2.1 Diversity and performance

Diversity is clearly a very hot topic in the social and business fields. Wherever diversity is embraced, it becomes a key success factor for business performance and social development because diverse groups of workers, managers, and stakeholders bring rich ideas, sift skills, and managerial practices into organizations (Joniaková et al., 2021). Diversity when adopted could also boost creativity and therefore leads to improve economic growth and cultural interaction among groups. A number of theories have attempted to explain the pros and cons of diversity. According to social identity theory (Turner et al., 1979), employees are attracted to colleagues and groups sharing the same gender, education, age, or ethnicity with them. This type of scenario does not help organizational growth and development. In the opinion of Turner et al.  (1979), that social identity perspective makes employees classify themselves in a particular group in which they feel comfortable and fit in. Consequently, the perspective creates an atmosphere of discrimination, bias, and conflicts, leading to decrease performance.

However, the social dominance theory (Sidanius et al., 2004) explains how some groups can exert influence and discrimination on other groups by not embracing diversity. For this theory, the existence of a dominant group can lead to inefficiency and most often threaten the efficient allocation of resources. Thus, leaders must better understand the concept of diversity and its consequences within the organizations (Homan et al., 2020). Harrison and Klein (2007) therefore described diversity as the collective differences among people within a society. This definition includes all types of differences between employees. Hayes-Thomas (2004) defined diversity as differences between humans that could affect their opinions, behaviors, performance, and work achievement. For Henry and Evans (2007), diversity is the combination of workforce groups based on different socio-cultural categories. In the literature, diversity has two dimensions, namely: visible and non-visible (Ashton, 2010; Harrison et al., 2002). The visible or surface diversity encompasses demographic characteristics such as age, gender, race, disability, and ethnicity. The non-visible or deep diversity level includes values, knowledge, experience, education, religion, income, marital status, social class, and other not immediately visible common characteristics.

Several studies have revealed that diversity like age, gender, and ethnicity can improve organizational performance. Gender diversity can stimulate innovative alternatives helping decision-making and problem-solving in complex contexts (Westphal & Milton, 2000). The presence of women in strategic positions such as membership of the board of directors can improve the decision-making, compensation policy, and financial performance (Ntim et al., 2017). Furthermore, it has been empirically proved that the existence of employees of different ethnic origins within the same organization enhanced the team performance and therefore, leads to improve financial performance (Opstrup & Villadsen, 2014). Different members from different cultures and countries could raise the knowledge exchange and enhance the organizational performance (Simbarashe et al., 2019). However, some companies can experience negative effects from the existence of different nationalities and races when the minority groups are treated with discrimination mainly during the crisis (Foma, 2014).

Moreover, the existence of different generations of employees inside the organization can provide a pool of mutual learning and enhance the transfer of experience from old professionals to young generations (Page, 2007). The presence of heterogeneous age groups of workers helps to enhance the satisfaction of customers (Canella et al., 2008). Richard and Shelor, (2002) found that age heterogeneity is associated with better organizational productivity and increase performance of the decision-making process. Diversity theorists explained that value diversity (a non-visible dimension) should be given serious consideration in the organizations (Jehn, 1994) because this diversity type shapes the behavior of the workforce and helps predict the output of employees (Hackman, 1990). Some studies also affirmed that value diversity has a significant impact on team success and performance. Another study reveals the positive impact of value diversity on the performance of organizations (Liang et al., 2012; Wang et al., 2020).

With specific reference to the healthcare industry, several scholars (Bradley, 2020; Brimhall, 2019; Gomez & Bernet, 2019; Koopmans et al., 2018; Rosen et al., 2018; Sfantou et al., 2017; Smith et al., 2018; Yousaf et al., 2021) explained that diversity can functionally improve both financial performance and patient care satisfaction. Their various studies revealed that healthcare professionals from different disciplines and levels can enhance the quality of care, improve performance and reduce the mortality rates in the hospitals. During the Covid-19 pandemic period, Joniaková et al. (2021) stated that both diversity management and diverse workforce have helped to develop creativity, improve team productivity and increase patient satisfaction in the hospitals, clinics, and care centers.

Similarly, Kringos et al., (Kringos et al., 2020) explained that in responding to the challenges posed by the ongoing pandemic, the managers in the health sector have resorted to mobilizing an interdisciplinary workforce from diverse backgrounds of health research, health information, medicine, health economics, medical statistics, health management, and public administration. The interdisciplinary diversity and collaboration became expedient and inevitable for a high level of communication, knowledge-sharing, and effective departmental coordination during the pandemic period for the purpose of improving the efficiency and outcome of teamwork. Based on the reviewed literature, the strategic practice of diversity has the plausibility of improving the performance of organizations. Thus, the first hypothesis is stated as follow:

H₁1- Diversity has a positive impact on the performance of healthcare sector during the Covid-19 pandemic period.

2.2 Entrepreneurial innovation and performance

Several studies discussed the effects of entrepreneurial innovation in the period of the COVID-19 pandemic on the performance of the small and medium enterprises/SMEs (Adam & Alarifi, 2021; Gerald et al., 2020; Guo et al., 2020). Particularly, Adam and Alarifi (2021) found that innovative practices adopted by SMEs during the pandemic had a positive effect on the performance and likelihood of business survival. Moreover, Guo et al. (2020) found that the deployment of digital technology has been helpful to SMEs for operational survival and the ability to cope with the adverse effects of the pandemic. Similarly, Gerald et al. (2020) revealed that strategic agility (an innovative practice) could help mitigate the negative effects of the pandemic on the performance of SMEs. The insights from all the foregoing findings validate the importance of entrepreneurial innovation in the recessionary period. Entrepreneurship as innovation is described as the best-known concept of entrepreneurship in economics credited to Joseph Schumpeter, who described an entrepreneur as an innovator (Foss & Klein, 2005). In the recessionary period, the Schumpeter's entrepreneur adjusts, adapts, and develops coping strategy that allows for the introduction of “new combinations”—new products, production methods, markets, sources of supply, or industrial combinations—thereby shaking the economy out of its previous equilibrium through a process of creative destruction (Foss & Klein, 2005; Schumpeter, 1911, 1939, 1949).

Besides, the behavioral theory (Cyert & March, 1963) explicates that organizations must adapt and embrace new strategies and activities in the period of uncertainties to enhance their performance and increase their competitive advantage. The initiation and implementation of research and development activities could help any organization sustain and develop its capabilities in an unstable environment. Similarly, the knowledge and resource-based theories are premised on the explanation that innovation inside the organization is important because it leads to enhance the competitive advantage and improve the overall performance (Mejri et al., 2018). Sharing and employing relevant and innovative knowledge could help any organization to improve its capacity to face crises and turbulent periods (El-Chaarani et al., 2021). From the foregoing, theories, the term entrepreneurial innovation can be viewed simply as creating competitive advantage in the market domain, by substituting, improving, renewing, and reinventing new products, services, and processes while responding to entrepreneurial opportunities (Nițu-Antonie, Feder and Munteanu, 2017). It extends is finding novel ways and means of delivering new, improved, better goods or services to the people and the society (Kinicki & Williams, 2010). El-Chaarani et al. (2021), Hu et al. (2020), and Montreuil et al. (2020) identify four important categories of innovation that can be implemented by medical and non-medical organizations. The first type of innovation is marketing innovation defined as the employment of new marketing methods and techniques related to place, promotion, price, and product to develop sales and improve competitive advantage (Hunt & Morgan, 1995). The second category of innovation is the product innovation identified as the implementation of a new product or the improvement of product features, characteristics, and functions to improve customers' perceptions and loyalty (Martínez-Román & Romero, 2017). The third type is process innovation defined as the improvement of procedures, processes, logistics, assembly line, and software to meet consumers' needs, reduce costs and improve financial performance (Ganzer et al., 2017; Karlsson & Tavassoli, 2016). The final type is organizational innovation defined as the implementation of new human resource management techniques and administrative procedures to improve organizational performance and decision-making methods (Armbruster et al., 2008; Damanpour et al., 2009).

Several scholars have revealed the impact of innovation on the performance of organizations during the Covid-19 pandemic period (Akinwale, 2020; El-Chaarani, 2021; El-Chaarani et al., 2021; Wang et al., 2020). They showed that innovation is very important during the crisis because it leads to provide efficient responses to customers' needs, and thus, could improve the competitive advantage. They argued that innovation has a direct and positive impact on the financial and non-financial performance of organization and leads to mitigate the liquidity risk and market volatility.

Lindgren et al., (2012) revealed that the rising cost and competition in the European healthcare sector cannot be met without the implementation of innovation. They recommended managers in European medical centers to implement the Open Business Model Innovation (O.B.M.I.) to enhance the overall performance. Yaqoob et al., (2021) stated that the implementation of innovation like blockchain technology in the healthcare sector can lead to improve data management and produce major enhancements mainly during a natural disaster. But, Vrontis et al. (2021) showed that the medical sector must implement a high level of managerial innovation and dynamism to sustain during the Covid-19 pandemic period. They showed that practicing dynamic and innovative managerial skills leads to improve the competitive advantage and enhance the financial and non-financial performance of the Lebanese health sector during the pandemic period. Darwish et al. (2020), confirmed the positive impact of innovative work behavior during the pandemic period for medical representatives in Bahrain. For Da Silva et al., (2021), the Covid-19 pandemic has promoted the dialog between governments, industries, and experts in the healthcare sector. They stated that innovation in science and technology needs to be improved during the post-pandemic period to make societies and governments well-prepared for future pandemics and emergencies.

The positive effect of innovation and new technology was also revealed by Alhasan et al. (2020). They stated that the use of Internet of Things (IoT) technology facilitated the mission of doctors during the pandemic period. The implementation of IoT technology in the healthcare sector led to sustain and meet patients' needs during the isolation period. Based on the reviewed literature and insights from the various theories of innovation, it is obvious that entrepreneurial innovation has the plausibility of enhancing the performance of the healthcare centers in the period of public health crisis. Thus, the second hypothesis that underpins this study is defined as follow:

H₁2- Innovation has a positive impact on the performance of healthcare sector during the Covid-19 pandemic period.

2.3 Diversity and entrepreneurial innovation

In the emerging knowledge-based economy, commercial and social organizations rely more on their intangible assets such as knowledge, skills, and abilities to gain competitiveness (Teece et al., 1997). Organizations with a variety of experiences and backgrounds among their workforce may have more capacity to be efficient (Quintana-Garca & Benavides-Velasco, 2008) and innovative (Bolli et al., 2018; Gallego & Gutiérrez, 2018; Gharama et al., 2020; Mir-Babayev et al., 2017) in different business fields. As a result, employee diversity is an important factor that could boost organization's development and innovation because both concepts improve the level of knowledge, ideas generation, and creativity (Woodman et al., 1993). Also, the adoption of diversity in terms of skills, genders, cultures, age categories, and educational backgrounds by an organization could help implement innovative strategies and consequently leads to mitigation of the risk of the Covid-19 pandemic (Vrontis et al., 2021).

A number of studies explored the nexus between innovation capabilities and workforce diversity. For instance, Özgen et al., (2013) found that a diverse foreign workforce within the same organization enhances innovation capabilities, and therefore, leads to improved outcomes. Similarly, the study of Gharama et al., (2020) revealed that cultural diversity improves the level of innovation, and diversity also plays the role of mediating variables in the relationship between innovation and strategic leadership. Furthermore, Ramasamy and Yeung (2016) found that value diversity (a non-visible asset that diverse people bring to an organization) has a positive impact on innovation while ethnic diversity has a negative influence on innovation. This study places emphasis on value diversity and downplays ethnic diversity. Moreover, a number of studies affirmed that that gender diversity has a positive impact on innovation. For instance, Gallego and Gutiérrez (2018) indicated that women's participation in manufacturing firms increases both technological creativity and organizational innovation. Pfeifer and Wagner (2014) also showed a positive impact of gender diversity on the innovation level of German manufacturing firms. They argued that women's participation increases the research and development investment, and therefore improves the financial performance. Similarly, Mir-Babayev et al., (2017) confirmed that both gender diversity and foreign diversity have a positive impact on innovation performance mainly when there is a moderate diversity level.

Besides, the nexus between age diversity and innovation has been reported in the literature. Different age categories with diversified knowledge and skills could facilitate the generation of new ideas and that are required to improve the relationship with customers from different age demographics (Galia & Zenou, 2012; Kang et al., 2007). In other words, they explicated the need for mixing employees with different age categories in order to stimulate innovation and improve organizational performance in the short and run. Backes-Gellner and Veen (2013) confirmed that age diversity could have a positive impact on innovation, and the impact extends to performance if employees are engaged in creative missions rather than routine activities Additionally, De Meulenaere et al., (2016) showed that the impact of age diversity on innovation depends on age distribution inside the organization. They found age diversity has a negative influence on innovation when it is polarized, but age diversity has a positive influence on innovation and performance when it is varied. Whereas, Mothe and Nguyen-Thi (2017; 2021) found a positive association between technological innovation and age variety, but age diversity has a negative impact on innovation and performance when tasks are classified based on sub-groups of homogeneous age categories.

But, Østergaard et al. (2011) argued that age heterogeneity could negatively affect innovation and creativity due to the potential conflicts between distinct age groups. Scholars argued that managers can control and manage potential conflicts that may arise from age diversity in organizations by improving the governance system, organizational efficiency, and internal communication between different business units (García-Martínez et al., 2017; Li, 2014). Gomez and Bernet (2019) studied the interaction between workforce diversity, financial performance, outcome, and innovation in the health sector, and consequently found that diversity can enhance innovation and thus subsequently leads to improved patient health outcomes and financial performance. All the insightful findings explicated above are supported by the information processing theory, which asserts that diversity could enhance organizational performance through an increase in shared knowledge (knowledge donation and knowledge collection) and innovation (Chung & Hossain, 2009). Based on the reviewed literature, diversity could enhance the innovation level and thus, may lead to improve the performance of the Lebanese healthcare sector. In addition, the impact of innovation on performance is conditioned by nature and the level of diversity. Thus, the last hypothesis is defined as follow:

H₁3- Diversity has a positive impact on the innovation in healthcare sector during the Covid-19 pandemic period.

3.1 Method and model definition

This study aims to explore the relationship between diversity, innovation and performance in the Lebanese healthcare sector during the Covid-19 pandemic period. The different sub-objectives of this research are: (a) reveal the impact of workforce diversity on entrepreneurial innovation, and (b) reveal the impact of workforce diversity on performance, (c) reveal the impact of entrepreneurial innovation on performance (Figure 2).

In this article, Structural Equation Modeling (SEM) approach is employed to reveal the interaction between innovation, diversity, and performance of the Lebanese health sector during the pandemic period. The first phase of the empirical research includes the evaluation of the reliability and consistency level of all items in each of the following constructs: entrepreneurial innovation, diversity, and performance. The second phase provides the analysis of the causal relationship between entrepreneurial innovation, diversity, and performance through SEM (Figure 3).

The analysis of the causal relationship between entrepreneurial innovation, diversity, and performance has two major socio-economic contributions. On the economic level, the exploration of causal pathways could help executives in healthcare sector to enhance their managerial practices by optimizing their workforce diversity practices and thus, leads to improve the innovation and performance of their medical organizations. On the social level, revealing the importance of workforce diversity in healthcare sector leads executives to review their workforce diversity practices, improve their communication strategies and eliminate any type of discrimination between different genders or different ages. In addition, the improvement of diversity practices could help executives to overcome the managerial instabilities by lowering the level of pressure on women (Boniol et al., 2019) that are suffering from high social stresses due to the unbalance between their work and their family duties during the extended lockdowns.

3.2 Sample definition

Data for this study were gathered directly from the Lebanese private healthcare centers. The 14 public hospitals in Lebanon were not considered in this study because they lack the required flexibility and capacity to innovate in the time of crisis. The financial system and human resource management operations of public hospitals are directly controlled by the ministry of public health in Lebanon. Unlike private hospitals, public hospitals have a high level of bureaucracy and rigid routine, which would not allow their managers and top executives to embrace diversity. The contacts (email, address, telephone number) of the selected private healthcare centers were directly extracted from the database of the ministry of health. From the 111 private hospitals in Lebanon, only 87 accepted to participate in this study and complete the survey (Figure 4).

The survey was distributed through emails after the questionnaire instrument had been pre-tested through a sample of 10 patients and 7 executives in the Lebanese private hospitals. The tasks of negotiating access, sample selection, questionnaire administration, and data collection were carried out in the first quarter of 2021.The sample of this research consists of two types of respondents. The first category of respondents is composed of 10 patients from each hospital. The second category of respondents is composed of three top executives from each of the selected hospitals comprising the head of the medical department, the head of the nurse department, and the head of administrative and logistic department. Overall, a total of 870 patients and 261 executives participated in this research (Figure 5).

Table 1 presents the demographics of the 261 executives (87 nurses, 87 physicians, and 87 administrative directors). All the executives were Lebanese citizens, there were no foreigners. With regards to age, the majority were in the age category of 30–40 years old (25.7%) and 40–50 years old (28.4%). The majority of the executives were women (70.1%). Out of the 261 executives, 42.5% had between 10 and 20 years of experience. Finally, the majority of the employees (86.3%) and nurses (79.4%) held bachelor's degree.

Table 2 presents the demographics of the 870 patients from 87 healthcare centers. All the executives are Lebanese citizens, there were no foreigners. The majority of the patients were in the age category of 50–60 and above 60 years old. Only 17.59% of the respondents were infected by Covid-19. Out of the 870 respondents, 44.02% were female. Finally, the majority of patients (62.3%) passed less than 5 days at the hospital.

3.3 Constructs definition

The variables that underpin this study were measured through multi-item construct based on previous research and after several modifications to make them fit with the Lebanese healthcare context. All variables and their constructs are presented in Table 3. All items were evaluated based on a 5-point Likert scale ranging from strongly agree (5) to strongly disagree (1).

Three different diversity constructs were considered namely: age, gender, and value. The other diversity constructs like ethnic origin, race, and education were not considered because of high level of homogeneity in the Lebanese health sector.

Two different dimensions of entrepreneurial innovation were considered in the Lebanese health sector, namely: process innovation and organizational innovation. The other innovation constructs like marketing innovation and product innovation were not considered because the Lebanese medical centers at the period of pandemic focused saving lives through treatments sick people and providing essential medical services at a minimum cost to the citizens. Finally, the performance of the health sector was evaluated based on three basic constructs: organizational performance, financial performance, and patients' performance (satisfaction).

4.1 Descriptive analysis

The diversity constructs do not have convergent results in the Lebanese health sector. Table 4 shows that women were well represented in the Lebanese medical centers during the pandemic period. All the mean values of gender diversity are above 3.34. However, there was a low level of age diversity in Lebanese medical centers. The result shows that young employees were not well represented in different hierarchical levels in the Lebanese health sector in spite of the fact that these young employees were provided career development opportunities. Moreover, the results in Table 4 indicate that the value diversity was moderated in the Lebanese healthcare sector during the pandemic period. The average means of value diversity are ranged from 3.01 to 3.44.

The Lebanese health sector showed high ability to innovate their process and organizational procedures (Table 5). During the pandemic period, the Lebanese medical centers improved their services speed, logistics, and procedures. They revised their cost and allocated them to cover pandemic costs. Furthermore, they upgraded and modified their managerial procedures, human resources management, managerial cycle, and strategic decisions. However, the medical centers were not focusing on the technological level during the Covid-19 pandemic period. They did not innovate their software, technologies, and management information system.

Table 6 shows that the mean values of financial performance indicators were very low (between 1 and 2.25) while the mean values of organizational performance indicators were above the average (between 3.05 and 3.96). Thus, the financial situation of the Lebanese health sector was very critical during the pandemic period. However, physicians, nurses, and employees showed high levels of commitment and engagement. The level of patients' satisfaction during the covid-19 pandemic period was very low and not convergent (Table 6). The mean values of medical service quality and facilities and hygiene are 2.85 and 2.72, respectively, while the mean value of staff quality is 3.75.

4.2 Causal relationships and hypotheses testing

The SEM was employed to explore the relationship between diversity, entrepreneurial innovation, and performance of the Lebanese healthcare sector during the Covid-19 pandemic period. The confirmatory factor analysis (CFA), values of composite reliability (CR), average variance extract (AVE), and Cronbach's alpha (Cronbach a) reveal that the SEM model used in this research has a high level of reliability (Table 7). The values of CFA are greater than 0.6, the minimum threshold, the values of CR and Cronbach's alpha are above than 0.7, the minimum acceptable level and, finally the values of the Average Values Extracted are greater than 0.5, the minimum threshold, indicating that the model is reliable and consistent.

All the validity indices (IFI:Incremental Fit-Index; NFI:Fitness of Extracted-Index; NNFI: Non-Normal Fit-Index; RMR: Root Mean Square of Residuals; SRMR: Standard Root Mean Square Residual; RMSEA: Root Mean Square of Approximation and Chi-Square) are within the acceptable standards and thresholds (Table 8). The values of incremental fit-index, non-normal fit-index and fitness of extracted-index are above 0.9, the minimum acceptable threshold. The values of root mean square of residuals and standard root mean square residual are close to zero, the acceptable standard. And finally, the values of Root Mean Square of Approximation and Absolute Value of the Residuals are within the acceptable standard. They are less than 0.1 and 3, respectively. Thus, all items and constructs must be maintained.

The results in Table 9 shows all the causal pathways between diversity, entrepreneurial innovation, and performance of the Lebanese healthcare sector during the Covid-19 pandemic period. The analyses of all the results are presented in the three next subsections.

4.2.3 Diversity ➔ performance

The result of SEM in Table 9 reveals that age diversity has a positive impact on organizational and patient performance. The coefficient causal pathway from age diversity on organizational performance is (+0.260) and from age diversity on patient performance is (+0.248). The result also shows that gender diversity increases organizational and patient performance. The coefficient causal pathway from gender diversity on organizational performance is (+0.313) and from gender diversity on patient performance is (+0.371). Oppositely, the result does not show any significant causal pathway between value diversity and performance. Moreover, there is no significant causal pathway between diversity (age and gender) and financial performance. Therefore, the first hypothesis H1 in which “Diversity has a positive impact on the performance of the health sector during the Covid-19 pandemic period” is partially supported. This result confirms several empirical studies in the health sector (Bradley, 2020; Brimhall, 2019; Gomez & Bernet, 2019; Koopmans et al., 2018; Rosen et al., 2018; Sfantou et al., 2017; Smith et al., 2018; Yousaf et al., 2021).

The result also reveals a potential indirect impact of gender diversity on patient satisfaction through organizational innovation. The direct coefficient causal pathway between gender diversity and patient satisfaction is (+0.371) while the indirect coefficient causal pathway between gender diversity and patient satisfaction through organizational innovation is (+0.396). Therefore, gender diversity can increase organizational innovation and thus leads to improve the level of patient satisfaction. During the Covid-19 pandemic period, executives and managers in the medical sector succeeded to improve organizational performance and patient satisfaction through efficient implementation of diversity management. However, they failed to increase the financial performance of the health sector due to the severity of Covid-19 shocks on the Lebanese economic conditions.

Figure 6 summarizes all causal pathways of the SEM between innovation, diversity, and performance. Arrows in bold showed the significant causal pathways, while arrows in gray indicated the non-significant pathways.

6.1 Managerial implications

From a practical standpoint, the insights from the literature affirmed that hospitals that accommodate professionals and employees with diverse knowledge, skills inabilities (KSAs) are able to sustain operations during crisis, improve their financial performance, and increase their competitive advantage. The knowledge generated in this article could be helpful to managers, executives, and government in the health sector as coping strategies for mitigating the impact of health or economic crises on operations. In the context of crisis period, it is recommended that managers employ dynamic managerial practices with specific focus on workforce diversity and high level of internal communication. Furthermore, this study provides researchers with an improved understanding on the impact of workforce diversity on entrepreneurial innovation and performance. In addition, it validates the impact of entrepreneurial innovation on performance of healthcare sector during crisis. Moreover, it was affirmed that gender diversity, age diversity, and organizational innovation are the most important determinants of healthcare performance during the pandemic period.

6.2 Theoretical implications

This study enriches extant literature with regards to diversity, entrepreneurial innovation, and performance from the context of the Lebanese health sector. First, this study examines the impact of diversity on entrepreneurial innovation and performance. In the end, empirical findings support the creative discovery and behavioral theories by showing that implementation of organizational innovation could lead to increase patient satisfaction and enhance organizational performance in unstable environments (Cyert & March, 1963). Second, in line with the information processing theory, knowledge-based theory, and resource-based theory, the results affirmed that diversity is an important managerial strategy that could be implemented by managers to generate different views, develop new ideas and increase performance (Chung & Hossain, 2009; Grant, 1996; Mejri et al., 2018; Wernerfelt, 1984).

6.3 Limitations and new research directions

This article has some limitations that should be pointed up and discussed. The first limitation is related to the sample characteristics and size. The sample of the study was extracted from 87 medical centers working in just one country, namely Lebanon. Moreover, beside the 870 patients, the sample was composed of different heterogenous members that work in different departments (administrative, nurse, and physicians). This first limitation calls for further research based on a larger and homogeneous sample extracted from different countries, which will allow the global generalization of the results and offer a promising opportunity for advanced studies related to the relationship between workforce diversity, entrepreneurial innovation, and overall performance. Interesting insights could also be obtained by applying the same research model on different sectors. This can also add more debates about the importance of workforce diversity practices between different sectors.

The second limitation of this research is related to the nature of employed methodology and the period of the study. This research employs a quantitative method based on cross-sectional data extracted during the first quarter of 2021 (at a point in time). Future research could consider a longitudinal structure to reveal the impact of time on the causal pathways between the tree main constructs of this study. As this article employs a pure quantitative method, the development of further qualitative research method is recommended to analyze in depth the impact of diversity practices on both entrepreneurial innovation and performance.

The third limitation of this research is related to nature of workforce diversity and the employed definitions of entrepreneurial innovation and performance. In this research, only three types of diversity are considered namely age, gender, and value diversity. Within this context, it would be fruitful to consider in future research other types of diversity like ethnicity, cultural, knowledge, race, and religion. As for the definition of entrepreneurial innovation and performance, it is highly recommended to employ in future research other dimensions of innovation like service and marketing innovation and other types and measurement of performance.

Beyond all the limitations presented above, it is recommended to include in future research works some moderating variables that could affect the causal pathways between the different constructs tested in this study. Toward this direction, testing the moderating impacts of leadership style of business environment and culture could add fruitful insights to the managerial practices in different sectors and mainly in healthcare sector. Finally, given the excessive employment of new tools in healthcare sector such as Blockchain, Bigdata, Virtual Reality, Internet of Medical Things, and 3D printing, other types of variables, like technological innovation have to be considered in future research.