PurposeKnowledge sharing is recognized as one of the most important ways to improve organizational performance. Organizations strive to facilitate knowledge sharing routines, yet these attempts often fail. Although the successful deployment of knowledge sharing practices has been a focus of knowledge management and organizational performance studies, little research has considered the impacts of institutional structures. As such, the purpose of this study is to investigate the extent to which institutional structures facilitate knowledge sharing practices and their impacts on organizational performance.Design/methodology/approachBased on 220 usable survey responses, the authors applied structural equation modeling (SEM) to observe the extent to which institutional structures enhance organizational performance through knowledge sharing, and other important knowledge sharing‐related constructs (i.e. leadership and punitive behavior). The healthcare industry was used as the research context as it is a knowledge‐intensive industry.FindingsThe study finds that knowledge sharing practices were strongly influenced by institutional structures, and together considerably enhanced patient safety. Furthermore, the institutional structures had a high impact on leadership roles and the abatement of punitive behaviors, which in turn collectively considerably enhanced patient safety.Originality/valueThis paper recognizes the power of institutional structures that successfully facilitate knowledge sharing practices within an environment that is unfriendly to knowledge sharing behaviors.

Patient safety improvement through management has been a prime issue since 2000, when the Institute of Medicine reported that preventable mismanagement was responsible for the majority of medical errors. Learning culture, interdisciplinary action teams, and punitive culture have been discussed as viable ways to address these errors. While these individual factors have been found to be significant, we have yet to understand the interactions of these elements. The role of leadership, which has been overlooked, is critical to facilitate or constrain these elements. The interactions of these three elements and the role of leadership were analyzed using structural equation modeling. Our finding revealed the three elements were closely knitted, and leadership roles had considerable impact in nurturing learning culture and constraining punitive culture, which in turn enhanced patient safety.

Knowledge sharing has been proposed as one of the most e®ective ways to reduce medical errors, yet research on knowledge sharing with regard to patient safety is sparse. Because employees' knowledge behaviours are enabled or constrained by organisational structures, knowledge sharing can be nurtured or suppressed by organisational structures such as rules and policies. As such, this study integrated organisational structure into the concept of community of practice (CoP) and holistically investigated knowledge sharing with regard to patient safety in the healthcare industry.

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