CAOS in Italian hospitals during COVID: an analysis of healthcare intangible resources
| DOI | https://doi.org/10.1108/JIC-12-2020-0365 |
| Published date | 09 June 2022 |
| Date | 09 June 2022 |
| Pages | 18-37 |
| Subject Matter | Information & knowledge management,Knowledge management,HR & organizational behaviour,Organizational structure/dynamics,Accounting & finance,Accounting/accountancy,Behavioural accounting |
| Author | Mauro Paoloni,Giorgia Mattei,Niccolò Paoloni,Giuseppe Modaffari |
CAOS in Italian hospitals during
COVID: an analysis of healthcare
intangible resources
Mauro Paoloni and Giorgia Mattei
Department of Business Studies, Roma Tre University, Roma, Italy
Niccol
o Paoloni
Department of Law, Roma Tre University, Roma, Italy, and
Giuseppe Modaffari
Department of Law and Economics of Production Activities,
Sapienza University of Rome, Rome, Italy
Abstract
Purpose –This paper aims to analyse the roles of relational capital (RC) and knowledge management (KM)
during the COVID-19 in Italian public and private hospitals, considering that intangible elements are essential
during periods of uncertainty.
Design/methodology/approach–Authors used a qualitative design in a case study on two Italian hospitals
that have different ownership structures, which are located in the epicentre of the pandemic in Lombardy. The
study was carried out using the CAOS (“caratteristiche personali”,“ambiente”,“organizzazione”and “start-up”)
model (Paoloni, 2021), which allows for comprehending and commenting on RC because of the connections
between typical factors that influence an organisation. The model also allows for discussion of the use of a
network and how it supports organisations.
Findings –Findings of the analysis showed that during the management of the COVID-19 health emergency,
ownership structure was not a discriminating factor, the created relationships were similar and they were
considered in the same way. The relationships were mainly formal (except for contributions by associations or
individuals) and temporary. The RC’s reactive role in overcoming crises was confirmed, and the findings
indicated that this result was possible also, thanks to the KM’s role played within the organisation.
Originality/value –Theoretical implications of the work are that it contributes to the sparse healthcare
literature on intellectual capital (IC) and on RC and its relationships with KM. The practical implications are
related to the creation of new relationships during the healthcare emergency between hospitals and the central
government, which can be considered a useful lesson for the future. The theoretical implications derived from
the analysis are generalisable to all organisations regardless of their type and location, as well as the practical
implications are applicable to the entire national territory.
Keywords Intellectual capital, Pandemic, Crisis, Public ownership, Private ownership
Paper type Research paper
1. Introduction
In Italy, the national healthcare service offers universal access to locally based healthcare,
where local authorities are responsible for the organisation and delivery of health services.
This leaves the Italian government with a weak strategic leadership in this sector (Armocida
JIC
23,7
18
© Mauro Paoloni, Giorgia Mattei, Niccol
o Paoloni and Giuseppe Modaffari. Published by Emerald
Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0)
licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both
commercial and non-commercial purposes), subject to full attribution to the original publication and
authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/
legalcode
The analysis of the cases was done using the publicly available online information of the considered
hospitals. The authors would like to thank the reviewers for their comments and suggestions during the
review process because they enabled to refine the research.
The current issue and full text archive of this journal is available on Emerald Insight at:
https://www.emerald.com/insight/1469-1930.htm
Received 2 December 2020
Revised 14 June 2021
19 October 2021
22 December 2021
12 January 2022
Accepted 18 January 2022
Journal of Intellectual Capital
Vol. 23 No. 7, 2022
pp. 18-37
Emerald Publishing Limited
1469-1930
DOI 10.1108/JIC-12-2020-0365
et al., 2020). In this Country, hospitals are public, private, for-profit and private non-profit.
All hospitals usually compete with others for the provision of services, directly or indirectly.
However, all are considered relevant players (Hansmann, 1980).
As in other countries, the healthcare sector continues to be at the centre of significant
changes and challenges (Pereira de Souza et al., 2021), especially from the 2020, where
healthcare sector was tested by the Covid-19 pandemic, which has created a global public
health emergency to which governments have been called to respond. During this emergency,
the lack of coordination is a problem (McDonald and Larson, 2020) nonetheless, the local
governments (LG) were left to respond independently. In Italy, the coronavirus outbreak in
the north, especially in Lombardy, which was identified as the epicentre of the pandemic, has
overwhelmed the public health system.
Regarding the need to cope with this type of event, scholars claim that the intangible
elements in organisations have strategic importance (Jia et al., 2019;Prasad et al., 2015).
In this panorama, the IC elements, such as human capital (HC), structural capital (SC)
and relational capital (RC) (MERITUM, 2002), become very important. These components
are essential for enhancing knowledge in organisations and allow them to become resilient
(Johnson et al., 2013). Previous studies assert that there is a close correlation between IC
elements and Knowledge Management (KM) (Kianto et al., 2014), which are both capable of
improving organisational efficiency through relational skills and external networking
(Kianto et al., 2014;Buenechea-Elberdin et al., 2018). Although the topic of IC has received a
lot of attention in the literature during the last 20 years, few previous studies have focussed
on the connection between IC components and KM (Buenechea-Elberdin et al., 2018). This
gap in research may have been because of the novelty of the topic, which has been
foregrounded in the context of the current pandemic. Therefore, this work aims to add ress
the following research question:
RQ1. What roles have RC and (KM) played in hospitals during the pandemic?
A multiple case study was used to answer the research question, where two hospitals located
in Milan (Lombardy, Italy), one private hospital and one public, were analysed. This study
wasdoneusedtheCAOS(anItalianacronymcaratteristiche personali,ambiente,
organizzazione and start-up) model (Paoloni, 2021); a qualitative approach developed
within the strategic management studies (Mason, 1939;Bain, 1968), that is useful to explore
the type and intensity of relationships (RC).
The findings reveal several implications. Firstly, the work contributes to the literature on
intangible assets by revealing that RC and KM are critical for health sector resilience during a
pandemic. RC is a considerable factor in reactive resilience, and KM thanks to its capacity to
manage the internal resource in an efficient manner, plays an important role in surviving
harsh periods. There are also some practical implications that are connected with the created
relationship between hospitals and the central government during the pandemic. In fact, as
the effects could be extended to the entire national territory, it is possible to assert that the
national management of the healthcare sector is preferable and the results generalisable.
Hospitals of different sizes and locations, even in peripheral areas, could benefit from this
relationship.
This paper is structured as follows. In section 2, the most interesting previous studies are
reviewed. This part also helped the authors to lay the foundation for the study. Section 3
describes the methodological protocol as well as the case selection process and the CAOS
interpretative model variables. In section 4, the results of the analysis of the relationships are
discussed. The final sections of the paper conclude the work, disclosing the limitations of the
study, recommending further research and highlighting theoretical and practical
implications.
CAOS in Italian
hospitals
during COVID
19
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