PurposeThis study examines the weighted technical efficiency and scale efficiency of Greek public general hospitals within the National Health System during the period 2019–2023, grouping hospitals by capacity size (small ≤ 200 beds, medium 201–400 beds, large ≥ 401 beds). The analysis investigates efficiency differentials across hospital size categories and the evolution of operational performance before and after the COVID-19 pandemic in a context of sustained fiscal pressure on public health systems. Design/methodology/approachEfficiency is assessed using Data Envelopment Analysis (DEA), applying Constant Returns to Scale (CRS) and Variable Returns to Scale (VRS) models. Indicators of technical efficiency, pure technical efficiency and scale efficiency (SE = CRS/VRS) are estimated using the MaxDEA Lite software. Weighted annual efficiency scores are calculated by hospital size group, enabling consistent intertemporal comparisons and a clearer interpretation of structural performance differences across hospital categories. FindingsThe results reveal variations in technical and scale efficiency across hospital size groups and differences in operational performance during the study period. Overall, efficiency shows a gradual post-pandemic improvement, indicating enhanced managerial adaptability and more effective resource utilisation, although structural differences between hospital size categories remain evident. Research limitations/implicationsThe study is subject to certain limitations. First, the analysis relies on administrative input–output data and does not incorporate indicators of quality of care, case severity, or clinical outcomes. Second, the results may be influenced by the exceptional conditions of the COVID-19 pandemic, which affected hospital operations and demand patterns. Third, spatial and demographic factors are not explicitly captured in the model, potentially affecting efficiency estimates. Future research could incorporate quality indicators, extend the analysis to other contexts, and apply complementary methodologies for a more comprehensive evaluation. Practical implicationsThe findings provide actionable insights for policymakers and hospital administrators by highlighting the need for differentiated strategies based on hospital size and scale efficiency. Large hospitals operating under decreasing returns to scale may benefit from service reorganization and improved internal coordination, while smaller and medium-sized hospitals require targeted investments in infrastructure and human resources. The results also support the adoption of performance monitoring systems, benchmarking practices, and digital health technologies to enhance efficiency, transparency, and long-term sustainability within the Greek public health system. Social implicationsThe findings highlight disparities in efficiency across hospital size groups, particularly affecting smaller and remote hospitals, which may affect equitable access to healthcare services. Strengthening these units through targeted support and collaborative arrangements can help reduce regional inequalities and improve service availability. Enhancing operational efficiency and resource allocation contributes to better quality of care and supports the long-term sustainability of the public health system. Originality/valueThe study provides empirical evidence on hospital efficiency in Greece and demonstrates the usefulness of weighted DEA for analysing heterogeneous hospital systems. The findings support targeted resource allocation, strengthened collaboration among hospital units and the development of benchmarking mechanisms to improve operational efficiency and long-term system sustainability.
Purpose This study examines how six knowledge management (KM) dimensions, namely creation, absorption, organization, storage, dissemination and application, relate to organizational creativity and innovation among managers in public primary healthcare. Design/methodology/approach A multi-wave cross-sectional survey was conducted among 95 managers across 20 public primary healthcare facilities between 2019 and 2022. Data were collected using structured measures of KM, creativity and innovation. Multiple regression, bootstrap confidence intervals, multicollinearity diagnostics and supplementary mediation analyses were used to examine associations. Recruitment-year differences and potential common-method bias were also assessed. Findings Knowledge absorption, dissemination and application showed positive associations with creativity and innovation. Knowledge creation was positively associated with innovation in bivariate analysis but showed a negative adjusted coefficient when the KM dimensions were entered simultaneously, suggesting sensitivity to shared variance among correlated predictors. After accounting for knowledge application, the direct association between knowledge creation and innovation was no longer statistically significant. Creativity and innovation were highly correlated (r = 0.907), indicating substantial construct overlap that may also reflect the organizational context. Research limitations/implications The study is limited by its modest sample size, multi-year data collection, individual-level self-reported measures and potential common method and selection biases. Recruitment spanned pre-COVID-19, COVID-19 and post-COVID-19 periods, and facility-level clustering was not modeled. The high correlation between creativity and innovation also raises concerns about discriminant validity. The findings should therefore be interpreted as associations rather than causal effects. Despite these limitations, the results indicate that knowledge application and absorption may be important areas for managerial attention in resource-constrained public primary healthcare settings and provide directions for future multilevel and longitudinal research. Practical implications The findings suggest that healthcare managers should place greater emphasis on mechanisms that enable relevant knowledge to be absorbed, shared and translated into routine practice. Structured knowledge-sharing routines, peer learning, interdisciplinary collaboration, documentation of effective practices, continuing professional development and integration of lessons into managerial procedures may support these processes. In resource-constrained settings, strengthening the use of existing organizational knowledge may be more feasible than relying primarily on additional financial or technological resources. Healthcare leaders and policymakers may consider incorporating these mechanisms into managerial development and organizational-learning initiatives, while recognizing that the present findings reflect associations rather than demonstrated causal effects. Social implications Effective knowledge management may contribute to stronger organizational capacity for creativity and innovation in public primary healthcare, with potential implications for the quality and responsiveness of healthcare services. Strengthening mechanisms for knowledge sharing, learning and application may help healthcare organizations make better use of existing knowledge and experience, particularly where financial and technological resources are limited. Such improvements may support managers and healthcare teams in responding to changing service needs and developing locally appropriate solutions. However, because this study identifies associations rather than causal effects, these potential social benefits should be considered as areas for further investigation rather than established outcomes. Originality/value The study contributes evidence from a resource-constrained public primary healthcare setting by jointly examining 6 KM dimensions against both creativity and innovation. The findings suggest that knowledge application and related processes may be particularly important for translating knowledge into organizational outcomes, while highlighting the need for larger multilevel and longitudinal studies.
Purpose Drawing on service-dominant logic (SDL) and value co-creation literature, this study examines the association between patient influencers' E-WOM quality (E-WOMQ) and parasocial relationships (PSR) in online healthcare communities (OHCs). It examines whether PSR are associated with patients' participation in value co-creation (PVCC) across four dimensions during the healthcare journey, and whether PSR mediate the E-WOMQ–PVCC association. The study also examines online community experience (OCE) as a moderator of the E-WOMQ–PSR association. Design/methodology/approach A cross-sectional survey was conducted among members of OHCs in Bangladesh between July 2024 and September 2024, yielding 609 useable responses. This study employed PLS-SEM in SmartPLS 4.0 to test the proposed hypotheses. Findings E-WOMQ is positively associated with PSR. PSR is positively associated with information seeking, information sharing, personal interaction and responsible behaviour, and significantly mediates the associations between E-WOMQ and all four PVCC dimensions. OCE does not significantly moderate the E-WOMQ–PSR association. Originality/value This study extends SDL by specifying an informational-to-relational pathway in OHCs, linking the perceived quality of patient-influencer's healthcare information with relational evaluations and multidimensional patient value co-creation. The findings offer practical guidance for healthcare organizations, OHC managers and patient influencers on communicating relevant, helpful and transparent healthcare information while supporting constructive patient participation during the healthcare journey.
Purpose This study examines the relationship between work overload and emotional exhaustion among nurses. Specifically, the study investigates the serial mediating effect of job stress and depression on the relationship between work overload and emotional exhaustion. Design/methodology/approach Data were gathered between October 2025 and January 2026 through an online and face-to-face cross-sectional survey of 613 nurses working in two state hospitals in Türkiye. Sequential mediating effects were analyzed using the Statistical Package for the Social Sciences PROCESS macro (Model 6). Findings The findings showed that work overload is positively related to emotional exhaustion. Furthermore, the results revealed that job stress and depression sequentially mediate the relationship between work overload and emotional exhaustion. Originality/value This research offers a clearer understanding of the potential psychological mechanisms underlying the relationship between work overload and emotional exhaustion among nurses. It also extends the literature by informing the development of interventions aimed at alleviating job stress and reducing depression levels among nurses in the healthcare sector. In particular, primary caregivers and hospital administrations responsible for nurses should develop work overload-conscious, stress-reducing, and mental health-supporting methods to improve nurse well-being and enhance the quality and safety of patient care.
Purpose This study seeks to identify and compare factors associated with nurses' work stress, mental stress and job happiness in civilian versus military teaching hospitals in Ghana. Workplace stress is the negative physical and emotional responses that arise when employees face mismatches between job demands and their level of control over meeting those demands. Mental stress stems from individuals' perceptions of events in their internal/external environment, leading to feelings of distress and anxiety. Job happiness is the satisfaction and enjoyment from work. Design/methodology/approach A quantitative, cross-sectional design was employed. Data were collected from 200 nurses using a structured questionnaire and analyzed via factor analysis. Findings Nurses in both settings reported work stress stemming from job pace and mental demands. Key differences emerged: military nurses appeared more affected by expectations of success and task-related frustration, while civilian nurses' satisfaction appeared to be more influenced by the work climate. For military nurses, the nature of the job itself appears to strongly relate to satisfaction. Research limitations/implications The study provides insight into how military hospital nurses face higher stress due to strict command structures, while civilian hospital nurses encounter more physical demands due to handling a higher volume of patients. It also highlights how nurses' job satisfaction is affected by their relationships with supervisors and co-workers, as well as opportunities for their advancement, both in military and civil hospital settings. Practical implications The findings reveal that military nurses face stress from rigid command structures, whereas civilian nurses observe physical strain from higher patient loads. For both groups, relationships with supervisors and peers, alongside career advancement opportunities, appeared crucial for job satisfaction. Hospital leadership can use these insights to tailor supportive interventions, address specific stressors and foster work environments where nurses can thrive in high-pressure acute care settings. Originality/value The research provides novel insights into the distinct and shared factors affecting the well-being of nurses in Ghana's military and civilian teaching hospitals.
