Organizational culture and leadership style in Spanish Hospitals: Effects on knowledge management and efficiency.

Hospital culture and leadership style have attracted considerable attention in research, with compelling evidence indicating their potential competitive advantages, including their crucial role in ensuring the successful implementation of knowledge management and its impact on hospital efficiency. The aim of this paper is to identify the effects of organizational culture and leadership style on knowledge management and hospital efficiency. Fuzzy cognitive maps (FCMs) are relational models that can be used to represent the opinions and knowledge of expert to infer cause-effect relationships among different concepts. The use of FCMs as a simulation tool enables the evaluation of potential scenarios based on different organizational cultures and leadership styles in hospitals. Developing an FCM for this study involved several steps. Firstly, data were collected through interviews with 21 experts in hospital management. The interviews were conducted between May and September 2023 either face-to-face or via videoconference. Once individual cognitive maps had been created, consensus among them was achieved through a multicriteria decision-making process, wherein the expert opinions were averaged. The separate cognitive maps of each expert were then integrated to produce a single FCM using the augmented FCM approach. Reflecting expert insights from the FCM, hospitals with a hierarchy culture exhibit diminished levels of knowledge creation, management, and overall hospital efficiency, whereas those with an adhocracy culture show improvements in knowledge creation, knowledge exploitation, and overall hospital efficiency in comparison to alternative ones. From the experts' FCM perspective regarding leadership style, transformational leadership achieves the highest level of knowledge management and hospital efficiency in hospitals with an adhocracy culture. Finally, this paper offers a reference for practising knowledge management and improving hospital efficiency through adhocracy culture and transformational leadership.