presented a value of Cronbach’s alpha largely above 0.7.
Construct
N
Number of items in
the original scale
Number of
validated items
Explained
variance (%)
Cronbach’s
alpha
Opening Leadership
78
7
7
48.772
0.813
Closing Leadership
80
7
7
71.732
0.933
Organizational Support
80
8
8
78.763
0.961
Organizational Creativity
80
13
13
73.461
0.968
Environmental Dynamism
80
17
14
34.543
0.836
Exploration Qualitative
80
9
8
41.727
0.778
Exploitation Qualitative
80
12
12
45.746
0.884
Exploration
80
19
10
35.215
0.784
Exploitation
80
20
15
38.311
0.874
Table 1. Resume of variables
4.2 HYPOTHESES TESTING
Opening leadership, closing leadership, organizational support, organizational creativity and
environmental dynamism were deeply analysed as independent variables, in order to define their
positive or negative impact on the dependent variables. In this view, both the strength and the
linear relationship between variables were described. Table 2 reported a strong relationship (p <
0.01) between ambidexterity and both exploration and exploitation, demonstrating how well the
first variable is explained by the two constructs. Furthermore, on the one hand it emerged that
exploration is strongly influenced by opening leadership, organizational support, and organiza-
tional creativity. On the other hand, the same trend emerged considering exploitation, that is al-
so positively influenced by closing leadership and environmental dynamism.
Construct
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(1) Ambidexterity
1
(2) Exploration
.826**
1
(3) Exploitation
.826**
.397**
1
(4) Opening leadership
.465**
.475*
.353**
1
(5) Closing leadership
.295**
.022
.557**
.207
1
(6) POS
.403**
.373
.394**
.494**
.515**
1
(7) Org. creativity
.501**
.408
.402**
.121
–.010
.242*
1
(8) Env. dynamism
.278*
.210
.305**
.037
.196
.139
.226*
1
Significance levels: * p < 0.05; ** p < 0.001
Table 2. Correlations among variables
With regard to the independent variables, organisational support, opening/closing leadership
and organizational creativity are strictly related. A good correlation is reported between envi-
ronmental dynamism and organizational creativity, demonstrating that in case of increasing the
dynamism level, physicians are more stimulated to propose creative ideas.
After having tested the correlation among variables, a regression analysis was conducted to test
hypotheses, thus examining the Adjusted R2 in order to control the explanatory power of each
model (Tabachnick and Fidell, 2007).

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Dependent variables
Independent variables
Exploration
Exploitation
Ambidexterity
• Opening Leadership
0.375**
0.389***
• Closing Leadership
0.506***
0.288**
• Organisational support
0.128
-0.012
-0.029
• Organisational Creativity
0.270*
0.529***
0.499***
• Environmental dynamism
0.224Ψ
-0.014
0.094
Moderators
• Opening Leadership x Environmental Dynamism
0.001
—
0.052
• Closing Leadership x Environmental Dynamism
—
0.066
0.191
• Organizational Support x Environmental Dynamism
-0.010
0.067
-0.086
• Organisational Creativity x Environmental Dynamism
0.007
-0.132
-0.126
R2
0.426
0.546
0.616
Adjusted R2
0.318
0.463
0.529
F value
3.957***
6.614***
9.741***
Δ R2
0.000
0.016
0.020
F(ΔR2)
0.003
0.773
0.020
Significance levels: *** p < 0.001; ** p < 0.01; * p < 0.05; Ψ p < 0.1
Table 2: Hierarchical regression for dependent variables
With regard to exploration, results shown that open leadership (β = 0.375; p < 0.01), organisation-
al creativity (β = 0.270; p < 0.05) and environmental dynamism (β = 0.224; p < 0.1) are ante-
cedents of exploration (Adjusted R² = 0.318). Exploitation is well explained by close leadership
(β = 0.506; p < 0.001) and organisational creativity (β = 0.529; p < 0.001), thus reaching an Ad-
justed R2 equal to 0.463. It should be noted here that a negative effect emerged between organi-
zational support and exploitation (β = –0.012; p > 0.1). With regard to ambidexterity, it emerged
that both opening (β = 0.389; p < 0.001) and closing (β = 0.288; p < 0.01) leadership, as well as
organisational creativity (β = 0.499; p < 0.001) were required to achieve ambidextrous behav-
iours, thus mostly explaining the variance of the dependent variable (Adjusted R² = 0.529).
5. DISCUSSION
The results presented in the previous section aimed at showing the existence of possible deter-
minants and predictors of ambidexterity, representing an original contribution to the scientific
evidence available nowadays, and being something that literature has not yet completely inves-
tigated, within the specific healthcare setting.
Considering the analyzed variables, the following considerations emerged:
• Both opening and closing leadership have a positive effect on ambidexterity, since a good
head physician, to be innovative, should not only monitor and control the professionals, but
also promote ideas and risk-taking. This is consistent with previous literature, demonstrat-
ing that ambidextrous leadership explains the variation that lead different leadership styles
into innovation (Rosing et al., 2011).
• Despite literature (Eisenberg et al., 1990) reported that organizational support should affect
positively the support that an individual has by organization in pursuing innovation, at least
in the present study, it would not affect the three dependent variables. On the one hand, cli-
nicians prefer working autonomously and do not share own abilities creating a distance be-
tween the hospital direction and the ward dimension (Kumar, 2013). On the other hand,
hospitals are continuously facing a lack of financial funds and this does not incentive the
organizational support towards clinicians.
• The presence of organizational creativity positively affects all the dependent variables, due
to the fact that clinicians are source of innovative ideas and solutions: they understand the
complexity of healthcare sector, thus allowing professionals to spread successful practices
(Cohen 2014). The results demonstrated that creative ideas are a necessary condition for in-
novation, in terms of exploring new sectors as well as exploit better existing activities. In
this view, new ideas are not only important for acquiring new knowledge, but also for use
better this new information in the ward and sharing it among the working team.

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• Environmental dynamism does not act as moderator, thus identifying that medical structures
are more confident in maintaining an internal stability and to be more resilient to change
(Mura et al., 2014). The only exception emerged with regard to the positive relationship be-
tween exploration and environmental dynamism, demonstrating the fact that a turbulence
context could motivate clinicians in proposing new solutions and searching for innovation
outside the organization.
According to this, Figure 4, 5 and 6 analytically described the most significant results achieved
during the hypotheses’ testing process.
Figure 4: Exploration framework with verified hypotheses
Despite the relevance of the results, the proposed study presented some drawbacks.
First, differently from other studies (He and Wong, 2004; Lubatkin et al., 2006), the analysis
used exploration, exploitation and ambidexterity as dependent variables, without considering
whether and how ambidexterity could effectively affect performances within the healthcare set-
ting, presenting a static picture of the context analysed.
Figure 5: Exploitation framework with verified hypotheses
Opening
leadership
POS
Organizational
creativity
Exploration
Environmental
dynamism
Closing
leadership
POS
Organizational
creativity
Exploitation
Environmental
dynamism
Closing
leadership
POS
Organizational
creativity
Ambidexterity
Opening
leadership
Environmental
dynamism
(A)
(B)
(C)
β= .224*
Opening
leadership
POS
Organizational
creativity
Exploration
Environmental
dynamism
Closing
leadership
POS
Organizational
creativity
Exploitation
Environmental
dynamism
Closing
leadership
POS
Organizational
creativity
Ambidexterity
Opening
leadership
Environmental
dynamism
(A)
(B)
(C)
β= .224*

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Figure 6: Ambidexterity framework with verified hypotheses
Second, the small size of the sample would be considered one of the main limitation from a
methodological point of view, as well as the fact that information from only one respondent per
ward was collected. This limitation was therefore amply overcome by testing the common
method bias.
Third, collecting a large amount of qualitative and quantitative data could also represent a limi-
tation of the proposed framework: this may be solved with a greater involvement of the hospital
wards.
Moving on from these considerations, it could be an interesting topic for future research to col-
lect more than one respondent per ward, in order to understand how clinicians interact, examin-
ing how these dynamics could affect innovation.
6. CONCLUSION
The original contribution of this paper was to underline and investigate the incremental measure
of ambidexterity, providing healthcare professional with qualitative and quantitative indicators.
The study results suggest that the presence of a leader is strictly required for the achievement of
ambidextrous behaviour, even if one of the most difficult point to overcome in the healthcare
setting is the resistance to change (Kumar 2013) and the consequent block of the improvement.
Leaders should be open to experiment new ways of working and new ideas that come from their
followers. The leadership is strictly linked with the creativity topic. A good leader, who wants
to foster innovation, should motivate physicians toward the development of a creative, organiza-
tional and open mind.
Furthermore, clinicians should be supported by top management in order to foster innovation: in
this view, it emerged the need to incentive the communication between managerial and clinical
departments (Oborn et al., 2013), according to the core value of Clinical Governance principles
(Scally and Donaldson, 1996).
Besides, a relationship between suppliers and organizations, as well as organizations and pa-
tients should exist: pressure from stakeholder is becoming more and more demanding. An easier
access to data and information allows patients to facilitate dialogues with their doctors concern-
Opening
leadership
POS
Organizational
creativity
Exploration
Environmental
dynamism
Closing
leadership
POS
Organizational
creativity
Exploitation
Environmental
dynamism
Closing
leadership
POS
Organizational
creativity
Ambidexterity
Opening
leadership
Environmental
dynamism
(A)
(B)
(C)
β= .224*

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ing diagnosis and treatment options. Costs information helps consumers to understand the inter-
section of cost and quality, in evaluating their care options (Santilli and Vogenberg, 2015).
According to this, the results explain something that literature has not yet investigated, giving so-
lutions to hospital wards, thus paving the way to the determination an efficient leadership style
together with a creative and open mind, useful to foster innovation and to present ambidexterity.
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