Introduction Globalization and rapid technological

Globalization and rapid technological advancement have pressured healthcare

leaders to catalyze innovation for economic growth, profitability, and improved patient

outcomes. However, significant hurdles in diffusing, adapting, and leading innovation

efforts have challenged healthcare leaders (Currie & Spyridonidis, 2019; Machon et al.,

2019). Effective innovation leadership can drastically improve organizational quality,

productivity, and efficiency (Avby & Kjellström, 2019; Avby et al., 2019; Dalton et al.,

2021). To catalyze healthcare innovation, leaders must successfully shape an

entrepreneurial climate and orientation, develop effective innovation management

practices, foster innovative work behavior, and promote creative and collaborative

internal and external partnerships (Afsar & Umrani, 2019; Avby et al., 2019; Bagheri &

Akbari, 2018; Kremer et al., 2019; Leonidou et al., 2020; Machon et al., 2019).

Entrepreneurial leadership is more likely to foster innovative behaviors in employees than

other leadership styles (Newman et al., 2018), though it has not been extensively adopted

within business management practices (Leitch & Volery, 2017). Thus, the doctoral study

research topic was entrepreneurial leadership strategies that catalyze innovation

performance.

Background of the Problem

Healthcare organizations’ survival and competitive advantage may depend on

leaders’ innovation capacity. The global healthcare environment is challenged with aging

populations, disease prevalence, rising clinical costs, limited resources, rapidly evolving

and disruptive technologies, and economic pressures (Currie & Spyridonidis, 2019; Lee

et al., 2019; Lombardi et al., 2018; Pesut, 2019). Healthcare leaders and the environment

are typically risk averse, evidence based, and compliance oriented, contrasting with an

innovation culture that embodies risk-taking, rapid change, and experimentation (Machon

et al., 2019). With competing operational needs, limited resources, and employee

challenges, leaders often consider employees’ time on strategy and innovation as

nonproductive (Machon et al., 2019), thus diminishing the potential for innovation

(Renkema et al., 2021). Innovation is pivotal to improving healthcare globally and

amplifying medical progress, and it is a top priority for business leaders. Despite

historical innovative drug discoveries, expiring patents, increased competition from

generic manufacturers, rising research and development (R&D) costs, and targeted novel

therapies have impacted healthcare companies’ market share and profitability (Califf &

Slavitt, 2019). A leader’s ability to innovate and focus on shaping an innovative and

performance-oriented culture requires various leadership styles to facilitate innovation.

Business leaders can drive economic growth, profitability, and optimized patient

outcomes through entrepreneurial leadership and innovation management.

Leaders must abdicate traditional leadership and adopt modern-day

entrepreneurial leadership strategies to conquer healthcare innovation challenges.

Entrepreneurial leadership is a specialized approach to realizing superior organizational

performance, innovation, and change through entrepreneurial strategies and high levels of

creativity, vision, and motivation (Nguyen et al., 2021; Purwati et al., 2021; Rehman et

al., 2021; Ricci et al., 2022). However, Leitch and Volery (2017) noted that many

entrepreneurial leadership concepts have yet to be extensively adopted within business

management practices. Therefore, the research goal was to explore leadership strategies

for catalyzing innovation using entrepreneurial leadership constructs, such as risk-taking,

experimentation, innovativeness and creativity, self-renewal, and agile resource

integration (Findsrud, 2020; Verma & Mehta, 2020). The background to the problem has

been provided, and the focus will now shift to the problem statement.

Problem and Purpose

The specific business problem is that some healthcare business leaders lack

entrepreneurial leadership strategies to catalyze innovation performance. Therefore, the

purpose of this qualitative multi-case study was to explore entrepreneurial leadership

strategies that some healthcare business leaders working in the pharmaceutical, medical

device, and consumer healthcare sectors in North America and Western Europe used to

catalyze innovation performance.

Population and Sampling

Population

The targeted population involved healthcare business leaders in North America

and Western Europe working in the pharmaceutical, medical device, and consumer

healthcare sectors who had successfully used entrepreneurial leadership strategies to

catalyze innovation. This population was appropriate for this study because healthcare

business leaders directly influence their organization's entrepreneurial orientation and

distinguish themselves from competitors by applying new knowledge and innovation (see

Dabić et al., 2021; Gifford & McKelvey, 2019; Shaher & Ali, 2020). Using individuals

within associated professional networks effectively diminishes access barriers to people

and data (Vuban & Eta, 2019). The sampled population interviewed involved six

healthcare business leaders who had demonstrated evidence of successfully applying

entrepreneurial leadership strategies to catalyze organizational innovation.

Sampling

I conducted a qualitative multi-case study to explore entrepreneurial leadership

strategies that some healthcare business leaders used to catalyze innovation performance;

therefore, a nonprobabilistic, purposive sampling method was appropriate for this study.

The process included an element of convenience sampling; however, the specific nature

of the criteria for involvement made this design purposive. The sampling strategy helped

in identifying suitable research participants. Matching interviewees with the research

objectives helps to improve a study’s rigor and the reliability of data and findings (S.

Campbell et al., 2020). The sampling strategy aligned with the research methodology,

aims, and objectives, contributing to research rigor.

The study involved multiple data sources, including six in-depth, semistructured

interviews and a review of participant-provided evidentiary documentation, such as

organizational business strategies and websites. Key eligibility criteria targeted healthcare

business leaders who were creative, who were strategic thinkers, and who had led or

significantly contributed toward strategic decisions within healthcare innovation

initiatives within the last 5 years. The specific eligibility criteria ensured that participants'

selection and use were nonprobabilistic, were purposive, were appropriate for the

research topic, and led to the collection of data on recent and relevant experience across

various entrepreneurial innovation conditions.

Nature of the Study

Qualitative methods were the basis for this study to explore entrepreneurial

leadership strategies that some healthcare leaders used to catalyze innovation

performance. Researchers use qualitative methodology to understand complex realities as

they contextualize a phenomenon's subjective and socially formed meanings, especially

from the subjects' perspective (Stake, 2005; Yin, 2018). Conversely, quantitative or mixed

methods allow for the objective and systematic collection of data and hypothesis testing

that may allow inferences and representation to broader populations (Bloomfield &

Fisher, 2019; Duckett, 2021). Qualitative research is increasingly being recognized as a

valuable methodology in the medical field for its meaningful research questions and

identification of suitable measures for future studies (Abramson et al., 2018). Due to the

study's exploratory nature and the fact that quantitative statistical data were not required

to answer the research question or test a hypothesis, qualitative research was more

suitable than quantitative or mixed-method approaches. In addition, the mixed

methodology approach would have been prohibitively extensive.

Qualitative research designs include phenomenological, grounded theory,

ethnographic, narrative inquiry, and case study. Phenomenological designs are suitable for

documenting participants' lived experiences (Pathiranage et al., 2020). Grounded theory

is suitable for discovering or constructing theory from data (Chun Tie et al., 2019).

Researchers immerse themselves in natural social settings within ethnographic designs to

understand cultural contexts (Pathiranage et al., 2020). Narrative designs are suitable for

capturing stories describing human events (Sonday et al., 2020). Phenomenological,

grounded theory, ethnographic, and narrative inquiry designs were unsuitable for the

study because lived experiences, life stories, and cultural elements would not be

emphasized or expected to contribute to the study. Within a qualitative multi-case study

design, researchers challenge existing theoretical assumptions and utilize several

evidence types and sources to explore complex phenomena from subjects' experiences

and perspectives in their natural settings (Stake, 2005; Yin, 2018). Therefore, a qualitative

multi-case study design was best suited for this study because it involves exhaustive

review and analysis of participants’ perspectives on a phenomenon.

Research Question

What entrepreneurial leadership strategies do some healthcare business leaders

use to catalyze innovation performance?

Interview Questions

1. How are you involved in leading innovation within your organization?

2. What entrepreneurial leadership strategies have you used to foster an

innovative or entrepreneurial orientation within your organization?

3. What challenges have you faced embedding an innovative or entrepreneurial

orientation?

4. What entrepreneurial leadership strategies have you used to manage and

implement innovation initiatives?

5. How do you judge the effectiveness of those entrepreneurial leadership

strategies?

6. How do you know when to apply specific entrepreneurial leadership

strategies?

7. What challenges have you faced in using those entrepreneurial leadership

strategies?

8. What have you done to meet those challenges effectively?

9. How do you measure innovation performance?

10. What additional information would you like to share about using

entrepreneurial leadership strategies to catalyze innovation performance?

Conceptual Framework

The conceptual framework of this study was entrepreneurial leadership.

Entrepreneurial leadership organically emerged as a new leadership concept from

entrepreneurship and leadership literature (Esmer & Dayi, 2017; Renko et al., 2015). No

author has claimed to be or been referred to as the original theorist; however, the concept

is well grounded and continues to evolve in the literature, making it worthwhile to add

constructs or insight to the body of knowledge. The concept of entrepreneurial leadership

is used to describe leaders' proficiency in influencing followers to achieve organizational

objectives through creative recognition and exploitation of entrepreneurial opportunities

for business growth (Pinelli et al., 2022; Renko et al., 2015). Key tenets, such as

opportunity recognition and exploitation, underlying the entrepreneurial leadership

concept are related to transformational leadership (Lopes Figueredo et al., 2022),

creativity-enhancing leadership (Makri & Scandura, 2010), and entrepreneurial

orientation (Lopes Figueredo et al., 2022; Lumpkin & Dess, 1996). The entrepreneurial

leadership concept holds that entrepreneurial leadership constructs offer a lens on how

leaders champion entrepreneurial behaviors and drive innovation performance within

organizations. Therefore, an organization's entrepreneurial orientation is likely to foster

entrepreneurial leaders who influence intrapreneurial attributes such as creativity,

risktaking, self-efficacy, and opportunity recognition and exploitation within employees

and culture (Bagheri, 2017; Dabić et al., 2021; Pinelli et al., 2022; Renko et al., 2015;

Shaher & Ali, 2020). Thus, entrepreneurial leadership is an antecedent to establishing an

organizational and individual entrepreneurial orientation that leads to the development of

future leaders.

Operational Definitions

Entrepreneurial leadership: Leaders' proficiency in influencing followers in

achieving organizational objectives through creative recognition and exploitation of

entrepreneurial opportunities for business growth (Niazi et al., 2020; Renko et al., 2015).

Entrepreneurial orientation: Comprises a firm’s collective organizational

processes, methods, and approaches while performing entrepreneurially (Lumpkin &

Dess, 1996).

Innovation management: An organization’s ability to renew itself and enhance its

value through novel or transformed ideas (Fontana & Musa, 2017).

Innovation performance: The degree of success (efficacy) in relation to the efforts

spent (efficiency) while undertaking the innovation process (Rehman et al., 2021).

Innovation process: Comprises a firm’s collective organizational processes that

govern idea generation, selection, development, and diffusion (Fontana & Musa, 2017).

Innovative work behavior: Comprises the behaviors that promote the development

of new ideas, technology, techniques, and methods related to specific business goals

(Afsar & Umrani, 2019).

Social entrepreneurship: The creation of positive social change through

entrepreneurial activity, adoption of innovative approaches, collection of resources, and

development of networks aimed at creating or pursuing social value (Stirzaker et al.,

2021).

Assumptions, Limitations, and Delimitations

Assumptions

Philosophical assumptions involve researchers' beliefs surrounding problem

formulation, research strategy, data collection, and data analysis, and they comprise

epistemological, ontological, and axiological suppositions (Almasri & McDonald, 2021).

Assumptions are accepted issues, ideas, or positions and may be found across the

research process (Theofanidis & Fountouki, 2019). Researchers make assumptions about

human knowledge, realities experienced within the research process, and how their values

potentially affect the research process (Almasri & McDonald, 2021). This study had two

fundamental assumptions. First, it was assumed that leaders with distinct

entrepreneurship experiences could speak on what it takes to be entrepreneurial and

catalyze innovation. The second assumption was that entrepreneurial leaders would

truthfully and transparently answer research questions and share explicit success

strategies that may benefit other leaders. Asking probing questions to achieve the depth

and breadth of insight and meaning served as a mitigation strategy for this study.

Limitations

Research study limitations are restrictions out of the researcher's control and are

often linked to the chosen research design, statistical model, funding, or other factors

(Theofanidis & Fountouki, 2019). As this study was conceptual and exploratory,

limitations were inherent and integral to the research. Several limitations that potentially

affected the study design, results, and conclusions must be considered. Due to the

qualitative case study design and the insignificant number of participants required to

reach data saturation relative to the overall target population, the generalizability and

reproducibility of the findings may be limited or not achieved. Thus, future longitudinal

studies encompassing larger sample sizes or controlled conditions could provide better

insights into how entrepreneurial leaders catalyze innovation. However, the study design

included using multiple data sources to enhance the reliability, validity, and credibility of

the findings and conclusions. The interpretations and inferences made through thematic

analysis of participants' responses are a cause for caution (K. Campbell et al., 2021).

Reflexivity exercises comprising self-examination and notating biases and assumptions

throughout the research process are warranted to minimize researcher bias.

Understanding, cloaking, and uncloaking personal social locations and positionalities are

essential in the ethical treatment of participants and when analyzing transcripts (K.

Campbell et al., 2021; Thurairajah, 2019). The credibility of research findings can be

strengthened if researchers are reflexive about their methodology, are transparent about

their worldviews, and build ethically close relationships with participants while

remaining objective in data analysis.

Delimitations

Delimitations are deliberately imposed limitations established by the researcher

and within the researcher's control (Theofanidis & Fountouki, 2019). Forming

delimitations establishes boundaries that may better accomplish research goals and are

primarily coupled with the study's theoretical or conceptual framework, purpose, research

questions, variables, and sample (Theofanidis & Fountouki, 2019). Several delimitations

were established to safeguard a favorable study outcome.

First, although an extensive literature search was conducted, it was primarily

limited to current journal articles published after 2019. There remains a possibility that

meaningful and relevant literature sources were missed. Future research could broaden

the scope of the literature search to prevent unexpected omissions. Second, there is no

universal definition of entrepreneurial leadership, and the literature does not indicate that

researchers are moving toward consensus. While Renko et al.'s (2015) definition of

entrepreneurial leadership was used in this study, other definitions contain additional

constructs that may catalyze innovation and are worth exploring in future research. Third,

this study explored the effects of entrepreneurial leadership style on innovation. Other

leadership styles, such as transformational or creative leadership, may influence

innovation differently. Accordingly, future studies should investigate other leadership

styles that may independently or simultaneously influence innovation (Afsar & Masood,

2018; Bagheri, 2017; Mehmood et al., 2020; Newman et al., 2018). Furthermore, future

studies should compare the effect of entrepreneurial leadership with other leadership

styles, specifically in healthcare.

Fourth, the selection of samples was limited to three sectors: pharmaceutical,

medical device, and consumer, within the healthcare industry in the United States and

Western Europe. As various contexts may influence entrepreneurial leadership practices,

future research should leverage the insights from this study in other industries, sectors,

and business settings in a broader global context. Fifth, the study was analyzed through

the lens of business leaders who had successfully catalyzed innovation through

entrepreneurial leadership. Future research should include the perceptions of both

healthcare leaders and employees. The personal leadership characteristics of leaders and

employees may have different influencing effects; hence, future research may provide

better insight into how specific entrepreneurial leadership traits catalyze healthcare

innovation. While several delimitations existed within this doctoral study, other

researchers may expand on the findings and contribute to the literature.

Significance of the Study

Contribution to Business Practice

Healthcare business leaders work in a highly competitive environment where they

must seek novel solutions to catalyze and sustain organizational innovation, value

creation, performance, and profit. This study may be of significant value to business

practice as the findings provide healthcare business leaders insights into the

entrepreneurial leadership strategies that may help positively influence innovation

outcomes and contribute toward organizational competitive advantage. Innovation is an

effective corporate strategy that may lead to a competitive advantage through better

products, reputation, and market performance (M. Ali, 2021; Gallardo-Vázquez et al.,

2019). Therefore, this study’s findings on entrepreneurial leadership strategies may

provide valuable insight that informs corporate innovation strategy and business practice.

This study’s contributions to business practice or improvement involve

establishing successful entrepreneurial leadership strategies that may serve as guidelines

for modeling desirable organizational citizenship behavior and developing new

capabilities and competencies. Furthermore, establishing an entrepreneurial orientation

and culture can enable innovation and foster creative outputs by influencing employee

productivity (Ahmetoglu et al., 2018). Proficient business leaders who cultivate an

entrepreneurial climate can create value for the organization by promoting

experimentation, idea generation, opportunity recognition and exploitation, and concept

implementation (Bagheri, 2017; Fontana & Musa, 2017; Pinelli et al., 2022). Innovation

can be vital to growing and sustaining long-term profitability if organizational leaders

develop entrepreneurial leadership strategies, formulate robust innovation processes, and

capture innovation as a value driver within their strategic vision (Usman et al., 2021).

Business leaders can increase value creation, performance, and profit by adopting

entrepreneurial leadership strategies that foster innovation.

Implications for Social Change

In addition to achieving business success, organizations can contribute to society

through social change initiatives. Positive social change, such as social entrepreneurship,

focuses on actions intended to benefit society and its members rather than organizations

(Lumpkin et al., 2018). Beyond the organizational environment, the implications for

positive social change include fostering social entrepreneurship and innovation that may

spark technological advancement, influence economic growth and job creation, and

enrich societal well-being (Scuotto et al., 2022). Social entrepreneurship and innovation

may help alleviate poverty through higher disposable income, financial wealth, and

economic self-sufficiency (Lumpkin et al., 2018). Business leaders who learn about

successful entrepreneurial leadership strategies and practice social entrepreneurship may

foster social capital by creating social networks for community learning and involvement

in addressing healthcare challenges creatively and innovatively (Lumpkin et al., 2018;

Wahyuningtyas et al., 2018). Therefore, social change and social entrepreneurship have

benefits beyond organizational citizenship.

A Review of the Professional and Academic Literature

The proceeding literature review is structured into three components. The first part

focuses on entrepreneurial leadership theory, which comprises leadership theory and

entrepreneurship theory, and how each has converged to form an entrepreneurial

leadership conceptual model. Next, the topical foundation of organizational innovation is

laid out, emphasizing how business leaders manage innovation for performance,

including developing a fundamental understanding of healthcare innovation. Lastly, the

topic in relation to the conceptual model is discussed, specifically entrepreneurial

leadership constructs, such as orientation, culture, behavior, skills, and leadership

characteristics, and how they potentially catalyze innovation. In their bibliometric

analysis of entrepreneurial leadership research, Aparisi-Torrijo and Ribes-Giner (2022)

found that entrepreneurship, leadership, innovation, social entrepreneurship,

entrepreneurial leadership, entrepreneurial orientation, sustainability, transformational

leadership, entrepreneurs, and gender were the most frequent topics within the literature.

To provide a comprehensive critical analysis of the entrepreneurial leadership

literature, this doctoral study’s literature review framework was designed to be consistent

with the key topics found by Aparisi-Torrijo and Ribes-Giner (2022), other than gender,

which was not a primary factor for analysis. The literature review comprised 108

references, of which 95% were peer-reviewed journal articles and 87% were published

within 5 years of the expected graduation date. Walden University's library served as the

primary database source for obtaining scholarly work, and specific keywords were used

to source appropriate material for inclusion in the literature review. For example,

keywords included entrepreneurial leadership, pharmaceutical innovation,

entrepreneurial leadership and innovation, innovation work behavior, entrepreneurial

leadership theory, entrepreneurial orientation, and innovation performance.

Entrepreneurial Leadership Theory

Leadership and entrepreneurship have primarily been researched and defined

independently, though contemporary research has begun converging the two concepts into

entrepreneurial leadership theory. While leadership and entrepreneurial leadership overlap

in specific attributes and broad definitions, little consensus toward a universal definition

exists. Entrepreneurial leadership has been argued to be a distinct form of leadership,

emphasizing the need to manage the associated contextual challenges and opportunities

that may require unique entrepreneurial strategies to overcome (Harrison et al., 2018).

Numerous researchers have suggested a relationship between entrepreneurial leadership,

innovative behavior, and organizational performance (Dabić et al., 2021;

Shaher & Ali, 2020; Simić et al., 2020). Understanding the leadership styles, behaviors,

and competencies influencing creativity is vital in driving innovation performance

(Mehmood et al., 2020). Effective entrepreneurial leadership may promote an

entrepreneurial culture and orientation conducive to superior performance (Dabić et al.,

2021; Kör et al., 2021). Organizational performance and entrepreneurial leadership style,

competencies, and behaviors have various dimensions and may be influenced by many

mediating factors. Although emerging as a new leadership theory, entrepreneurial

leadership is a dynamic concept defined by various leadership influences within

entrepreneurial contexts.

Leadership

As leadership theory has strongly influenced entrepreneurial leadership theory, a

fundamental understanding of complementary and distinct leadership styles enables a

deeper appreciation of entrepreneurial leadership's effect on catalyzing innovation

performance. Leadership theories, such as entrepreneurial leadership, help explain the

traits and behaviors specific individuals use to influence the performance of others and

have led to the creation of multiple leadership styles with distinct and overlapping

characteristics. A particular leadership style may produce a drastically different outcome

than another and is highly dependent on situational context. Therefore, it is essential to

understand the makeup of the core leadership styles found in the literature, their effect on

entrepreneurship and innovation performance, and how they may have contributed to

entrepreneurial leadership theory. Leadership is the new driver for innovation and

comprises the ability of leaders to influence or motivate others to focus efforts on the

successful accomplishment of organizational objectives (Alharbi, 2021; Gutu, 2020).

Leadership influence encompasses various approaches, situations, skills, behaviors,

competencies, and qualities (Alharbi, 2021; Fries et al., 2021). The role and effect of

adaptive leadership, leader–member exchange (LMX), path–goal theory, servant

leadership, creative leadership, and transformational leadership on organizational

entrepreneurship and innovation are discussed in this section.

Adaptive Leadership. Individuals use adaptive leadership to tackle complex

challenges in agile ways and may lead to enhanced innovation performance. Adaptive

leadership is influential in organizational innovation, performance, growth, and survival

in fast-paced, uncertain, and hyper-competitive business environments (Busola

Oluwafemi et al., 2020; Mukaram et al., 2021; Yeo, 2021). Busola Oluwafemi et al.

(2020) uncovered that the combination of opening and closing (ambidextrous) leadership

behaviors predicted employees' explorative and exploitative innovation behaviors, while

adaptive or flexible leadership mediated the relationship. Furthermore, Mukaram et al.

(2021) confirmed a significant positive relationship between adaptive leadership and

organizational readiness for change. Yeo (2021) concluded that leaders should use their

vulnerability as a basis for inner strength through others' support, leverage collective

wisdom to accelerate decision-making, venture into innovation through experimentation,

and exercise personal instinct and objective judgment to think and act differently. Using

adaptive leadership may help entrepreneurial leaders encourage employees to explore,

experiment, and act creatively within innovative settings. Leaders’ adaptive

characteristics are essential for navigating complex and uncertain business environments

and are thus an essential facet of entrepreneurial leadership and innovation performance.

Leader–Member Exchange. High quality leader–member relationships may

enhance innovation performance and firm competitive advantage through the effective

development of innovative employee behavior, creativity, and talent management. Tingyi

Li et al. (2020) recognized that leaders' psychological capital has a significant positive

(direct and indirect) effect on employees' innovation behavior through high quality LMX.

However, Mascareño et al. (2020) contended that LMX did not directly affect employee

innovation, though employee creativity indirectly mediated the relationship. Furthermore,

Mulligan et al. (2021) explained that mindfulness and engagement served as mechanisms

of high quality LMX and subsequently positively facilitated innovation. Though the

literature supports a positive relationship between LMX and innovation, various LMX

constructs may have differing effects on innovation, underscoring the need for further

research. Entrepreneurial leaders may wish to foster employee innovativeness through

effective employee interactions to catalyze innovation performance.

Path–Goal Model of Leadership. The instrumental role of the leader in

supporting employees, resources, and information; helping them overcome deficiencies;

and improving performance in achieving individual and organizational goals can be

explained by path–goal leadership theory. Magombo-Bwanali (2019) defended that

participative path–goal leadership behavior is the primary leadership behavior associated

with team leaders and that supportive and achievement-oriented behavior significantly

influences subordinate performance. Saleem et al. (2020) argued that directive leadership

significantly affected performance, followed by supportive and achievement-oriented

leadership styles, though participative leadership was not considered a significant

predictor of performance. Furthermore, Singh and Rangnekar (2020) ascertained that

empowering leadership directly influenced employee proactivity; that empowering

leadership, employees' goal orientation, and job conditions are essential antecedents of

employee proactivity; and that goal orientation and job conditions concurrently partially

mediate the empowering leadership and employee proactivity relationship. In essence, a

leader’s role using path–goal leadership is to increase employees' motivation and job

satisfaction by adding value, removing hurdles, clarifying organizational goals, and

rewarding performance. Path–goal leadership may be insufficient to catalyze innovation

performance; however, constructs within the theory, such as hurdle removal, may be an

effective entrepreneurial leadership strategy that enables employees to be more

innovative, thus affecting innovation performance.

Servant Leadership. Servant leadership is a people-oriented leadership style that

significantly influences innovative employee behavior and, subsequently, innovation

performance, organization success, and competitive advantage. Iqbal et al. (2020)

discovered that servant leadership has a direct and positive relationship with employees'

innovative behavior and that psychological safety and thriving mediate the relationship.

Furthermore, F. Li et al. (2021) identified a positive relationship between servant

leadership and innovative employee service behavior, which was further mediated by

employee customer orientation. Lan et al. (2021) reported that servant leadership

indirectly influenced leaders' innovative behavior through their sense of accomplishment

and that leaders' extraversion strengthened the relationship and mediating effect. Whether

it involves influencing employees through leadership or increased self-motivation as a

leader, servant leadership can promote creative activities and innovativeness that lead to

business growth. With its positive effect on innovative employee behavior, servant

leadership may be a practical approach for entrepreneurial leaders to drive innovation

performance.

Creative Leadership. Effective leadership styles, such as creative leadership, are

an influential component of individual, team, and organizational creativity and innovation

vital to organizational survival. Zaman et al. (2020) determined that transformational

leadership constructs such as intellectual stimulation and inspirational motivation are

critical for innovation as they inspire creativity, unique problem-solving, and risk-taking

that leads to innovative behavior, value creation, and sustained competitive advantage.

Teng Li and Yue (2019) further identified a positive relationship between leaders'

creativity and team creativity, including a mediating effect from task complexity;

however, leader empowerment weakened the relationship. Qin et al. (2019) argued that

creative leadership is not without impediments and that a leader's creative mindset is

associated with state based moral disengagement that could limit leaders' self-regulation

capacity and potentially lead to abusive behavior, such as aggressiveness. Creative

leadership may influence and motivate employees to think and act innovatively,

overcome complex and challenging tasks or situations, and generate positive business

outcomes. Creative leadership empowers leaders to realize innovative solutions within

complex and rapidly evolving business contexts, such as entrepreneurship pursuits.

Transformational Leadership. Transformational leadership may be a practical

approach to organizational change and performance via innovative employee work

behavior. Creativity, new ideas, and innovations are significant factors in organizational

competitive advantage and can be enhanced through employee innovative work behavior

(Afsar & Umrani, 2019; Hadi et al., 2019). Hadi et al. (2019) determined that

transformational leaders influence employee motivation, thus enriching innovative work

behavior. Furthermore, the relationship between transformational leadership and

innovative work behavior is mediated by employees’ motivation to learn and moderated

by task complexity and innovation climate (Afsar & Umrani, 2019). Sivarat et al. (2021)

contended that employee creativity is emphasized by transformational leadership and

contingent rewards in exchange for their efforts in meeting innovation goals.

Transformational leadership significantly influences employee creativity and innovative

work behavior, supporting positive organizational innovation outcomes. While a valuable

tool for catalyzing innovation performance, transformational leadership may still be

insufficient within entrepreneurial climates.

Summary. As entrepreneurial leadership theory stems from leadership and

entrepreneurship theories, business leaders should develop, and practice leadership

strategies derived from several leadership styles to catalyze innovation performance in

entrepreneurial ways. Entrepreneurial leaders who can agilely adapt to complex and

rapidly changing conditions through adaptive leadership characteristics may foster

innovation performance by promoting innovative work behavior and preparing the

organization for change. With the right leadership traits, entrepreneurial leaders are well

positioned to foster high quality LMX that encourage innovativeness and positively

influence innovation outcomes. Through path–goal leadership, entrepreneurial leaders

must remove obstacles and provide the support, resources, information, and rewards

necessary to motivate employees to be creative, take risks, and increase their

discretionary effort.

Furthermore, entrepreneurial leaders may practice servant leadership and creative

leadership to cultivate discretionary effort and innovativeness and encourage out-of-

thebox thinking, risk-taking, and experimentation in an environment where employees

feel supported, willing to tackle challenges, and free to generate and implement new

ideas. To foster employee innovative work behavior and create an innovative

organizational culture, entrepreneurial leaders may leverage the influencing power of

transformational leadership to nurture a community oriented toward entrepreneurship.

Leaders who can develop and demonstrate entrepreneurial leadership traits and strategies

congruent with their environment may succeed more in catalyzing innovation, improving

business performance, and creating a competitive advantage.

Entrepreneurship

Like leadership theory, entrepreneurship theory is a significant part of

entrepreneurial leadership theory’s constitution. Entrepreneurial leadership was the

conceptual framework of this study; therefore, it is essential to understand

entrepreneurship constructs. Entrepreneurship is a prominent topic of inquiry in the

literature, though it lacks a universally aligned definition. In Clark and Harrison’s (2019)

literature review, the authors described various schools of thought and argued that a

holistic approach inclusive of multiple perspectives of entrepreneurship served the field

better than making compromises or concessions through integration. Fundamentally, the

entrepreneurial context, characteristics, strategies, and functions of the entrepreneur and

entrepreneurial process are essential for understanding entrepreneurial leadership and its

effect on innovation performance.

Entrepreneurial Context (Types). Firm performance can be improved through

innovation by employing various forms of entrepreneurship. Examples of

entrepreneurship that affect firm performance include corporate, opportunity-driven,

innovative, and digital entrepreneurship (A. Ali, Kelley, et al., 2020; Sahut et al., 2021).

Prince et al. (2021) reconceptualized entrepreneurship as the development and validation

of ideas and included such constructs as a firm start-up, uncertainty, innovation, value

creation, and opportunity recognition or creation. Ali, Kelley, et al. (2020) showed that

innovative and corporate entrepreneurship was high within economies with basic

institutional conditions and efficiently functioning markets. However, external contexts

that promote innovation had a negative relationship with opportunity-driven and

innovative entrepreneurship and a positive relationship with corporate entrepreneurship.

Sahut et al. (2021) discovered that corporate innovation is enhanced through digital

entrepreneurship and that digital platforms and crowdfunding create opportunities for

knowledge creation and exchange, better decision-making, and the promotion of

supportive networks. Entrepreneurship comes in many configurations and can influence

innovation and firm performance differently. Business leaders should focus on strategic

entrepreneurship practices within their specific context that support the achievement of

corporate objectives and create organizational value and wealth.

Corporate strategy is vital in navigating business leaders within complex

environmental contexts and establishing a competitive advantage. Benevolo et al. (2020)

and Rindova and Martins (2021) uncovered gaps in the extant entrepreneurship literature.

Rindova and Martins developed a framework that comprises three constructs: articulating

shaping intentions for changing an existing situation into a preferred one, designing

without final goals, and stakeholder dialogue and co-creation. The authors purported that

the three constructs could lead to value-creation and novel strategies. Benevolo et al.

(2020) designed an integrated framework to support global strategy creation, especially in

entrepreneurial firms seeking to exploit global opportunities. Fostering corporate

entrepreneurship by creating and implementing entrepreneurial strategies requires an

entrepreneurial mindset and creativity (Altahat & Alsafadi, 2021). Emphasizing

entrepreneurship within corporate strategies may increase competitiveness and

competitive advantage within highly complex environments. Corporate strategies that

comprise effective and efficient entrepreneurial innovation processes focused on

converting an idea into a product or service that delivers customer value may boost

organizational performance.

Entrepreneurial Process. Strategic entrepreneurship and innovation may lead to

opportunity recognition, enhanced risk-taking, greater flexibility, and improved

organizational performance. The dynamic external business environment warrants firms

to rapidly innovate, change and transform, rendering entrepreneurial action an essential

facet of any innovation ecosystem (Chebbi et al., 2020; Minafam, 2019; Tseng & Tseng,

2019). Minafam (2019) recognized that corporate entrepreneurial activities lead to higher

innovative product and process development rates. Tseng and Tseng (2019) established

six strategic approaches: the need to motivate innovative behavior, concentrate and

develop entrepreneurial capabilities, cultivate innovative-minded individuals, reward

corporate entrepreneurship, encourage big-picture thinking, and educate employees on

corporate entrepreneurship. Chebbi et al. (2020) contended that an internal marketing

strategy was needed to help drive internal stakeholder engagement, organizational

transformation, and adoption of a corporate entrepreneurship strategy. Through strategic

entrepreneurship, business leaders can achieve superior value by establishing an

actionoriented entrepreneurial and innovative climate that influences employee

innovative work behavior and engagement and leads to the development and adoption of

dynamic capabilities. Focusing on internal entrepreneurial activity through effective

entrepreneurial strategies and processes can promote innovative thinking, behavior, and

performance and is essential to catalyzing innovation performance.

The entrepreneurial process can be defined differently, though models share

similar external influencing factors and effects on firm performance. One model,

CROWAI, proposed by Carvalho (2022), comprises interconnected and permanently

looped entrepreneurial attributes: context, resources, objectives, will, action, and impact.

Carvalho’s attributes are essential when considering what entrepreneurial strategy or

leadership approach to implement, given the unique circumstances a business leader faces

and the effect or outcome they wish to achieve. Certain environmental conditions are

more conducive to entrepreneurship. For example, Guerrero et al. (2021) learned that

professional support, incubators/accelerators, and R&D investments are favorable, while

lack of funding sources, labor market conditions, and social norms are less favorable. The

development of incubators/accelerators may serve as a microcosmic ecosystem and can

be a powerful approach to innovation while agilely targeting and managing resources.

Altaf et al. (2019) reported that management support, work discretion, entrepreneurial

education, previous entrepreneurial experience, and time availability significantly and

positively impacted business performance and were moderated by an entrepreneurial

passion for inventing. Altaf et al. effectually tie in leaders, specifically leadership

constructs, as critical components of strategic entrepreneurship often overlooked in more

process-oriented models. There is no single approach to strategic entrepreneurship, as the

literature supports the significant positive effect that numerous entrepreneurial process

constructs have on firm performance. Though, the entrepreneur remains a central tenet of

strategic entrepreneurship.

Entrepreneur/Intrapreneur Characteristics. Entrepreneurial intentions,

knowledge, skills, and capacity play a significant role in entrepreneurs' success in

competitive and uncertain markets. Gieure et al. (2020) upheld that individuals are likely

to have an attitude and inclination to be entrepreneurial if they have the necessary skills,

knowledge, and capacity. Iwu et al. (2021) asserted that the content and design of

entrepreneurial education programs and the caliber of the lecturers influenced individuals'

entrepreneurial intentions. Furthermore, subjective norms influenced entrepreneurial

intentions and strongly predicted entrepreneurial behavior and action (Gieure et al.,

2020). Su et al. (2020) contended that entrepreneurs gain motivation through happiness

and satisfaction in their entrepreneurial pursuits. Positive emotions promote

entrepreneurial intention and, subsequently, the acquisition of resources and ability (Su et

al., 2020). Lastly, emotional value, like economic value, is a performance and

motivational driver within the entrepreneurial process (Su et al., 2020). Business leaders

focusing on entrepreneurship training and knowledge management, skill development,

and strategic resource management could significantly affect innovative work behavior

and foster financial, human, and social capital that capitalize on opportunities to catalyze

innovation and create wealth. In addition, business leaders should find ways to foster

entrepreneurial interest and competency development through formal training programs

and active engagement.

Managerial or leadership practices are critical in the development of

entrepreneurial competencies and for forming an entrepreneurial environment and

orientation that positively influences firm performance. Pesha et al. (2021) proposed two

methods to foster internal entrepreneurship; the first method is to develop a creative

environment that stimulates business improvement initiatives, and the second is to

leverage employee development programs to implement business projects. Furthermore,

Gandhi et al. (2021) proposed that leaders develop intrapreneurs through a tailored

incentive system, empowering them to source project resources, holding them

accountable for certain risks, connecting them to cross-departmental resources, and

establishing an innovation framework comprised of experimentation. Khan et al. (2021)

avowed that developing entrepreneurial competencies, culture, and orientation positively

influences firm performance. Leaders are pivotal components of strategic

entrepreneurship, as their leadership strategies and approach can yield different results. In

addition, leaders applying diverse and contextually based leadership traits with an

entrepreneurial orientation can enhance organizational innovation. Leaders could catalyze

innovation performance by fostering an entrepreneurial organizational culture and

promoting entrepreneurial competencies and innovative work behavior.

Entrepreneurs often work within complex and uncertain environments where

resources and key stakeholder relationships, such as mentoring relationships, are essential

to successful entrepreneurial outcomes. St-Jean and Tremblay (2020) acknowledged that

mentoring supports the development of entrepreneurial self-efficacy concerning

opportunity recognition for individuals with low learning goal orientation. Furthermore,

the effect of mentoring entrepreneurs decreases once the mentorship ends, emphasizing a

need for long-term support (St-Jean & Tremblay, 2020). Entrepreneurs with high learning

goal orientation also experience a slight decrease in self-efficacy with intense mentorship

(St-Jean & Tremblay, 2020). Entrepreneurs significantly gain from mentoring

relationships, with coachable entrepreneurs benefiting the most. Kuratko et al. (2021)

recognized that entrepreneurs' coachability positively correlated with goal progress,

product innovativeness, firm performance, investment decisions, and mentorship

expectations. The literature overwhelmingly supports the need for business leaders to

support the growth and development of budding entrepreneurs through training,

information sharing, coaching, and mentoring. Active and long-term leadership support,

tailored to the idiosyncratic needs of novice entrepreneurs, plays a pivotal role in their

development and success, and can significantly influence their attitude, behavior, and

goal attainment. Therefore, effective entrepreneurial leadership strategies, such as

coaching and mentoring, are necessary to positively affect innovative work behavior and

firm performance.

Strategic entrepreneurship processes, also called intrapreneurship within corporate

settings, coupled with adequate resource management and leadership support, can

positively influence organizational innovation. Intrapreneurs can enable and revitalize

organizational performance through innovation development and implementation if given

the necessary resources and conditions to develop and implement innovative ideas and

projects (Alpkan et al., 2010; Brigić & Alibegović, 2019; Usman et al., 2021). Brigić and

Alibegović (2019) noticed that intrapreneurship activities directly and positively

impacted product, process, and marketing innovations. Organizational and environmental

characteristics also positively influence intrapreneurship and, subsequently, growth and

profitability (Galván-Vela et al., 2021; Usman et al., 2021). Furthermore, management

support and risk-taking tolerance significantly influence innovation performance (Alpkan

et al., 2010). Though, performance based reward systems and offering employees free

time to innovate did not influence innovativeness (Alpkan et al., 2010). For

intrapreneurship to succeed, entrepreneurial leadership, entrepreneurship-trained

employees, and an entrepreneurial-oriented climate must be present. Strengthening these

intrapreneurial facets may promote innovative behavior and result in firm growth and

profitability. Business leaders should align the corporate strategy, business environment,

and resources to successfully implement innovation initiatives while supporting strategic

entrepreneurship and employee innovativeness.

Summary. As entrepreneurship takes on many forms, it is crucial to note that

capitalizing on opportunities and mitigating challenges requires contextually based

leadership strategies and approaches. Each strategy will share similar attributes, such as

considering the business environment, leadership style, the entrepreneur, and the

innovation process. The innovation or entrepreneurial process should factor in knowledge

development, skill improvement, and leadership support beyond standard task-oriented

procedural steps. Long-term coaching and mentoring are strategies that improve an

entrepreneur’s experience and output. Formal development programs can encourage

innovativeness and provide active leadership support.

Furthermore, a climate that supports opportunity recognition, idea generation,

risk-taking, experimentation, and knowledge sharing can further promote

entrepreneurship and value creation. Developing entrepreneurship capabilities, such as

incubators/accelerators, may enable business leaders to rapidly innovate, change, and

transform the organization, leading to firm growth and profitability. To catalyze

innovation and firm performance, a business leader must align the strategy, environment,

and resources; doing so in an entrepreneurial way may amplify the positive effects.

Entrepreneurial Leadership

The conceptual framework of this study is entrepreneurial leadership theory,

which is an amalgamation of leadership theory and entrepreneurship theory.

Entrepreneurship is increasingly becoming more popular as individuals pursue

opportunities for financial gain, personal development, and social change, even if they

work for an established firm (Renko, 2018). Understanding the relationship between

leadership and entrepreneurship is essential in relating to millennials and the future

workforce, developing markets and firms that lack structure or legitimacy, and

capitalizing on opportunities, market share, and competitive advantage (Renko, 2018).

While the definition of entrepreneurial leadership is nebulous, it is imperative to

understand it as a contextual phenomenon, company culture, leadership style, and an

entrepreneur's leadership characteristics.

Definition. Like the broad definition of leadership, authors use diverse definitions

of entrepreneurial leadership within the literature, resulting in a lack of consensual

meaning and universally integrated definition (Harrison et al., 2020; Ruttan, 2019).

Several authors have leaned toward transformational leadership characteristics, such as

influence (Yukl, 1999) and vision (Gupta et al., 2004), while others have described

innovation (Fontana & Musa, 2017) or risk-taking (Kuratko et al., 2021) as core tenets of

entrepreneurial leadership. Entrepreneurial leadership has been described relative to Bass’

(1985) four theoretical constructs of transformational leadership: idealized influence,

inspirational motivation, intellectual stimulation, and individualized consideration. To be

successful entrepreneurial leaders are required to be charismatic role models of

entrepreneurial qualities, motivationally communicate high expectations and a clear

shared vision to inspire commitment and entrepreneurial behavior, challenge followers to

think creatively and innovatively, and shape a supportive climate for opportunity

recognition, exploitation, and implementation (Northouse, 2019). Renko et

al. (2015) attempted to bridge the gap by defining entrepreneurial leadership in its

simplest form, as leaders' ability to influence and direct followers' performance in

exploiting entrepreneurial opportunities while pursuing organizational goals. Rost

thoroughly analyzed leadership theories, origins, and word use and concluded that

definitions are contradictory, models discrepant, and research disconnected from

leadership's true nature (Rost & Amarant, 2005). Despite inconsistencies across the

literature, the broad definition of entrepreneurial leadership allows researchers and

practitioners to apply different lenses that focus on leaders' proficiencies and traits, thus

contributing to a deeper understanding of leadership's complexity.

Leadership Characteristics. Unlike other leadership styles, entrepreneurial

leadership characteristics are more advantageous in navigating an increasingly complex,

turbulent, and competitive business environment. Harrison et al. (2018) determined that

to be successful, entrepreneurial leaders should develop skills within the following

categories: technical, conceptual, interpersonal, and entrepreneurial. Bagheri (2017)

asserted that leaders who demonstrate entrepreneurial leadership principles model

entrepreneurial behavior and encourage employees toward new idea creation while

fostering an innovative culture. Additionally, Mehmood et al. (2020) confirmed that

entrepreneurial leaders, through their creative abilities, motivate, involve, and develop

creativity in followers, resulting in exploring and exploiting new entrepreneurial

opportunities. Furthermore, supported by Cai et al.’s (2019) study, Mehmood et al.

recognized that entrepreneurial leaders create psychologically safe situations in which

knowledge and idea-sharing between leaders and followers mediate the relationship

between entrepreneurial leadership and employee creativity. While these recent studies

support that entrepreneurial leadership characteristics are similar, in some cases distinct,

to other leadership styles, they also support the significant positive influence

entrepreneurial leadership has on followers, innovation, and organizational performance.

Many influencing factors not evaluated within these studies could affect entrepreneurial

leadership. While other mediating factors were not controlled for, it can be inferred from

the research that entrepreneurial leadership is an essential leadership style and plays a

more significant role in realizing economic value within highly turbulent and uncertain

environments.

Summary. Entrepreneurial leadership is a newer leadership paradigm derived

from leadership theory and entrepreneurship theory and is the conceptual framework of

this study. Currently, there lacks a universal definition of entrepreneurial leadership

within the literature; however, countless authors have examined entrepreneurial

leadership constructs, such as entrepreneurial orientation, opportunity recognition,

risktaking, and innovative work behavior, and their influence on innovation performance.

While other leadership styles share similar leadership traits, skills, and behaviors,

entrepreneurial leadership is tailored toward influencing and motivating followers to

recognize and exploit new opportunities that create business and social value in complex

and dynamic environments. Entrepreneurial leadership constructs have been shown to

have a significant positive influence on innovation performance and are discussed within

the literature review's entrepreneurial leadership and innovation section.

Organizational Innovation

The healthcare industry does not typically foster an entrepreneurial climate;

therefore, the onus falls on healthcare leaders to catalyze organizational innovation using

entrepreneurial approaches. Leaders who can successfully shape an entrepreneurial

climate, embed effective innovation management practices, and promote creative and

collaborative partnerships could positively affect healthcare innovation (Kremer et al.,

2019; Machon et al., 2019). To achieve remarkable innovation performance, leaders must

first develop innovative work behaviors of employees by cultivating opportunities to

share knowledge, generate ideas, and collaborate within creative settings.

Healthcare Innovation

Healthcare and pharmaceutical innovation are critical to developing life-saving

drugs. However, leaders are faced with significant challenges in supporting innovation

diffusion, adaptation, and leadership efforts. Currie and Spyridonidis (2019) recognized

that shared leadership significantly impacted innovation diffusion and local adaptation.

Furthermore, Crespo-Gonzalez et al. (2020) noticed that the adaptation of innovation was

vital to the long-term sustainability of the firm; though, innovation adaptation could also

present a barrier due to required maintenance and loss of effectiveness over time. Machon

et al. (2019) observed that a leader's ability to adapt to environmental changes and

demonstrate a high degree of collaboration were essential to healthcare innovation. While

radical innovation can be challenging in highly regulated industries, opportunities exist at

the organizational level to foster entrepreneurial climates that promote innovativeness.

Entrepreneurial leadership and innovation management play instrumental roles in

healthcare innovation. Leadership characteristics that shape innovative organizational

capabilities are critical to innovation performance and sustainability.

Establishing innovation leadership as a core capability can support innovation

management and improve firm performance. Innovation leadership is vital for improving

quality, productivity, and efficiency, whether managing internal innovation processes or

the external pressure from healthcare reform (Dalton et al., 2021). Avby et al. (2019)

acknowledged three types of innovation: service, process, and organizational innovation

in healthcare systems, and that innovativeness was influenced by entrepreneurial

leadership practices, cross-team collaboration, robust performance metrics, and a

learning-oriented culture. Avby and Kjellström (2019) described that better innovators are

managers and teams who effectively manage development (exploration) and production

(exploitation) challenges. Dalton et al. (2021) retrospectively reviewed 953 leadership

statements and concluded that health leadership was not clearly recognized within health

professional practice standards. If innovation leadership can be embedded in the

organization's fabric, leaders may be better positioned to direct the flow of innovation

toward new opportunity recognition and match the necessary resources to exploit them.

Although the importance of innovation leadership is well established within the literature,

there still exists a need for effective leadership frameworks to drive healthcare

innovation, reform, and improve patient outcomes. Entrepreneurial leadership practices

may help leaders develop individuals’ creativity, establish innovation management

processes, and promote a climate that enables exploring and exploiting opportunities and

challenges.

Innovation Management

Effective innovation management is essential for establishing an innovative

culture and processes that create new business value. Innovation is a significant factor in

a firm's ability to enter new markets, increase market share, and realize a competitive

advantage and corporate sustainability (Bocken & Geradts, 2020; Kremer et al., 2019).

Renkema et al. (2021) contended that human resource management could positively

influence employee-driven innovation, specifically, that innovation initiatives form

through the organizational route, the formalized-system route, and the project-initiative

route. Kremer et al. (2019) further suggested six best practices for managers to become

innovation leaders: develop appropriate group norms, design teams strategically, manage

external stakeholder interactions, show leadership support, display organizational support,

and effectively use performance management. Leaders need to understand how to manage

and sustain corporate innovation, promote a culture of creativity, and understand how

innovation transcends all aspects of the organization: strategy, structure, processes,

incentives, and people (Bocken & Geradts, 2020). An organization’s entrepreneurial

orientation is a significant influence on innovation and performance.

Understanding and applying effective innovation management strategies may

facilitate enhanced stakeholder engagement and the implementation of innovation using

cost-effective or lean processes that contribute to firm performance. Retkoceri and

Kurteshi (2019) opined that business leaders associate innovation with ideas and a

systematic management process that leads to new products and services. The authors also

reported that process innovation was the most common form of innovation, followed by

product and service innovation (Retkoceri & Kurteshi, 2019). Business model innovation

is often overlooked, even though it is essential in fostering an innovation culture

(Retkoceri & Kurteshi, 2019). Solaimani et al. (2019) explained that using lean methods

is a practical innovation approach, especially in coaching leadership, which enables the

hard and soft processes that lead to enhanced innovativeness. Furthermore, Leonidou et

al. (2020) identified that engaging various internal and external stakeholders through

collaborative partnerships can enhance innovation output and entrepreneurship

development. Effective innovation management practices are essential in facilitating an

innovation process that produces a favorable cost-benefit relationship and creates value.

Innovation Work Behavior

Innovative work behavior is essential to innovation performance as it enables

individuals to generate, promote, and implement new ideas. Knowledge management,

including information sharing, organizational learning, and diversity, are essential tenets

of innovation that drive organizational growth, performance, and sustainability through

employee innovative work behavior. Anser et al. (2020) described that functional

flexibility and knowledge sharing mediated the relationship between knowledge

management infrastructure capabilities and innovative work behavior. More specifically,

knowledge management infrastructure capabilities significantly predict functional

flexibility and knowledge sharing, positively affecting innovative work behavior (Anser

et al., 2020). Furthermore, knowledge sharing moderated knowledge management

infrastructure capabilities and functional flexibility (Anser et al., 2020). Battistelli et al.

(2019) ascertained that information sharing positively correlated with task-related and

interactional dimensions of work based learning. Furthermore, task-related learning

positively correlated with innovative behavior through challenging tasks (Battistelli et al.,

2019). Lastly, interactional learning had an indirect, positive relationship with innovative

behavior through organizational commitment and challenging tasks (Battistelli et al.,

2019). Leaders establishing a robust knowledge management system can foster a learning

and knowledge-sharing culture that promotes innovative work behavior leading to idea

generation and implementation. Consequently, innovation performance can be enhanced

through knowledge management and innovative work behavior.

An innovative climate can help engrain innovative work behavior within the

organization's fabric. Antecedents of innovative work behavior, such as employee

engagement, knowledge sharing, organizational climate and capabilities, and

selfleadership, positively contribute to desired innovation outcomes (Kör et al., 2021).

Ali, Farooq, et al. (2020) recognized that organizational climate for innovation and

employee engagement had a direct and indirect effect on innovative work behavior and

that employee engagement partially mediated the relationship between organizational

climate for innovation and innovative work behavior. Kör et al. (2021) contended that

perceived organizational innovativeness, self-leadership, and self-leadership strategies

were positively related to managers' innovative behavior. Furthermore, self-leadership

mediated the organizational innovativeness and innovative behavior relationship, while

risk-taking moderated the mediating effect (Kör et al., 2021). Bogilović et al. (2020)

confirmed that cognitive group diversity mediated the negative relationship between

visible dissimilarity and innovative work behavior. Furthermore,

innovative/entrepreneurial and team/clan climates moderated the relationship between

visible dissimilarity and cognitive group diversity, thus reducing the negative effect

visible dissimilarity had on innovative work behavior (Bogilović et al., 2020). Fostering

innovative work behavior, employee engagement, and self-leadership within an

entrepreneurial-oriented culture positively influences innovation performance. Innovation

must receive leadership support and be incentivized to encourage employee commitment

and the development of creative ideas.

Summary

Leadership is a crucial influencing factor in healthcare innovation, especially as

healthcare settings are often less entrepreneurial and risk averse. Entrepreneurial

leadership positively influences innovation performance when leaders establish an

entrepreneurial orientation and foster innovative work behavior (Bagheri et al., 2020;

Bocken & Geradts, 2020). Embedding appropriate innovation management practices is

vital to facilitating creative and collaborative internal and external partnerships and

diffusing and adapting innovative solutions across and within organizations.

Entrepreneurial and innovation leadership has been shown to improve quality,

productivity, and efficiency by exploring and exploiting new opportunities and challenges

(Avby & Kjellström, 2019). Through entrepreneurial leadership and innovation

management, healthcare companies can enter new markets, increase market share,

establish competitive advantage, create new business models, and develop new products

and services that meet the needs of a rapidly evolving healthcare landscape (Bocken &

Geradts, 2020). Thus, innovation performance can be catalyzed by a suitable

entrepreneurial climate, innovative work behaviors, and leadership practices.

Entrepreneurial Leadership and Innovation

Entrepreneurial leaders have an opportunity to shape the healthcare landscape.

Healthcare leaders may significantly influence innovation performance by developing

entrepreneurial characteristics and demonstrating entrepreneurial behaviors. Leaders who

model innovative behavior may encourage others to do the same and cultivate an

entrepreneurial-oriented organizational culture, form, and function. Overall,

entrepreneurial leadership as an innovation driver could lead to positive organizational

performance, growth, and competitive advantage.

Entrepreneurial Orientation

Organizations with an entrepreneurial orientation can convert opportunities and

challenges into organizational growth and profit. Organizational strategy, resources,

entrepreneurial traits, and entrepreneurial spirit significantly contribute to organizational

orientations that influence innovation performance, firm growth, and success.

AbouMoghli (2018) noticed a significant positive relationship between innovative,

collaborative, and proactive entrepreneurs and business success, though surprisingly

discovered that innovativeness and risk-taking entrepreneurial attributes are not crucial.

Jeong et al. (2019) observed that leaders who establish an adaptive organizational culture

and people-centered management style influence firm entrepreneurial orientation and

performance. Song et al. (2019) further contributed that firm performance is positively

influenced by knowledge capabilities fostered through an entrepreneurial and interaction