How Organizational Design Facilitates Team Outcomes: The Mediating Role of Knowledge-Creation Processes in Healthcare Organizations

Knowledge-intensive organizations rely on multidisciplinary collaboration, yet the organizational structures that convert specialized knowledge into collective capabilities remain insufficiently understood. This cross-sectional study examined whether knowledge-creation processes mediate the associations between group formality and contextual performance and perceived emotional synchrony in Japanese healthcare organizations. An anonymous online survey included 500 participants: 250 healthcare professionals and 250 medical administrative staff. Structural equation modeling showed that group formality was positively associated with knowledge-creation processes (β = 0.420), which were positively associated with contextual performance (β = 0.635) and perceived emotional synchrony (β = 0.492). The direct association between group formality and perceived emotional synchrony remained significant (β = 0.159), whereas its direct path to contextual performance could be omitted without worsening model fit. The revised model yielded RMSEA = 0.064 and SRMR = 0.055, although CFI = 0.890 and TLI = 0.886 remained slightly below the conventional 0.90 criterion. Multigroup analyses supported metric invariance, with no significant differences in focal structural paths between staff groups. These findings suggest that appropriately designed formal structures may support behavioral and affective team outcomes by facilitating knowledge creation rather than merely imposing control. Longitudinal and interventional studies are needed to assess temporal ordering and causal mechanisms.