Can the public sector break the mold? Exploring antecedent factors driving sensing capabilities with fsQCA in the Tuscan family and community nurse model

Public sector organizations (PSOs) operate in dynamic environments where they must anticipate change in societal needs. Developing sensing capabilities, understood as the capacity to detect opportunities and threats, is critical to ensure adaptability. This study investigates how PSOs develop sensing capabilities by analyzing combinations of internal (organizational) and external (environmental) antecedent factors using a Fuzzy-set Qualitative Comparative Analysis. Drawing on the implementation of the Family and Community Nurse (FCN) model across 26 Tuscan local health districts, the analysis identifies three configurations for sensing capabilities development: (1) strong interorganizational structures paired with a moderately dynamic external environment, (2) the joint presence of organizational experience, culture, and structure, and (3) a highly dynamic environment paired with a strong trust-based and results-oriented culture, combined with low levels of inter-organizational structures. The findings show that sensing capabilities can emerge through multiple pathways determined by complementarities between internal organizational conditions and external environments. The study advances dynamic capabilities theory in the public sector and challenges the assumption that high environmental turbulence is a necessary precondition for capability development. Practically, the results indicate that health authorities can actively foster sensing capabilities through alternative combinations of organizational design, professional culture, and inter-organizational coordination.