Intellectual capital disclosure and its determinants in healthcare organisations – Evidence from Italy

• DOI: https://doi.org/10.1108/IJPSM-06-2022-0149
• Published date: 05 December 2022
• Date: 05 December 2022
• Pages: 20-45
• Subject Matter: Public policy & environmental management,Politics,Public adminstration & management
• Author: Giuseppe Nicolò,Diana Ferullo,Natalia Aversano,Nadia Ardito

Intellectual capital disclosure and

its determinants in healthcare

organisations –Evidence from Italy

Giuseppe Nicol

o, Diana Ferullo, Natalia Aversano and Nadia Ardito

Department of Management and Innovation Systems, University of Salerno,

Fisciano, Italy

Abstract

Purpose –The present study aims to extend the knowledge of intellectual capital disclosure (ICD) disclosure

practices in the Italian Healthcare Organisations (HCOs) context. The ultimate goal of the study is to provide

fresh insight into the possible explanatory factors that may drive the extent of ICD provided by Italian HCOs

via the web.

Design/methodology/approach –The present study applies a manual content analysis on the websites of a

sample of 158 HCOs to determine the level of voluntary ICD. A multivariate regression model is estimated to

test the association between different variables –size, gender diversity in top governance positions, financial

performance and indebtedness –and the level of ICD provided by sampled HCOs through their official

websites.

Findings –Content analysis results reveal that –in the absence of mandatory requirements –Italian HCOs

tend to use websites to disclose information about IC. Particular attention is devoted to Structural and

RelationalCapital. The statisticalanalysis pinpoints that size and indebtedness negatively influence the level of

ICD. In contrast, the presence of a female General Manager (GM) positively drives ICD. Also, it is observed that

Research and University HCOs and those located in the Italian Northern Regions are particularly prone to

discharge accountability on IC through websites.

Originality/value –To the best of the authors’knowledge, this is the first study that examines voluntary ICD

practices through websites in the Italian HCOs’context. Also, since prior studies on IC in the healthcare context

are mainly descriptive or normative, this is the first study examining the potential determinants of ICD

provided by HCOs in terms of size, gender diversity in top governance positions, financial performance and

indebtedness.

Keywords Intellectual capital, Intellectual capital disclosure, Healthcare, Hospital, Reporting

Paper type Research paper

1. Introduction

In recent years, Intellectual Capital (IC) –as a combination of intangible resources crucial to

value-creation processes (Guthrie et al., 2006;Carlucci and Schiuma, 2012)–has gained

progressive prominence in healthcare (Manes-Rossi et al., 2020;Paoloni et al., 2020).

Healthcare Organisations (HCOs) are knowledge-intensive systems as they strongly depend

IJPSM

36,1

20

© Giuseppe Nicol

o, Diana Ferullo, Natalia Aversano and Nadia Ardito. Published by Emerald

Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0)

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The authors whose names are listed above certify that they have NO affiliations with or involvement

in any organization or entity with any financial interest (such as honoraria; educational grants;

participation in speakers’bureaus; membership, employment, consultancies, stock ownership, or other

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The current issue and full text archive of this journal is available on Emerald Insight at:

https://www.emerald.com/insight/0951-3558.htm

Received 20 June 2022

Revised 30 September 2022

8 November 2022

Accepted 14 November 2022

International Journal of Public

Sector Management

Vol. 36 No. 1, 2023

pp. 20-45

Emerald Publishing Limited

0951-3558

DOI 10.1108/IJPSM-06-2022-0149

on their employees’specialised knowledge, skills and abilities (Carlucci and Schiuma, 2012;

Pirozzi and Ferulano, 2016). HCOs deal with a highly unpredictable environment determined

by the need to ensure high-quality care and volume of services while simultaneously

containing costs and satisfying public agendas (Peng et al., 2007;Cavicchi, 2017). In recent

years, HCOs have been facing massive changes imposed by significant budget constraints,

increasing operating costs, new diseases and treatments emerging and increased competition

(Uyar et al., 2021). Following these circumstances, IC –as a combination of intangible

resources –has acquired a pivotal role in enhancing the efficiency and effectiveness of the

HCOs through innovation and adaptive change (Pirozzi and Ferulano, 2016). IC has become a

crucial lever that allows HCOs to achieve strategic objectives, reducing healthcare costs and,

in turn, improving their overall performance (Pirozzi and Ferulano, 2016;Gravili et al., 2020).

The relevance gained by the IC in the HCOs context has progressively triggered greater

demand for information by citizens and stakeholders about how HCOs effectively manage IC

resources to create public value (Pirozzi and Ferulano, 2016;Andrades-Pe~

na et al., 2021). Being

PublicSector Organisations(PSOs), HCOs areunder massive scrutiny from thepublic audience

to demonstrate accountability for using public resources and performance achieved (Ram



ırez

et al., 2022;Andrades-Pe~

na et al.,2021).Therefore, since IC represents both the input and output

of their processes (Vagnoni and Oppi, 2015), according to stakeholder theory , HCOs need to

incorporate IC information within their reporting systems to provide stakeholders with a

comprehensive understanding of their objectives and performance (Pirozzi and Ferulano, 2016;

Manes-Rossi et al., 2020). However –being focused on financial measures –traditional HCOs

reportingsystemsfail to recognisethe relevanceof IC resources(Veltri et al., 2011). This provides

room for exploring alternative tools, such as websites to provide voluntary IC disclosure and

meet emerging stakeholders’information needs (Alcaraz-Quiles et al.,2015;Nicol

oet al., 2021a).

Nevertheless, despite its relevance, previous research on Intellectual Capital Disclosure

(ICD) in the public sector is still limited (Dumay et al., 2015;Manes-Rossi et al., 2016). Some

studies focused on universities (e.g. Low et al., 2015;Manes-Rossi et al., 2018;Nicol

oet al.,

2020) and local governments (e.g. Schneider and Samkin, 2008;Manes-Rossi et al., 2016;

Ram



ırez et al., 2022). In contrast, the HCOs’domain is still virtually unaddressed by IC

academics, as there is a “lack of attention given to the issue of disclosure”(Paoloni et al., 2020,

p. 373). Furthermore, the limited research on ICD in the HCOs’domain is mainly descriptive or

normative (e.g. Habersam and Piber, 2003;Zigan et al., 2009) as it did not dive deep into the

possible factors that could drive disclosure.

Therefore, in the context of the above arguments –based on stakeholder theory’s

arguments, the present study aims to answer the recent call made by Paoloni et al. (2020) for

more research investigating ICD practices in the HCOs. It also intends to cover the research

gap about the possible explanatory factors of ICD provided by HCOs.

To this end, we applied a manual content analysis on the websites of a sample of 158

HCOs. Following mainstream ICD research (e.g. Guthrie et al., 2004;Ram



ırez et al., 2022), a

disclosure index has been constructed to examine the online voluntary ICD of sampled HCOs.

Since most studies on ICD focus on traditional reporting tools such as annual reports, there is

currently little knowledge on the amount and nature of IC information disclosed via the

Internet (Lee et al., 2007;Manes-Rossi et al., 2018).

The ultimate goal of the study is to provide fresh insight into the possible explanatory

factors that may drive the extent of ICD provided by Italian HCOs via the web. Accordingly,

this study applies an Ordinary Least Squares (OLS) regression technique to test the

association between different variables, including size, gender diversity in top governance

positions, financial performance and indebtedness, and the level of ICD provided by sampled

HCOs through their official websites. The regression model also tests the effect of some

control variables related to the presence of Research and University HCOs and their

geographical localisation.

Intellectual

capital

disclosure in

Italian HCOs

21