In the current context, public health systems are facing an unprecedented challenge, namely, being able to manage increasing complexity resulting from demographic aging, chronicity and the need to integrate frontier technologies in contexts of limited resources. In this scenario, the healthcare organization evolves from a simple bureaucratic structure to a “knowledge ecosystem”. the healthcare organization becomes a dynamic network in which the value lies in individual services, but also and above all in the ability to generate, share and apply multidimensional knowledge. This study was born with the aim of exploring how organizational capabilities act as a fundamental pillar to support and, above all, make these ecosystems sustainable in the long term. The central objective of the research is to identify the key organizational capabilities necessary to overcome information fragmentation and promote real integration between the different players in the system (clinicians, managers, patients and technological partners). To achieve this aim, the study adopts a qualitative methodology based on interviews with strategic decision-makers, highlighting three macro-categories of essential capabilities.
First, the absorptive capacity emerges, therefore, the organization’s propensity and ability to identify, assimilate and apply all those external innovations and complex clinical data to translate them into efficient operational protocols. Secondly, relational and collaborative skills, essential for breaking down functional silos and promoting more widespread leadership models. These capabilities allow the transition from hierarchical personnel management to a community of practice that enhances human capital as the driver of the ecosystem. Finally, strategic digital capabilities, understood not only as infrastructural equipment, but as the organization’s ability to manage data interoperability and mitigate phenomena of resistance to change and technostress. The results suggest that the sustainability of a knowledge ecosystem does not depend exclusively on technological investment, but also on a strategic alignment between organizational culture and knowledge management processes. Without a solid foundation of organizational capabilities, digital infrastructures risk becoming mere repositories of unused data. The research contributes to the debate on healthcare management by proposing a model in which performance is directly proportional to the company’s ability to continuously regenerate its knowledge assets.