Marika Intenza, Nunzia Capobianco, Fabrizia Sarto, Sara Saggese
By adopting a sequential mixed-method research design, this study investigates the dynamics of Entrepreneurial Ecosystems (EEs) and their influence on the financial performance of hospital facilities, as well as the mediating role of innovation. The analysis is focused on the Italian context and is structured around three interrelated research phases that integrate qualitative and quantitative methodologies. Main findings suggest that stronger EEs enhance the financial performance of Italian private healthcare organisations by fostering access to resources and collaboration. Besides, innovation has a nuanced mediating effect: while R&D investments support long-term innovation, tangible outputs such as patents are crucial for generating positive financial returns. As one of the first studies linking EEs to financial outcomes in healthcare, the paper highlights the distinct roles of innovation inputs and outputs. These findings offer insights into the complex mechanisms through which EEs influence financial performance, supporting strategic policy and management decisions. • Entrepreneurial ecosystems (EEs) shape financial performance in healthcare. • Innovation serves as the primary mechanism linking EEs to financial outcomes. • R&D investments and patents are critical drivers of financial returns. • Strong EEs enhance access to resources and opportunities for collaboration. • Macro-level EE conditions shape firm-level financial results.