Depiction of Health. 2024;15(1): 52-63.
doi: 10.34172/doh.2024.05
  Abstract View: 270
  PDF Download: 153

Health Care System Management

Original Article

Investigating the Mediating Role of Unlearning in the Relationship between Organizational Culture and Knowledge Management in Public Hospitals of Iran

Fatemeh Taheri 1* ORCID logo

1 School of Management and Accounting, College of Farabi, University of Tehran, Qom, Iran
*Corresponding Author: Email: F_taheri@ut.ac.ir


Background. Knowledge, as the most valuable asset of the organization, should include social factors as well as economic and technological factors. This study aimed to investigate the relationship between organizational culture and knowledge management by considering the mediating variable of unlearning.
Methods. This study was a descriptive correlational study, and its initial statistical population included 450 employees of the support area from public hospitals in Tehran province, out of which 420 people participated in the research. The standard organizational culture, knowledge management, and unlearning questionnaires were used to collect the required data. Data analysis was performed using structural equation modeling in SPSS 16 and AMOS software.
Results. The study results confirmed the assumed structural relationships, so that the organizational culture affected the knowledge management directly (0.34) and indirectly through unlearning (0.78). In addition, the unlearning variable had a significant and positive effect on the knowledge management (0.55).
Conclusion. Considering the positive relationship between organizational culture and knowledge management and the role of unlearning as a mediating variable in this relationship, it was suggested that organizational culture development and unlearning dimension improvement may have facilitated implementing knowledge management and its development in hospitals. This, in turn, may have increased the patient satisfaction and improved the quality of services provided by the medical centers.

Extended Abstract

Organizations' failure to pay attention to the social factors in the knowledge management process can result in their overall failure. One of the most important social factors is organizational culture. Culture provides the main assumptions about what the knowledge is and why it is worthy of managing, the relationships between individual knowledge and organizational knowledge, and the context of social interaction. Culture, moreover, provides the basis for change in an organization and abandonment of the outdated ineffective procedures, that is, unlearning. Dynamic knowledge management is a continuous and cyclic process of learning, unlearning, and learning. The present study aimed to develop a theoretical framework to investigate the direct/indirect effects of organizational culture on knowledge management in public hospitals through the process of establishing unlearning in order for improving knowledge management in these organizations.


In this applied and descriptive study, a structural equation modeling was adopted. The statistical sample included 420 employees of the support area of 30 public hospitals in Tehran province, who were selected using census method. Data collection tools were Segara and Sanchez online unlearning questionnaire with 18 questions addressing three dimensions of fitting Lens (five questions), consolidation of emergent understandings (six questions), framework for changing individual habits (seven questions), knowledge management questionnaire Huang and Li with eight questions addressing the three dimensions of knowledge acquisition (three questions), knowledge sharing (three questions) and knowledge application (two questions), as well as Zeng et al.'s organizational culture questionnaire inquiring four dimensions of adaptability, consistency, involvement, and mission (four questions in each dimension) with sixteen questions. Cronbach's alpha coefficients for unlearning, knowledge management, and organizational culture variable were 0.78, 0.83, and 0.91, respectively. The face and content validity of the questionnaires was confirmed by five available experts with at least five years of work experience and at least a master's degree in the field of healthcare management.

To satisfy the elites of the statistical sample regarding the questionnaires' questions, a brief description of the research variables and their roles in the course of current discussions of the organization was sent to them with prior coordination. In this study, the confidentiality of the obtained data was guaranteed, and the participants were informed of their rights to participate in the study on voluntary basis and withdraw from it at any time without fear of consequences.

All statistical calculations were performed using SPSS statistical software, and the analyses related to structural equation modeling were conducted using AMOS software. The significance level of all tests was set at P≤0.05 and without direction (two-tailed).


Pearson's correlation coefficient was used to investigate the relationship and correlation among the research variables in order to model the structural equation. The Kolmogorov-Smirnov test (K-S: Kolmogorov Smirnov Test) was used to check the normality of the variables before using Pearson's correlation coefficient, and the results showed that all research variables had a normal distribution.

According to the results of Pearson's correlation test measuring the research variables, organizational culture was associated with knowledge management (r=0.364, P≤0.001) and organizational culture was correlated with learning (r=0.763, P≤0.001). Furthermore, there was a significant positive relationship between learning and knowledge management (r=0.55, P≤0.001). Also, there were significant relationships between organizational culture and unlearning (factor loading=0.814, t=5.790); organizational culture and knowledge management (factor loading=0.349, t=2.680); and unlearning and knowledge management (factor loading =0.551, t=3.910).

Investigating the indirect effects of variables showed that "organizational culture" had a direct effect on "unlearning" with a path coefficient equal to 0.81. Also, "unlearning" had a direct effect on "knowledge management" with a path coefficient equal to 0.55. In addition, culture had an indirect relationship with knowledge management through unlearning (0.44).

Therefore, organizational culture had a positive and significant effect on knowledge management by focusing on unlearning. The Chi-square of the freedom degree of the structural model was equal to 2.356, and the comparative fit index (CFI) and the normalized fit index (NFI) as the main indicators of the model fit were higher than 0.9, which were suggestive of the model approval. The X2/df ratio was less than 3 and the RMSEA value was less than 0.08, which were indicative of the model's acceptability.


The responsibility of the service-oriented organizations (e.g., hospitals) towards people's health created great expectations from these organizations and their employees. The knowledge sharing culture for promoting effective services when the needs and demands of customers were constantly changed, therefore, resulted in the development of personal and social abilities of the employees and improvement of their performance and flexibility in these organizations. Effective organizational learning, mistake repetition prevention, time-saving ideas and measures, organizational cost reduction, and creativity were all direct/indirect outcomes of sharing knowledge. Moreover, the knowledge management as an innovative and effective approach led to the development of organizations. In this regard, a focus on organizational culture and establishment of unlearning mechanisms may have significantly facilitated and stabilized the processes of knowledge acquisition, knowledge sharing, and its application.

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Submitted: 19 Oct 2023
Revision: 21 Dec 2023
Accepted: 14 Feb 2024
ePublished: 18 Feb 2024
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