Institutional change and service innovation in Taiwan's school-based health centers: the mediating effect of organizational professionalism

PURPOSE: This study examines the associations between perceived institutional change and service innovation in Taiwan's School-Based Health Centers (SBHCs), with particular attention to the mediating role of organizational professionalism. DESIGN/METHODOLOGY/APPROACH: A cross-sectional survey was conducted with 298 school nurses managing SBHCs across multiple educational levels. Using validated measures of institutional change, organizational professionalism, and service innovation, hierarchical regression analysis tested the hypothesized mediation model. FINDINGS: Results indicate that institutional change is positively associated with both organizational professionalism (β = 0.40, p < 0.001) and service innovation (β = 0.38, p < 0.001), with moderate effect sizes. Furthermore, organizational professionalism demonstrates a substantial partial mediating effect, accounting for approximately 52% of the total effect, indicating that it is significantly associated with the relationship between institutional change and service innovation in SBHCs. PRACTICAL IMPLICATIONS: Strengthening organizational professionalism through leadership, training, and resource alignment may enhance SBHCs' adaptive capacity and sustain innovation under conditions of institutional reform and resource constraint. ORIGINALITY/VALUE: This study integrates institutional theory, professionalism, and service innovation research to advance understanding of how meso-level professionalism functions as an internal mechanism linking systemic change to organizational innovation in hybrid healthcare-education settings.