Guest editorial Free

Intellectual capital (IC) is a crucial asset for healthcare companies. Indeed, they usually have access to large structured and unstructured elements of formal and informal know-how distributed across, for instance, knowledge of users that reside in databases or reports and/or embedded in the culture of organizations themselves (Pirozzi and Ferulano, 2016). Nowadays, information and communication technologies (ICTs) in healthcare, such as radio frequency identification (Anand and Fosso Wamba, 2013), Internet of things (IoT) (Papa et al., 2018) or big data analytics (Wang et al., 2018), may more than ever before enable healthcare organizations to deliver high quality services to their stakeholders as well as create new and more effective data-driven business models, increasing their performance (Fosso Wamba et al., 2017; Ferraris et al., 2018; Singh and El-Kassar, 2019; Schiavone et al., 2020). The rise of new technologies in healthcare generated different types of knowledge and pushed innovative business models. They are often applied by healthcare organizations in global markets to manage successfully the multiple stakeholders participating to such complex industry (e.g. physicians, policymakers, payers and patients) (Elton and O'Riordan, 2016).

As a consequence, recent studies attested the importance on the organizational aspects related to the management of innovation and IC in healthcare (Evans et al., 2015; Wang and Byrd, 2017) as well as related practices and tools to manage intra- and interorganizational knowledge (Del Giudice and Maggioni, 2014; Wang and Byrd, 2017), especially regarding the creation, sharing, storage and use of relevant knowledge resources (Mazzotta, 2018; Santoro et al., 2018) and design and effectiveness of smart medical wearables (Papa et al., 2018). Evans et al. (2015) conceptualized IC of healthcare organizations as a mix of intangible resources, coupled with the value derived from internal capabilities and external relationships. Other studies support managers' perspective in incorporating flexibility in decision-making (Dortland et al., 2014). Indeed, the consequence of health context restructuring saw the emergence of activity of decentralization and the splitting of decision-making power. Thus, in order to maximize the effectiveness of knowledge transfer strategies at the national, regional and local levels, healthcare organizations have to develop structures, activities and processes that allow the creation of a valid and convincing value proposition for all the stakeholders involved (Peng et al., 2007; Evans et al., 2015). Measuring and disclosing IC as well as comparing the value and the IC strategy in different time frames or with similar companies operating in the same sector allows providing the quantitative basis for more objective quantification of the useful indicators for an economic assessment purpose (Petty and Guthrie, 2000; Maditinos et al., 2011; Giacosa et al., 2017).

Drawing on these assumptions, and after our editorial work as guest editors, we can argue IC nowadays in healthcare is a research topic able to integrate and make closer many scientific domains and perspectives, as reported in Figure 1, such integrated reporting, disclosure, international management, digital transformation and data intelligence, value creation and sustainability, strategy and innovation.

This special issue comprises nine papers in addition to the current editorial. The first one is entitled “Knowledge and Intellectual Capital in Internationalizing SMEs, case Study in Technology-Based Health Companies”. Zakery et al. (2021) grounded their analysis in the health industry in an emerging country: the Iranian advanced medical equipment companies. Within this context, the authors merge existing literature about internationalization knowledge configuration and IC by improving our understanding of small and medium-sized enterprises (SMEs) internationalization from developing markets. The IC perspective is useful for analysing what knowledge assets SMEs need and what are the current or desired levels of these assets. By interviewing the CEOs of technology-based firms, the authors developed a framework for measuring IC in internationalization based on human, social and relational capital about (1) technical, (2) market and (3) internationalization knowledge. The main idea around this work is that for health companies, and especially the medical equipment sector, the identification, measurement and control of knowledge assets are vital for improving international outputs.

In “Social capital, knowledge sharing, work meaningfulness, and creativity: Evidence from the Pakistani pharmaceutical industry”, Bhatti et al. (2021) analyse the relationship between IC and knowledge management (KM) by explicitly focussing on the effect of social capital on knowledge sharing in the Pakistani pharmaceutical industry. Using a structural equation modelling (SEM) and Hayes method, the authors empirically test their hypothesis finding organizational social capital positively affects employees' willingness to share their knowledge with colleagues, which in turn has a positive effect on employee creativity. Interestingly, they also found that work meaningfulness positively moderates the aforementioned relationship. The paper contributes to the microfoundations of employee's creativity by providing evidence of another important focal and pivotal performance outcome of organizational social capital.

Gravili et al.'s (2021) contribution, “Value that matters: Intellectual Capital and Big Data to assess performance in healthcare. An empirical analysis of the European context”, investigates the effect of IC on the healthcare industry organizational performance while deepening our knowledge on the role of data analytics and big data in healthcare value creation. The paper proposes a data-driven innovative model that presents a new approach to IC assessment. It also highlights the existence of a positive mediator (the physical asset, i.e. the available beds in hospitals on total population) on the relationship between IC and performance. This shows the crucial role of IC in this sector as well as challenge the views of knowledge sharing deeply held inside organizations by creating “new value” developed through a more collaborative and permeated approach in terms of knowledge spillovers.

The paper “Managing intellectual capital in healthcare organizations. A conceptual proposal to promote innovation” has been developed by Leone et al. (2021), and it is a conceptual paper that explores how knowledge-based activities are designed and implemented to promote healthcare innovation and value creation. The authors proposed a framework based on three main axes that are connected to IC, that are: (1) the establishment of a value co-creation strategy to develop capabilities for each health stakeholder (human capital); (2) the development of a market access approach to promoting innovation, that is linked to the relational capital and (3) a digital “servitization strategy” that may be referred to the structural capital. The main contribution of the paper, i.e. the conceptualization, lies at the intersection between innovation diffusion and IC management literature.

Dameri et al.'s (2021) contribution, “Implementing Integrated Reporting to Disclose Intellectual Capital in Health Organisations: A case Study”, theoretically and practically shows how to implement the International Integrated Reporting Framework in an Italian non-profit healthcare organization. This is in line with a new trend in IC research that aims at highlighting value creation over time as well as supporting management policies and decisions. Here, the article sheds light on the role of IC and its disclosure as a value creation lever. Its main originality lies in the “adjusted reporting” that enables to specifically highlight what value or values a healthcare organization delivers (its outcomes), for whom (its stakeholders) and how (its specific business processes) within a business model effectively connecting them.

In “The contribution of intellectual capital to Financial stability in Indian pharmaceutical Companies”, Festa et al. (2021) investigates the top five pharmaceutical companies in India to underline the role of IC in facing financial stability and risk of bankruptcy. The sector is grown and becomes one of the most important in the world, thanks to both governments' actions and foreign direct investments. This study adopts an IC perspective, with specific reference to intellectual property (IP) and drug patents as the main proxy parameter. The authors found that Indian big pharmaceutical companies should redesign their business orientation towards IC, mainly when impacting patents. One of the most original results is that IC can support financial stability, and the authors suggest how to manage firms' financial structure, both statically and dynamically. Finally, the strongest evidence regarding IC in the pharmaceutical industry is the knowledge stock deriving from patents in the R&D portfolio that are the result of the efficient interaction between human and structural capital, although some contribution from relational capital may arise (e.g. collective intelligence in R&D).

The next article titled “Knowledge management practice of cloud medical logistics industry: transportation resource semantic discovery based on ontology modelling” is an original attempt to couple the IoT and artificial intelligence techniques in the KM innovation for the healthcare industry. In this paper, Zhou et al. (2021) used the ontology modelling approach for both transportation resources and task information modes, and they propose a medical transportation resource discovery mechanism. From the viewpoint of KM, the authors shed light on how to improve task-resource matching accuracy under a cloud scenario. This includes three main stages: (1) filtering reasoning, (2) QoS-based matching algorithm and (3) user preference ranking algorithm based on user context to satisfy the personalized demands of users.

The paper by Orlando et al. (2021), entitled “Open innovation and patenting activity in health care”, aims to explore the interplay between open innovation and IP. Differently from previous studies, the authors argue that open innovation fosters firms patenting activity. Data are drawn from the Eurostat statistics and refer to a large sample of European firms (NACE Rev.2). The findings confirm that open innovation fosters patenting activity in healthcare, also thanks to huge government expenditures in this market. The study focusses solely on European firms, and it adopts a traditional linear approach. So, it could be possible different dynamics may occur across European borders.

The ninth and last paper by Pflugfelder (2021) investigates how KM and IC can increase the organizational performance of ambulatory healthcare providers and how such performance can be assessed. A structured review of peer-reviewed English-speaking articles up to 31 December 2019 was conducted. A search of ACM Digital Library, Cochrane Library, (DARE), EBSCOHost, Medline, ProQuest, PubMed, ScienceDirect, Scopus and Web of Science produced 8,391. All studies that did not examine the impact of KM initiatives on organizational performance in an ambulatory healthcare provider setting were eliminated. The final sample of 31 studies was examined regarding the design of the KM initiatives as well as performance concepts and indicators. The review enables further research on the interplay of IC, KM and performance in ambulatory care and points to several research gaps. It provides managers with guidance for designing KM initiatives in their organizations.

Overall, we can underline at least three main fruitful future directions of IC studies in the healthcare industry: (1) how to change/adapt the management and organizational aspects in the light of coronavirus disease 2019 (COVID-19) crisis; (2) how to improve the effectiveness of IC disclosure and (3) how to manage and measure IC in the new forms of capitalism.

Regarding the first, organizations should develop new practices and managerial structures in order to embrace a digital culture with the aim to improve customer experience. This imply firstly to scan the external environment to draw the more suitable technologies (e.g. wearable, telehealth) to apply in each specific context and function (e.g. technologies that make healthcare more accessible and personal) and secondly, to effectively integrate them within the organization. With this regard, the development of a digital culture is crucial for delivering better customer experience and enabling positive changes. To do that, there is a need of new leaders and change agents to engage at the same time key managers in the information technology (IT) department to gain their buy-in, insights and internal support as well as all the employees in order to stimulate positive behaviours. Then, the key technology investments decisions should come with the consumer (and end user) in mind. In this regard, healthcare organizations should focus on “interoperability”, i.e. a system that not only aggregates important data but also communicates that information across the organization. Future studies should deeply focus on these aspects as well as on identifying which specific characteristics should change within the decision-making processes (saving them time and money) and organizational structure.

Regarding the second, in the lights of the digital transformation and the aforementioned changes in the healthcare management practices all the previous conceptual efforts developed in the direction of IC disclosure (e.g. Giacosa et al., 2017) should be revised or updated. This has been well emphasized in the Dameri et al.'s contribution (this issue) but some key questions remain uncovered in the digital health domain, such as which are the roles should cover each stakeholder in IC disclosure and the role of social capital and relational capital in both profit and non-profit organizations. Such research gaps about the IC disclosure by healthcare organizations offer promising opportunities for the development of new theoretical models, concepts and mechanisms “tailored” for the present digital business era.

Regarding the third, we do believe a very interesting area of investigation for IC researchers, also in the light of the recent business dynamics occurred in the healthcare sector, should be about the development of new theory for managing and maximising the value and impact of IC within the current technology-based paradigms of capitalism, such as the fourth industrial revolution (the so-called “Industry 4.0”) and the sharing economy. As shown in the articles by Gravili and co-workers (this issue) and Pflugfelder (this issue), digital technologies allow healthcare organizations to design and implement new and successful business models fitting with these new forms of capitalism. For instance, future research could explore how healthcare actors use their various IC assets to create and capture value within a digital platform based on the sharing economy principles.

Finally, in order to conclude the present editorial piece, we want to explicitly thank Professor Merrill Warkentin, Veronica Scuotto, all the authors and reviewers who supported us in this editorial effort.