1 INTRODUCTION

In today's hyper-technological and cyber age, organizations need to possess extensive knowledge to sustain competition and effectively manage their operations, allowing them to make accurate and timely decisions. Effective knowledge management (KM) and the factors that influence it are crucial for the success of an organization, as it is a vital aspect of organizational performance (OP).¹ Organizations need to improve their performance to survive, grow, and increase profitability. Incorporating knowledge into an organization's culture is crucial for enabling employees to demonstrate their dedication and engagement, which is fostered by management.² Every organization, including health and treatment centers, requires the assistance of various fields of knowledge to accomplish its objectives. This will preserve the competitive advantages of these organizations and reduce costs.^{3, 4} Correct and beneficial access to knowledge within these organizations will result in prompt and appropriate responses, providing the best services.⁴ Insufficient knowledge within these organizations can lead to irreparable medical errors and increased costs.⁵ The research conducted by Ayatollahi and Zeraatkar in Iran demonstrated that organizational culture and structure, information technology, and performance evaluation and measurement were identified as the key factors that influenced the successful implementation of KM in healthcare organizations.⁶

Therefore, organizations have recognized the importance of KM processes, such as acquiring and creating knowledge, sharing knowledge, and preserving and applying knowledge among individuals both within and outside the organization. KM processes, especially the sharing of organizational knowledge in the workplace, can enhance employees' job satisfaction (JS).⁷ Knowledge sharing is the exchange of individual and group information within an organization.⁸ Knowledge sharing promotes learning, innovation, and problem-solving. Employees who engage in knowledge sharing feel valued and recognized for their expertise, which leads to enhanced JS and promotes teamwork. Leal and Marques argued that sharing formal knowledge within healthcare organizations increases JS among healthcare professionals, and also enhances their perceived performance.⁹

Knowledge transfer refers to the interactive process of transferring knowledge from one individual or group to another through formal training programs, mentorship, or documentation. Knowledge transfer is crucial for preserving organizational knowledge, preventing knowledge loss, and maintaining OP. Promoting and facilitating the exchange and dissemination of knowledge, as well as providing adequate job training, have the potential to enhance levels of JS.¹⁰ Conversely, the absence of a culture that promotes knowledge sharing or insufficient support for knowledge transfer can lead to a decline in JS. By actively encouraging knowledge sharing and transfer within healthcare organizations, satisfaction levels can be elevated, ultimately leading to improved performance.¹¹ Health and medical organizations can foster collaboration and professional growth by implementing strategies that effectively manage knowledge.¹² This includes addressing existing gaps in organizational knowledge and creating a conducive environment for continuous employee learning. As a result, this can lead to an increase in JS levels and overall organizational success.

KM has a significant impact on OP. However, employee JS is also a crucial factor that affects OP. JS, which refers to an individual's attitude toward their job, can result in higher productivity, the acquisition of new skills, and a stronger commitment to the organization. Locke¹³ defined JS as a pleasurable emotional state that arises from an individual's evaluation of their job experiences.¹⁴ Satisfied human resources are valuable assets that contribute to the efficiency of an organization. Management characteristics affect employee satisfaction. Therefore, organizations should pay attention to the needs of their employees to improve efficiency and sustainability.¹⁵ Numerous studies in the field of JS have demonstrated that several variables are associated with JS and can be categorized into four groups: organizational factors, environmental factors, individual factors, and the nature of work. Smith et al.¹⁶ examined six subscales of JS, which included the nature of work, supervisor, colleagues, promotion opportunities, salary, and work environment. In general, JS refers to an individual's overall sense of contentment with their job within an organization. JS is related to various factors, including the quality of relationships with colleagues and superiors, job performance, perceptions of organizational culture,¹⁷ successful job experiences, and the fulfillment of logical needs.

Human resources are considered the primary and most valuable factor in OP. Therefore, the utilization of KM, OP, and ultimately, employee JS as key factors in the success of organizations is particularly significant. This research can be useful for the Health and Treatment Network of Haji Abad City, as well as other health and treatment networks in Hormozgan Province and throughout Iran. By examining the current state of KM and implementing necessary measures through regional and national plans, officials and policymakers in the healthcare sector can identify areas for improvement. This, in turn, can enhance JS and OP of employees. Therefore, in this study, the researcher aims to answer the question of whether there is a relationship between KM, OP, and JS among employees in the Health and Treatment Network of Haji Abad City. Although many studies have been conducted regarding KM in the banking and tourism industries, few studies have been conducted in the field of healthcare. Healthcare organizations play an important role in addressing knowledge gaps by consistently generating new knowledge. This research aimed to investigate the effect of three variables of KM, JS, and OP on the employees of the Health and Treatment Network in Haji Abad City by using the SEM approach.

2 METHODOLOGY

The research population consisted of employees from the Haji Abad Health and Treatment Network. These included 480 employees working in various locations Within the Health Network (63), Fatima Al-Zahra Hospital (169), Amani Martyr Center (26), Ansari Martyr Center (21), rural centers (165), and health emergencies (36) in Haji Abad City, Hormozgan province, Iran. Two hundred and fourteen employees were selected from this population using stratified random sampling. Out of the 214 distributed questionnaires, 211 questionnaires were returned. (Response rate: 98.6%). Answering the questionnaire was completely free, and informed consent was obtained from all employees, including physicians, nurses, midwives, environmental and occupational health experts, administrative staff, laboratory staff, radiology staff, and other healthcare workers, before completing the questionnaire. Three questionnaires were used in this study. Newman and Kennard's standard questionnaire consists of 22 questions,¹⁸ Hersey and Goldsmith's questionnaire with 28 questions,¹⁹ Smith Kendall and Hulin's questionnaire with 32 questions,¹⁶ were used for assessing KM, OP, and JS, respectively. In the research questionnaires, a 5-option Likert-type scale was used, with ranging from 1 (completely disagree) to 5 (completely agree). The hypothetical model presented in this research includes KM processes (creation, transfer, application, and retention), JS (work, promotion, superiors, salary, and colleagues), and OP (job ability, understanding, support, motivation, feedback, validity, and environmental compatibility). In this study, the independent variable was KM, while the dependent variables were JS and employee performance. To assess the reliability of the questionnaire, the initial questionnaire was first distributed to 30 employees, after collecting the initial data, Cronbach's ɑ reliability index was calculated for the variables. The Cronbach's ɑ values ranged from 0.72 to 0.94. This research employed confirmatory factor analysis to ascertain whether the items effectively represent the intended factors (structures). The diagnostic validity method was then used to determine the constructs' average variance index or correlation matrix. Additionally, in the exploratory factor analysis, the eigenvalues' percentage of variance was used to rotate the factors. Structural equation modeling (SEM) was performed using LISREL 8.8. This research has been approved by the ethics code of IR. HUMS.REC.1402.015 by the Hormozgan University of Medical Sciences.

3 RESULTS

Data were collected from 211 employees (physicians, nurses, technicians). Of these employees, 57.3% were men, and 67.9% of them were between the ages of 30 and 50. Additionally, 35.5% of the participants had work experience ranging from 6 to 11 years, while 61.6% of them had a bachelor's degree or higher (Supporting Information: Table 1). According to the fit indices values for the SEM in KM, OP, and JS presented in Table 1, the research model demonstrates a good fit. The values obtained for the RMSEA, root mean square residual, incremental fit index, comparative fit index, normal fit index, and non normed fit index indices were all within the appropriate range, except for the GFI index. Therefore, the acceptance criteria for the indices have been met. Additionally, the three investigated models were validated overall, as indicated by the fit indices.

According to Figure 1, the standard coefficient results for the relationship between KM and OP were 0.70, and for the relationship between KM and JS were 0.80. There was a significant relationship between KM and both OP and JS among employees of the Health Treatment Network in Haji Abad City.

The standardized coefficients obtained from modeling the structural equations of KM processes on OP are shown in Figure 2. The correlation coefficient between knowledge retention and OP was 0.74. There was a significant relationship between knowledge retention and OP.

According to Figure 3, the standard coefficient between knowledge creation and JS was 0.45, while the coefficient between knowledge retention and JS was 0.33. The relationship between knowledge transfer and JS was not statistically significant. Furthermore, the standardized coefficient for the relationship between knowledge application and JS was 0.74. This study revealed a significant relationship between KM processes (creation, retention, and application) and JS among employees of the Health and Treatment Network in Haji Abad City. The Three investigated models were confirmed overall, as indicated by the fit indices.

Summarized results for the effects of the variables are shown in Table 2. The results showed that all of the standardized coefficients fell within the range of 0.3– 0.6. As shown in Table 2, the effect magnitudes of knowledge transfer and JS did not fall within the range of 0.3–0.6. Therefore, the relationship between knowledge transfer and JS was not considered significant.

4 DISCUSSION

This research aimed to investigate the effect of three variables of KM, JS, and OP on the employees of the Health and Treatment Network in Haji Abad City by using the SEM approach. The demographic data of this study demonstrated a higher percentage of males with educational levels of bachelor's degree or higher respondents in Health and Treatment Network. The SEM results showed that the research model had a good fit, and the indicators met the acceptable level. In the modeling section, the results indicated a significant and direct relationship between the indicators of the independent variable, KM, and the dependent variables of JS and OP. In general, a significant relationship was found between KM and JS. In other words, JS also increases when KM among employees increases or improves. Different researchers consider new management methods, including KM, as a solution for organizations to gain a better understanding of their employee's strengths and weaknesses. By understanding the needs of employees, organizations can work toward resolving any issues they may have. KM is beneficial for both employees and the organization as it promotes employee retention and familiarizes employees with the organization. Similar to our study the findings of the Kiano study indicate a strong correlation between the presence of KM processes in the workplace and increased levels of JS. In particular, the sharing of knowledge within the organization emerges as a crucial KM process that enhances JS across various employee groups.¹ Also consistent with our study, the findings of Masa'deh's study in Jordan showed there was a significant positive impact of KM infrastructure on JS. They also mentioned that organizational culture had the highest effect on JS, followed by information technology.⁷ Also, in line with the findings of our study, a study conducted by Tsogtsuren and Tugsuu in Mongolia compared JS and commitment among employees in public and private universities. The study found that factors such as KM and employee participation have a positive effect on JS.¹⁴

The standardized coefficients obtained from modeling the structural equations of KM on OP showed the correlation coefficient between KM and OP was 0.70, which, indicated the strong and direct impact of KM on OP. And there was a significant relationship between KM and OP in the Haji Abad Health and Treatment Network. In other words, increasing KM leads to improved OP. Today, KM is recognized as an important tool for maintaining a competitive advantage and improving OP. The results of numerous studies conducted in different parts of the world indicate a direct correlation between KM and improved OP. Thus, if the quality of organizational knowledge is good, it can be expected that the performance of the management and organization will improve significantly. This finding is consistent with the study conducted by Tang.²⁶

The standardized coefficients obtained from modeling the structural equations of the KM process on JS showed that the correlation coefficient between knowledge creation and JS was 0.45, while the correlation coefficient between knowledge retention and JS was 0.33. This indicates a positive and direct impact of knowledge creation and retention on JS. Furthermore, the standardized coefficient for the relationship between knowledge application and JS was 0.74, indicating a strong and direct impact of knowledge application on JS. There was a significant relationship between the dimensions of KM (knowledge creation, knowledge application, and knowledge retention) and JS but our results showed no significant relationship between knowledge transfer and JS of employees in the Haji Abad Health and Treatment Network. According to Hernaus et al.²⁷ study, despite the diligent attempts made by organizations to encourage knowledge sharing among employees, research indicates that in numerous cases, organizational members tend to conceal their knowledge from others. Numerous studies have been conducted in the realm of knowledge hiding and its underlying factors. These studies have demonstrated that knowledge hiding is influenced by individual distrust and knowledge complexity,²⁸ as well as psychological characteristics²⁹ and the level of competitiveness within the organization.²⁷ The fear of losing the power level is a big obstacle in sharing knowledge. Our results showed no significant relationship between knowledge transfer and JS of employees in the Haji Abad Health and Treatment Network. In our study, it appears that the complexity of tasks and time plays a significant role in the aforementioned issue. The primary goal in the healthcare sector is to efficiently provide high-quality medical and therapeutic services to patients. However, the lack of human resources and time constraints caused by excessive workload hinder the staff's ability to participate in knowledge transferring and sharing. In addition, there may be other factors, such as organizational culture, leadership style, or work-life balance, that could potentially impact JS. However, these variables were not included within the scope of our research.

Considering today's cyber-technological era, the key to the success of organizations is to align with the technological advancements of the day to compete at the international level. Therefore, organizations with knowledge-oriented characteristics should be at the forefront of identifying existing gaps, eliminating obstacles, and creating new knowledge. The results of our investigation align with the research conducted by Purwanto.³⁰ Additionally, our findings are consistent with the study conducted by Arif and Rahman which examined KM in various industries, including healthcare.³¹ Both studies revealed a positive association between JS and KM. Extensive research and validation have demonstrated that job design, skill variety, and position ambiguity are essential factors contributing to high levels of JS among nurses.³² Similar to our study, the study conducted by Khalil et al. on nurses at a hospital in Pakistan showed the impact of KM on JS.³³ The findings of Andreeva and Kianto showed that knowledge processes, especially knowledge creation, have a positive impact on innovation. Additionally, knowledge documentation and sharing are effective tools for creating and promoting knowledge within organizations.³⁴ The findings of Risambessy et al., conducted in a hospital setting, have demonstrated a significant and positive impact of knowledge-sharing practices on employee performance. Moreover, the study also revealed that organizational citizenship behavior had a significant and constructive influence on employee performance. However, JS did not had any significant influence on employee performance.³⁵ Knowledge transfer is crucial for disseminating information and exchanging ideas within an organization. Despite personnel turnover, it allows for the retention of knowledge within the organization. Knowledge transfer can have both positive and negative impacts on JS. It depends on factors such as effective communication, proper workload management, recognition of employees' contributions, and support for career development. Knowledge transfer may not directly impact JS among healthcare employees. Factors such as the work environment, organizational culture, effective leadership, individual differences, values, and motivation can influence the impact of knowledge transfer on JS. Therefore, it is expected that a series of internal and unmeasured variables will moderate the relationship between these two variables. The lack of time to transfer knowledge can be a factor that moderates this relationship. The employees of an organization usually spend most of their time on tasks that benefit them. Many studies had results that contradicted our findings, such as the study conducted by Rafique and Mahmod. Their research demonstrated that knowledge sharing had a positive influence on JS, and conversely, JS had a significant impact on knowledge sharing among individuals employed in various organizations.³⁶ Of course, some studies, such as de Vries et al.,³⁷ associate the effect of mediators like willingness to share and passion with knowledge sharing. And also, Popa et al. conducted a study in the Romanian healthcare system found that KM practices had a significant impact on the satisfaction of healthcare workers. They also discovered that knowledge acquisition variables positively influenced worker satisfaction, while, conversely, increasing knowledge sharing decreased employee satisfaction. They considered the influence of the moderating variable, specifically the type of health organization, on the variability of intergroup relations to be related to this result.³⁸

The standardized coefficients obtained from modeling the structural equations of KM processes on OP showed that the correlation coefficient between knowledge retention and OP was 0.74, which indicates a strong and direct impact of knowledge retention on OP. There was a significant relationship between the dimensions of KM (creation, transfer, retention, and application) and OP among employees in the Health and Treatment Network in Haji Abad City. Past literature on the effect of KM on performance shows a positive impact.³⁹ Similar to our study, a study conducted by Etori and Alilah found that KM had a significant impact on OP. They also found that giving importance to KM by the managers of the institutes improved their performance. This is effective for the sustainable development of institutions and the well-being of employees.⁴⁰ In consistency with our results, a study conducted in Malaysia by Ha et al. showed that four KM processes enhance OP. Additionally, it has a positive correlation with both financial and nonfinancial performance.⁴¹ Hosseini et al.'s study showed the mediating role of knowledge application and its transfer in knowledge storage and innovative performance in Iranian hospitals.⁴² The application of knowledge within an organization can lead to the generation of new knowledge in the organizational knowledge cycle.

5 CONCLUSION

The study's findings addressed the primary research question, which examined the correlation between KM, JS, and OP among employees of the Haji Abad Health and Treatment network. The research model had a good fit, and the KM processes had a positive effect on both job performance and JS. However, no significant relationship was found between knowledge transfer and JS among employees in the Haji Abad Health and Treatment Network. These results could assist healthcare administrators and policymakers in enhancing satisfaction and performance through the implementation of KM strategies. More research is needed to identify mediating variables and factors influencing this phenomenon in healthcare centers.

6 LIMITATION AND FUTURE RESEARCH

By ensuring the confidentiality of information, conducting group analysis of data, and allowing voluntary participation in the study, we were able to address employees' hesitation to answer the questionnaire. Factors such as conservatism, inaccuracy, and frankness can influence how participants respond, and individuals may have various reasons for not accurately reflecting on themselves and the organization. This limitation was addressed by the researcher through prequestionnaire discussions with the employees. During these discussions, the researcher provided information about the research variables, explained the impact of these variables on improving the work environment and relationships within the organization, and aimed to create a friendly and calm atmosphere. This research utilized the SEM approach to examine the relationships between KM, JS, and OP. Further studies, employing quantitative and qualitative approaches, as well as meta-analysis, can be conducted to explore other potential relationships, especially when considering mediating variables.

AUTHOR CONTRIBUTIONS

Nasrin Fadaie: Conceptualization; data curation; visualization; writing—review & editing. Parvin Lakbala: Conceptualization; project administration; supervision; writing—original draft; writing—review & editing. Amin Ghanbarnejad: Formal analysis; methodology; writing—review & editing.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ETHICS STATEMENT

This study was approved by the ethical committee of HUMS (approval number IR. HUMS. REC.1402.015).

TRANSPARENCY STATEMENT

The lead author Parvin Lakbala affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.