Abstract
Drawing on social exchange theory, this study examines how responsible leadership contributes to sustainable performance by shaping employees’ knowledge search behaviors and how work morale conditions these relationships. This study was conducted in Pakistan’s healthcare sector which operates under high pressure and limited resources. Using a two-wave survey design, data were collected from healthcare professionals and analyzed using partial least squares structural equation modeling SMART PLS 4.1. The findings indicate that responsible leadership enhances sustainable performance both directly and indirectly through exploitation and exploration knowledge search. Importantly, the findings indicate an asymmetric moderating role of work morale. Specifically, work morale enhances the relationship between responsible leadership and exploration knowledge search. However, work morale does not moderate the relationship between responsible leadership and exploitation knowledge search. This nuanced pattern highlights that not all reciprocal behaviors are equally contingent on employees’ affective states. Furthermore, the importance–performance map analysis reveals that responsible leadership and exploration knowledge search exhibit high importance but comparatively low performance, identifying them as priority areas for managerial intervention to improve sustainable performance. The study makes three key contributions. Theoretically, extends social exchange theory by linking responsible leadership to sustainability-oriented outcomes through differentiated learning mechanisms and a selective boundary condition. Empirically, provides evidence from the underrepresented healthcare sector of a developing country, thereby enhancing the contextual relevance of leadership research. Practically, the findings offer actionable insights for healthcare managers, human resource practitioners and administrators seeking to foster sustainable performance through responsible leadership and supportive work environments.
Keywords: Responsible leadership, Sustainable performance, Exploitation knowledge search, Exploration knowledge search, Work morale
Introduction
The healthcare sector faces mounting pressure to improve service quality while simultaneously adopting environmentally responsible practices [4]. Global awareness intensifies sustainability, healthcare organizations to operate efficiently, ethically and responsibly without compromising their essential mission of patient care [58]. Responsible leadership emerges as a crucial driver to balance sustainability and health care operations [32]. Healthcare managers are increasingly expected to make decisions that align with ethical standards [34], support environmental sustainability [73] and ensure high-quality patient outcomes [6]. Prior research emphasized that healthcare institutions should adopt more sustainable practices due to their high energy consumption, significant waste generation and overall environmental footprint [65, 66]. Responsible leadership can guide institutions toward a more sustainable future by encouraging the adoption of environmentally conscious initiatives while safeguarding the quality of care provided to patients [64].
Although there is an increasing interest in the sustainability related initiatives in healthcare, little is known about the direct effects of responsible leadership on the behavioral impacts of employees’ sustainable performance. The current literature focuses largely on organization policies [40], environmental technologies [44] and regulatory compliance [8] as opposed to psychological and behavioral mechanisms among employees. This narrow scope overlooks the significant role of frontline healthcare employees in achieving sustainability, particularly through their knowledge searching behavior and willingness to adopt incremental and innovative practices.
Specifically, there is an apparent gap exists regarding the role of responsible leadership in determining exploration and exploitation knowledge search behavior. These two processes are critical to organizational learning and long-term performance. Despite the fact that leadership studies have focused on the effects of responsible leadership with respect to ethical behaviors and stakeholder interactions [56]. Few studies have focused on cognitive and behavioral processes of employees as concerns knowledge utilization and innovation, particularly in developing economies such as Pakistan. Knowledge search behaviors are essential in healthcare organizations [37]. Practitioners must refine existing routines (exploitation) and develop new solutions (exploration) to respond rapid changes in medical technologies, patient demands and operational challenges [76].
Furthermore, the interaction between responsible leadership, work morale and knowledge search behaviors remains underexplored. The researchers raised the issue that no clear definition has been made about this gap. The current study clearly states that previous frameworks have not addressed how work morale can either promote or diminish the effect of responsible leadership on the two avenues of exploration and exploitation knowledge search. The work morale applies especially in the healthcare sector where employees may experience emotional pressures, work overloads and resource limitations [69] that may seriously influence their level of motivation and ability to adopt knowledge search behaviors. High work morale can motivate employees to pursue new knowledge, explore better ways to do things and utilize existing knowledge more effectively that yield sustainable performance [3].
The existing literature has not combined the principles of responsible leadership, work morale and the two aspects of knowledge search into one framework to explain sustainable performance in a healthcare setting. This gap is particularly evident in Pakistan, where economic, cultural and institutional issues are unique and distinctive. This is a major gap since sustainable healthcare system development is not only a matter of infrastructure and policy but also the psychological and behavioral preparedness of employees. Previous research investigated CSR [45], employee satisfaction [32] and environmental compliance as mediators [9] but the contribution of exploration and exploitation knowledge search as the mediating mechanisms between relationship leadership and sustainable performance has been ignored. Addressing this gap advances theoretical understanding of responsible leadership by uncovering how it motivate employees to learn, adapt, innovate and improve work processes.
Therefore, this present study develops a conceptual framework where responsible leadership contributes to sustainable performance under two mediating variables; exploitation and exploration knowledge search. This updated framework directly contribute to the literature by offering a clearer and more specific research gap, emphasizing that responsible leadership has not yet been sufficiently examined in relation to employee knowledge search mechanisms in emerging healthcare settings. Moreover, this study investigates the moderating role of work morale, proposing that employees with higher morale are more likely to respond positively to responsible leadership by engaging in both types of knowledge search behaviors. The comprehension of these relationships will help to further appreciate the role of psychological conditions in determining the effectiveness of leadership strategies designed to promote sustainability.
The present study has a number of theoretical and practical contributions. Theoretically, this study expands the responsible leadership literature by combining psychological (work morale) and behavioral (knowledge search) processes to offer a more detailed explanation regarding the role of responsible leadership in sustainable performance. It also adds to the body of knowledge management literature by showing how leadership supports the exploration and exploitation knowledge search in resource-bound healthcare settings. Practically, this study provides healthcare managers and policymakers with insights into how responsible leadership can be leveraged to cultivate a knowledge searching behavior that supports sustainable organizational outcomes. By determining the conditions under which responsible leadership is most effective, healthcare organizations can implement interventions that enhance work morale, encourage knowledge search behaviors and increase long-term sustainability as illustrated in Fig. 1.
Fig. 1.
Study framework. Note: Solid line shows the direct effects. Dotted line shows the mediation effects. Dash line shows the moderation effect
Literature review
Theoretical foundation
The Social Exchange Theory (SET) offers a framework for conceptualizing how responsible leadership influences employee behaviors that contribute to sustainable performance. According to SET, organizational relationships are dynamic and functioning in a two reciprocal way where positive treatment of a leader motivates employees to treat leader in a return favor through positive attitudes and behaviors [14, 36]. SET justifies, why employees react to responsible leadership by showing knowledge searching behavior and eventually contributing to organizational sustainable performance.
Responsible leadership focuses on ethical behaviors, fairness and true interest in employees [51]. The employees perceive such behaviors as a sign of encouragement and organizational concern. SET forecasts that such actions of leaders leave an obligation upon employees to return it by putting more effort into their work, learning, process improvement and contribution to long-term organizational objectives [15].
In this context, exploration and exploitation knowledge search are important mediating processes. Exploration knowledge search includes finding new ideas and trying innovative solutions that are unfamiliar [17]. Whereas exploitation knowledge search aims at perfecting the existing routines and implementing familiar methods more efficiently [18]. According to SET, employees are more likely to invest time and energy in both types of knowledge searching behavior when they perceive that responsible leaders value their input and provide support [84]. These behaviors represent a positive exchange through which employees reciprocate the support received from their leaders.
Work morale serves as a moderator, which determines the intensity of this two-way process. High work morale implies enthusiasm, emotional preparation, motivation and more responsive to leader behaviors [68]. With high work morale, the employees become in a better position to convert responsible leadership to active knowledge searching [50]. On the other hand, low work morale undermines this exchange, decreasing the willingness of the employees to participate in learning and improvement processes. Therefore, work morale influences the extent to which responsible leadership builds the knowledge behaviors required to achieve sustainable performance.
In the SET perspective, the suggested model clarifies the reason why responsible leadership promotes sustainable performance. Responsible leadership signals organizational support, prompting employees to engage in knowledge searching behaviors that foster innovation [42]. The inclusion of work morale as a moderator clarifies the conditions under which responsible leadership is most effective in generating these outcomes. Thus, SET provides a coherent and theoretically grounded explanation for the indirect and conditional pathways linking responsible leadership to sustainable performance in Pakistan healthcare sector.
Hypothesis development
Responsible leadership has gained a greater role in healthcare organizations due to its focus on ethical behavior, transparency and the promotion of stakeholders well-being [1, 2]. These attributes are particularly appreciated in the healthcare sector in Pakistan. The working conditions of hospitals and clinics are always under pressure due to lack of resources, large number of patients and staff shortages [61]. In such conditions leaders are expected to be fair, guiding and supportive to the employees [10]. Responsible leadership also contribute to establishing trust and creating a workplace that employees feel respected and valued [13]. Employees tend to align their behavior with organizational values and long-term objectives when they perceive their leaders as responsible [80]. Healthcare sustainable performance requires effective use of resources, environmental standards and quality treatment of patients [20]. Raising a culture of responsibility, ethical decision-making fosters these behaviors with responsible leadership. Thus, responsible leadership will have a direct positive impact on the sustainable performance of healthcare organizations.
H1: Responsible leadership has a positive effect on sustainable performance.
Although responsible leadership can directly affect the sustainable performance, a significant part of its effect on sustainable performance caused by the actions of the employees [52], including exploitation knowledge search behavior. The effort of the employees to perfect the current knowledge, standardize processes and enhance accepted practices [65, 66]. Exploitative knowledge search is a key requirement in the healthcare sector, as hospitals are characterized by operational inefficiencies, outdated procedures and high service diversification [7]. Responsible leaders prompt employees to apply their knowledge in a more systematic way, learn through the previous experience and enhance the current processes [84]. Employees are more likely to invest energy in improving existing routines when they perceive their leaders as fair and supportive [22]. In this way, responsible leadership may impact sustainable performance by encourage employees to increase the efficiency and reliability of healthcare services. Therefore, exploitation knowledge search is suggested as a significant mediating factor.
H2: Exploitation knowledge search significantly mediates the relationship between responsible leadership and sustainable performance.
Exploration knowledge search represents another critical channel through which responsible leadership can influence sustainable performance [17]. Exploration knowledge search focuses on seeking new ideas, novel methods and innovative solutions [37]. In the healthcare context, it can be applying novel treatment methods, the use of digital tools and developing alternative workflows [63]. Exploration knowledge search is especially helpful in Pakistan where hospitals frequently find it hard to follow global trends in medicine. Responsible leaders establish a psychologically safe workplace, where employees are not afraid of being blame, instead encouraged to be creative and seek innovative ways to performs tasks [43]. These leaders convey the message of openness to innovation, making the employees more willing to implement the innovative solutions [75]. Exploration knowledge search behaviors enable organizations to respond, evolving healthcare requirements and increase sustainability in the long-term [5]. Therefore, responsible leadership enhance sustainable performance by promoting exploration knowledge search among employees.
H3: Exploration knowledge search significantly mediates the relationship between responsible leadership and sustainable performance.
Although responsible leadership can indirectly influence sustainable performance through exploitation and exploration knowledge search, this relationship is shaped by employees’ psychological states, particularly work morale. Work morale refers to emotional strength, motivation and willingness of employees to work [68]. In the healthcare sector of Pakistan, work morale tends to vary with high work load, emotional pressure and less institutional support. Employees feel more enthusiastic and confident when the morale is high [53]. They are open to leadership practices and ready to be more active. High work morale strengthens the relationship between responsible leadership and exploitative knowledge search, as motivated employees are better positioned to refine existing processes and improve operational routines [27]. When morale is low, the employees might lack the emotional ability to participate in these learning activities, even when the leaders act responsibly. Therefore, work morale is a boundary condition of the interaction between responsible leadership and exploitation relationship.
H4: Work morale positively moderates the relationship between responsible leadership and exploitation knowledge search.
Work morale is also vital in realizing the effects of responsible leadership in search of exploration knowledge search. Exploration activities are associated with creativity and cognitive flexibility as well as risk-taking [33]. Highly motivated employees feel free to experiment and contribute to unorthodox ideas [25]. Exploration knowledge search can be encouraged by responsible leaders, but this impact is more powerful when the employees are energized and motivated [39]. In the healthcare setting of Pakistan, where employees experience uncertainty and stress frequently, work morale plays an important role in facilitating exploratory knowledge search. Low work morale employees can even be afraid of experimenting due to their fatigue or lack of motivation. However, highly motivated individuals more frequently translate responsible leadership cues into creative behaviors [21]. Consequently, work morale is expected to strengthen the relationship between responsible leadership and exploration knowledge search.
H5: Work morale positively moderates the relationship between responsible leadership and exploration knowledge search.
Taken together, these hypotheses outline a model in which responsible leadership supports sustainable performance directly and indirectly through employee knowledge behaviors, while work morale enhances the influence of responsible leadership on both forms of knowledge search. This combination is an insight into the psychological and behavioral processes that define sustainability in the healthcare sector.
Method
Data collection procedure
This study employed a quantitative, time-lagged survey design to examine the relationships among responsible leadership, exploitative and explorative knowledge search, work morale and sustainable performance in the Pakistan healthcare sector. The time-lagged methodology was chosen in order to minimize common method bias as well as enhance temporal sequencing suggested in the theoretical framework [46]. The design enabled the measure of the predictor variable (responsible leadership) preceding the mediators and moderator and the outcome variable (sustainable performance) at a later point. In organizational psychological studies, such designs are usually suggested to enhance causal inferences and to decrease respondent fatigue [72].
Multi-stage sampling method was used. The scholars first defined the biggest urban centers in Pakistan where healthcare activity is concentrated. Hospitals differ in their size, structure and volume of patients [62]. Cities in various provinces were chosen in order to make the sample diverse. The hospitals were contacted to be a part of it according to the pre-set inclusion criteria. This methodological strategy was suitable since healthcare institutions in Pakistan vary extensively in organizational culture, resources and operational pressure [57]. By selecting hospitals across multiple cities and both public and private sectors, the study ensured adequate variability and enhanced the generalizability of the findings.
Four major cities were chosen including Karachi (Sindh) as the largest healthcare center in Pakistan with a diverse group of public and private tertiary hospitals. Lahore (Punjab) having a variety of healthcare institutions and big teaching hospitals. Islamabad/Rawalpindi (Federal Capital region) as the representatives of federal healthcare institutions with well-organized administrative systems. Peshawar (Khyber Pakhtunkhwa) was added to capture healthcare dynamics in areas there are various socio-economic and infrastructural issues. Hospitals were identified using official health department records, medical university listings and public databases, including both public and private institutions. Selection was based on sufficient staff size, departmental diversity and voluntary participation, followed by administrative approval and onsite briefings to ensure smooth data collection without disrupting hospital operations.
The study employed full-time clinical healthcare employees that are directly supervised and work at the public and private hospitals in Pakistan. This involves nurses, paramedics and other allied health care professionals that are directly involved in patient care and knowledge-based work. In individual participating hospitals, purposive sampling was applied to sample employees meeting the inclusion criteria of full-time employees with at least six months of tenure. This was to make sure that the respondents were exposed to responsible leadership behaviors and workplace dynamics.
G*Power was used to compute the required sample size [41]. The parameters used the effect size f2 = 0.15 (a medium effect size), probability of error = 0.05, Statistical power = 0.95 and Predictors = 4. G*Power showed a required sample size of 129 respondents as indicated in Fig. 2. The resulting matched data set was larger than the minimum necessary sample and had sufficient statistical power to perform mediation and moderate analyses as well as reduce the probability of Type II errors [77].
Fig. 2.
Sample size determination
Data were gathered on two waves to reduce common method bias. Wave 1 was held during July 2025. A total of 720 questionnaires were distributed in this wave of which 520 completed questionnaires were received. This would lead to adequate response rate in large scale field survey. The Wave 1 survey included the perceptions of responsible leadership among employees with the addition of demographic data. The questionnaires were given to each respondent with a special identification code so that responses can be identified across waves and anonymity could be maintained.
Wave 2 took place one month later, during September 2025. In this wave, 680 questionnaires were distributed to same respondents participated in wave 1 and 477 completed questionnaires were returned. The wave 2 survey assessed work morale, exploitation knowledge search, exploration knowledge search and sustainable performance. The same identification codes were used to pair responses from both waves.
After removing unmatched, incomplete responses and inconsistencies across the two waves, the final matched sample consisted of 446 participants. This final sample size exceeded the minimum requirement determined through a previous G*power analysis and provided sufficient statistical power for testing mediation and moderation effects within structural models.
Scale measurement
Responsible leadership was measured using a five item scale developed by [74], which captures leaders’ ethical behavior and consideration of stakeholder interests. A sample item is: “My supervisor considers the consequences of decisions for all stakeholders.” Exploitation knowledge search was assessed with three items adapted from [48], focusing on the refinement and improvement of existing knowledge and work practices. A sample item is: “We focus on improving and refining existing work practices.” Exploration knowledge search was also measured using three items from [48], capturing employees’ efforts to seek new ideas and experiment with novel approaches. A representative item is: “We actively search for new ways to do our work.”
The work morale was assessed with the help of five-item scale designed by Minor et al., [54], which involves the measurement of the enthusiasm, motivation and emotional energy of the employees at work. A sample item is: “I feel enthusiastic about my work most of the time.” Sustainable performance was assessed on an eight-item scale that was modified by [49] and covered the environmental, social and operational aspects of performance. A sample item is: “Our organization strives to balance operational efficiency with social and environmental responsibility.” All items were rated on a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).
Data analysis
The study used partial least squares structural equation modeling through Smart PLS 4.1 to assess the proposed research model. The PLS-SEM was selected due to the main aim of this study: to test the predictive relationships as well as to evaluate the complex model involving mediating and moderating effects [70]. It is an appropriate analytical method in exploratory research and theory extension studies in which the focus of the study is to describe the variation in endogenous constructs [81].
PLS-SEM also fits data acquired in an applied organizational context such as healthcare institution where the multivariate assumptions of normality do not hold [55]. Moreover, this procedure is efficient working with moderate sample sizes as well as enables the simultaneous assessment of the measurement (reliability and validity of constructs) and structural (hypothesized relationships among constructs) models [11].
Demographic profile
The demographic profile of the respondents is provided in Fig. 3 (N = 446). The sample shows a relatively balanced gender distribution with males constituting 54% and females 46% of the respondents. Regarding age, the highest percentage of participants is between 30–39 years (39.0%), 20–29 years (25.1%) and 40–49 years (24.2) with fewer numbers aged 50 years and above (11.7). In terms of job position, nurses constitute the largest group (45.8%), followed by allied health staff (29.7%) and paramedical staff (24.5%), indicating strong representation of frontline healthcare professionals. In terms of organizational tenure, most respondents indicate 4–6 years (35.0%) and 1–3 years (31.8%) of experience. Finally, the sample includes participants from both public (55%) and private (45%) hospitals, reflecting institutional diversity.
Fig. 3.
Demographic profile
Construct reliability and validity
This measurement model has good reliability and validity. All indicator loadings are more than the recommended threshold of 0.70, meaning that there is a high indicator reliability [29] as seen in Fig. 4. The values of the variance inflation factor (VIF) are lower than the critical value of 5.0, which indicates the absence of multicollinearity [31]. The internal consistency reliability is also robust with the values of Cronbach alpha and composite reliability (CR) of all constructs surpassing the required threshold of 0.70 [30].
Fig. 4.
Measurement model
Convergent validity is also verified with the average variance extracted (AVE) values between 0.704 and 0.843, which is higher than the threshold of 0.50 [24]. In general, the findings show that the measurement model is sound and can be used for further structural analysis as presented in Table 1.
Table 1.
Measurement model
| Construct | Loadings | VIF | Alpha | CR | AVE |
|---|---|---|---|---|---|
| Responsible Leadership | 0.894 | 0.899 | 0.704 | ||
| RL1 | 0.772 | 1.755 | |||
| RL2 | 0.808 | 2.109 | |||
| RL3 | 0.843 | 2.381 | |||
| RL4 | 0.883 | 3.173 | |||
| RL5 | 0.883 | 3.143 | |||
| Exploitation Knowledge Search | 0.907 | 0.911 | 0.843 | ||
| EXPLTKS1 | 0.944 | 3.607 | |||
| EXPLTKS2 | 0.939 | 3.488 | |||
| EXPLTKS3 | 0.870 | 2.157 | |||
| Exploration Knowledge Search | 0.812 | 0.833 | 0.725 | ||
| EXPLRKS1 | 0.811 | 1.787 | |||
| EXPLRKS2 | 0.844 | 1.656 | |||
| EXPLRKS3 | 0.898 | 2.100 | |||
| Work Morale | 0.940 | 0.950 | 0.806 | ||
| WM1 | 0.893 | 3.649 | |||
| WM2 | 0.927 | 3.447 | |||
| WM3 | 0.912 | 2.499 | |||
| WM4 | 0.903 | 3.722 | |||
| WM5 | 0.853 | 2.319 | |||
| Sustainable Performance | 0.942 | 0.944 | 0.713 | ||
| SP1 | 0.826 | 2.677 | |||
| SP2 | 0.880 | 3.131 | |||
| SP3 | 0.853 | 3.443 | |||
| SP4 | 0.857 | 2.191 | |||
| SP5 | 0.864 | 3.275 | |||
| SP6 | 0.874 | 2.561 | |||
| SP7 | 0.803 | 3.474 | |||
| SP8 | 0.795 | 2.233 |
RL Responsible leadership, EXPLTKS Exploitation knowledge search, EXPLRKS Exploration knowledge search, SP Sustainable performance, WM Work morale
Discriminant validity
Table 2 indicated that the discriminant validity was measured based on the heterotrait- monotrait ratio and the Fornell Larcker criterion. The ratio of heterotrait and monotrait of all constructs is much lower than the suggested value of 0.85, which means that the exploration knowledge search, exploitation knowledge search, responsible leadership, sustainable performance and work morale are empirically different constructs [35]. The Fornell-Larcker criterion also supports the discriminant validity because the square root of the average variance extracted of each construct are larger than the corresponding inter-construct correlations. This shows that the constructs have more variance with their respective indicators than with the other constructs. Hence, supporting sufficient discriminant validity [24].
Table 2.
Discriminant validity
| EXPLRKS | EXPLTKS | RL | SP | WM | |
|---|---|---|---|---|---|
| Heterotrait-monotrait ratio (HTMT) | |||||
| EXPLRKS | |||||
| EXPLTKS | 0.224 | ||||
| RL | 0.495 | 0.334 | |||
| SP | 0.302 | 0.240 | 0.391 | ||
| WM | 0.274 | 0.199 | 0.190 | 0.179 | |
| Fornell-Larcker criterion | |||||
| EXPLRKS | 0.852 | ||||
| EXPLTKS | 0.195 | 0.918 | |||
| RL | 0.430 | 0.306 | 0.839 | ||
| SP | 0.272 | 0.219 | 0.360 | 0.845 | |
| WM | 0.251 | 0.185 | 0.179 | 0.172 | 0.898 |
RL Responsible leadership, EXPLTKS Exploitation knowledge search, EXPLRKS Exploration knowledge search, SP Sustainable performance, WM Work morale
Predictive accuracy
Table 3 illustrate that the partial least squares structural equation model had a predictive ability that was assessed through the coefficient of determination, predictive relevance, root mean squares error and mean absolute error [59]. The values of the coefficient of determination suggest that the model can explain 23.3% variance of exploitation knowledge search, 11.2% of the variance of the exploration knowledge search and 15.8% of the sustainable performance. The values indicate a low explanatory power, which is reasonable in the context of a behavioral and social science study [29].
Table 3.
PLS method coefficient of determination
| Construct | R2 | Q2 | RMSE | MAE |
|---|---|---|---|---|
| Exploitation knowledge search | 0.233 | 0.094 | 0.888 | 0.683 |
| Exploration knowledge search | 0.112 | 0.217 | 0.954 | 0.828 |
| Sustainable performance | 0.158 | 0.134 | 0.933 | 0.781 |
Predictive relevance, assessed through the Stone–Geisser criterion, shows positive values for all endogenous constructs, confirming that the model has satisfactory out of sample predictive relevance [26, 67]. Moreover, the value of the root mean square error and mean absolute error is also quite low, which means that the degree of prediction accuracy is acceptable and proves that the model can be used to predict.
Hypothesis testing
Table 4 shows the hypothesis testing results, direct, mediation and moderation effects. Responsible leadership has direct impact on sustainable performance is positive and statistically significant (β = 0.270, t-value = 4.880, p-value < 0.000), good indicator suggesting relationship is supported. This finding suggests that the greater the degree of responsible leadership, the greater the sustainable performance.
Table 4.
Hypothesis testing
| Hypothesis | Beta | S.D | t-value | p-value | Decision |
|---|---|---|---|---|---|
| Direct effects | |||||
| H1: RL→ SP | 0.270 | 0.055 | 4.880 | 0.000 | Accepted |
| Mediation effects | |||||
| H2: RL →EXPLTKS→SP | 0.031 | 0.015 | 2.022 | 0.043 | Accepted |
| H3: RL→EXPLRKS→SP | 0.051 | 0.021 | 2.400 | 0.016 | Accepted |
| Moderation effects | |||||
| H4:WM*RL→EXPLTKS | 0.018 | 0.050 | 0.341 | 0.733 | Rejected |
| H5:WM*RL→EXPLRKS | 0.127 | 0.046 | 2.760 | 0.006 | Accepted |
RL Responsible leadership, EXPLTKS Exploitation knowledge search, EXPLRKS Exploration knowledge search, SP Sustainable performance, WM Work morale
In terms of mediation effects, the relationship between the responsible leadership and the sustainable performance significantly mediated by the exploitation knowledge search (β = 0.031, t-value = 2.022, p-value = 0.043). Similarly, the exploration knowledge search is also an important mediator of the relationship between responsible leadership and sustainable performance (β = 0.051, t-value = 2.400, p-value = 0.016). These findings suggest that responsible leadership enhances sustainable performance partly through its influence on both exploitation and exploration knowledge search.
Moreover, moderation interaction between work morale and responsible leadership does not have a significant effect on exploitation knowledge search (β = 0.018, t-value = 0.341, p-value = 0.733), leading to the rejection of this hypothesis. In contrast, the interaction between work morale and responsible leadership has a positive and statistically significant effect on exploration knowledge search (β = 0.127, t-value = 2.760, p-value = 0.006), indicating that work morale strengthens the impact of responsible leadership on exploration knowledge search as shown in Fig. 5.
Fig. 5.
Structural model
Importance performance map analysis
Table 5 demonstrate the results of the importance–performance map analysis, which assesses constructs based on their total effects on sustainable performance (importance) and their average latent variable scores rescaled from 0 to 100 (performance). Higher importance values indicate a stronger influence on the target construct, while higher performance scores reflect better current execution [29].
Table 5.
IPMA results
| Constructs | Importance | Performance |
|---|---|---|
| Responsible leadership | 0.349 | 42.037 |
| Exploitation knowledge search | 0.111 | 57.590 |
| Exploration knowledge search | 0.135 | 42.152 |
| Work morale | 0.039 | 51.361 |
Although no strict cut-off values exist for importance, constructs with relatively higher total effects are considered more critical for improving the outcome variable. Responsible leadership has the greatest value of importance (0.349) in this research compared to the other constructs hence it is a powerful contributor to sustainable performance. Nonetheless, its performance score (42.037) falls short of the threshold of 50, which indicates poor performance and responsible leadership is a top priority area for improvement.
The importance of exploration knowledge search is moderate (0.135) and the performance is low (42.152) which also does not reach the standard threshold of 50. This combination suggests that the sustainable performance might be significantly increased through the improvement of exploration knowledge search activities. Exploitation knowledge search has a lower importance (0.111) and relatively high performance (57.590), which is above the threshold of the midpoint. Although at present the search of exploitation knowledge search is developed, additional investments are unlikely to bring any more benefits towards sustainable performance.
Work morale has the least significance (0.039) and moderate performance (51.361) marginally above the midpoint value. This means that work morale is sufficiently covered and plays a minimal role in contributing towards sustainable performance in the existing model. Overall, managers should prioritize high-importance, low-performance constructs including responsible leadership and exploration knowledge search, to enhance sustainable performance.
Discussion
Grounded in social exchange theory and situated in the healthcare sector of Pakistan, this study deepens understanding of how responsible leadership contributes to sustainable performance by elucidating its underlying mechanisms and boundary conditions. The social exchange theory argues that a fair, caring and mutually binding relationship inspires a person to return with positive attitude and behavior [47]. In this context, responsible leadership is a desirable organizational asset that is reciprocated by healthcare employees in the form of increased knowledge search practices and performance results [82]. This study addresses a recommendation of more context specific leadership studies by situating the analysis in a context of developing country healthcare and generalizing the social exchange theory to the sustainability oriented consequences.
In line with previous studies, the findings prove that responsible leadership is a key factor towards achieving sustainable performance. Responsible leadership has primarily been examined for its ethical, stakeholder [12] and socially responsible characteristics [21]. Prior research has also linked responsible leadership to positive organizational outcomes [71], including corporate social responsibility [16], trust and long-term value creation [78]. Although these studies confirm that responsible leadership is an issue of concern, they tend to offer little information regarding the knowledge search mechanisms involved. The research builds on the previous literature by evidencing that responsible leadership plays a role in sustainable performance both directly and indirectly through its influence on the way organizations are searching and utilizing knowledge.
A key contribution of this study lies in distinguishing between exploitation knowledge search and exploration knowledge search as parallel mediating mechanisms. The earlier leadership and ambidexterity studies often consider organizational learning as a single construct and largely emphasize on innovation outcomes [28, 38]. In this study, responsible leadership promotes both exploitation and exploration knowledge search. Exploitation supports efficiency and incremental improvement, whereas exploration facilitates innovation and long-term renewal [83]. Consequently, the study points out that sustainable performance does not come as a result of one learning pathway but a mixture of pursuing existing knowledge and exploring the possibilities in an equal measure. This two-pronged clarification moves the responsible leadership research a step further by connecting it more directly with organizational learning theory and sustainability initiatives.
Another important insight concerns the role of work morale as a boundary condition. The findings indicate that work morale strengthens the relationship between responsible leadership and exploration knowledge search, but not the relationship between responsible leadership and exploitation knowledge search. The Fig. 6a shows that exploration knowledge search increases as responsible leadership increases under both low and high levels of work morale. However, the slope is steeper when work morale is high, indicating that responsible leadership has a stronger positive effect on exploration knowledge search in conditions of high work morale. This suggests that employees with higher work morale are more responsive to responsible leadership by engaging more actively in exploration knowledge search behaviors.
Fig. 6.
a WM strengthens the positive relationship between RL and EXPLRKS. b WM strengthens the positive relationship between RL and EXPLTKS
Figure 6b illustrates the moderating role of work morale in the relationship between responsible leadership and exploitation knowledge search. The figure shows that exploitation knowledge search increases with higher levels of responsible leadership under both low and high work morale. However, the difference between the slopes is minimal, indicating that work morale does not meaningfully alter the strength of this relationship. This visual pattern supports the finding that work morale does not moderate the effect of responsible leadership on exploitation knowledge search, suggesting that refinement and efficiency oriented knowledge search behaviors are relatively less dependent on employees’ morale morale.
This asymmetric effect enriches existing leadership research, which often assumes that positive employee states uniformly enhance all forms of work behavior. Instead, the results suggest that exploration knowledge search activities such as experimentation, risk-taking and the pursuit of novel ideas are particularly sensitive to employees’ motivational and affective states. In contrast, exploitation knowledge search activities appear to be more routinized and less dependent on morale, relying instead on established processes and structures. This distinction deepens understanding of when responsible leadership is most effective in stimulating learning behaviors that support sustainability.
The complexity of sustainable performance is also highlighted by the predictive evaluation of the model. Despite the fact that responsible leadership and knowledge search can account a sizable part of sustainable performance, the findings also suggest that sustainable performance is influenced by various organizational and environmental variables beyond leadership. This corresponds to the previous sustainability studies that define sustainable performance as a complex construct that is affected by the strategic, institutional and contextual factors. The placement of responsible leadership in such a broader context ensures that the study does not overvalue the impact and at a same time, emphasizes its strategic significance.
The importance performance map analysis provides further theoretical and practical information as demonstrated in Fig. 7. Responsible leadership turned out to be the strongest construct of sustainable performance but exhibited quite low performance, which implies a significant difference between its significance and the current rate of its realization. This result indicates that organizations might understand the importance of responsible leadership but have difficulties in its full operationalization. The same trend was evident in exploration knowledge search, which supports the notion that forward looking and sustainability focused learning is still not widely developed within most organizations. Collectively, the findings enable the literature by revealing that responsible leadership and exploration knowledge search behavior are important and underutilized keys to improving sustainable performance.
Fig. 7.
IPMA analysis graph
Theoretical contributions
First, this study extends social exchange theory in leadership research by positioning responsible leadership as a critical social resource that shapes employee behaviors relevant to sustainable performance [43]. While social exchange theory was originally developed to explain reciprocal exchanges in organizational relationships [19]. The findings demonstrate that responsible leadership initiates exchange processes that motivate employees to reciprocate through knowledge search behaviors. This expands social exchange theory by linking leadership driven exchanges to sustainability oriented outcomes, particularly in complex service contexts such as healthcare.
Second, the study advances leadership literature by unpacking the mechanisms through which responsible leadership affects sustainable performance. By identifying exploitation knowledge search and exploration knowledge search as parallel mediators, the study moves beyond prior research that largely emphasized direct effects and general behavioral outcomes [23, 79]. In line with social exchange theory, employees who perceive responsible leadership as supportive and fair reciprocate by engaging in both efficiency oriented and innovation oriented learning behaviors [60]. This clarifies how responsible leadership translates into sustainable organizational performance and enriches the explanatory power of social exchange theory in leadership research.
Third, the study adds to the social exchange theory by modifying the work morale as a selective boundary condition. The results indicate that work morale enhances the mutual relationship between responsible leadership and exploration knowledge search but not exploitation knowledge search. This difference narrows down social exchange theory by showing that the nature of reciprocity that arises depends on employees affective states [1, 2]. Exploration knowledge search behaviors involve uncertainty and creativity, require stronger motivational resources than exploitation knowledge search behaviors, thereby highlighting the context dependent nature of social exchanges.
Fourth, this research enhances social exchange theory by demonstrating the dynamic and mutually reinforcing nature of the employee and organization relationship. Responsible leadership provides ethical guidance and support, while employees reciprocate through knowledge behaviors that improve both current practices and future adaptability [45]. This reciprocal process underscores how responsible leadership creates a sustainable exchange system in which both leaders and organizations benefit through improved long term performance.
Finally, this study expands the contextual framework of social exchange theory and responsible leadership research by addressing the healthcare sector of Pakistan. It shows that the exchange based leadership processes work in the environment of non-Western, resource-restricted and stake-intensive services. This contextual contribution motivates further studies to examine the functioning of responsible leadership and social exchange processes in the context of various institutional and cultural environments.
Practical implications
This study has specific and precise practical implications to managers, human resource practitioners, healthcare administrators and policymakers.
First, the results indicate to managers and clinical leaders the importance of responsible leadership behaviors in practice, including transparent decision-making, role modeling, and consistent concern for employee well-being. Responsible leadership may be operationalized by managers through regular team discussions on ethical issues. Managers ought to foster candid communication of mistakes and areas of improvement and acknowledge the employee input in service quality and innovative efforts. These practices have the potential to initiate mutual employee reactions in the shape of improved knowledge search behaviors that enhance sustainable performance.
Second, the findings reinforce the idea that human resource practitioners must integrate responsible leadership into the systems of leadership development and performance management. Human resource departments should develop training programs that emphasize ethical leadership, stakeholder responsibility and relational skills rather than focusing only on technical competence. Moreover, fair reward systems, psychological safety, and continuous learning initiatives can enhance work enthusiasm and promote both exploitation and exploration knowledge search among healthcare employees.
Third, the findings imply that responsible leadership in an institution is more likely to achieve sustainable performance, as supported by healthcare leaders and policymakers. Administrators are able to establish the governance structures and policies that will encourage leaders’ ethical practice, foster learning oriented cultures and knowledge sharing. Healthcare policymakers at the policy level can incorporate the laissez-faire leadership principles into the accreditation and evaluation systems so that leadership standards are evaluated along with clinical and operational performance.
Last, the study demonstrates that work morale is a critical enabling condition, particularly for exploration knowledge search activities. Therefore, administrators should prioritize employee well-being initiatives, such as workload management, mental health support and participatory decision-making, to create conditions under which responsible leadership can effectively translate into innovation and long-term sustainability.
Limitation and future research directions
Despite its contributions, this study has several limitations that should be considered when interpreting the findings. For clarity, these limitations are categorized into methodological and contextual constraints, followed by specific directions for future research.
First, despite the fact that the study has used a two-wave data collection design which can help mitigate the issue of common method bias and enhance temporal distance between key variables. It does not entirely determine causality. Time-lagged design enhances the degree of confidence with the suggested relationships, but causal inferences are still restricted. Future studies might utilize a longitudinal or multi-wave panel study design to better measure reciprocal and dynamic relationships hypothesized by social exchange theory.
Second, the research used self-reports as the major method and this can be affected by perceptual bias or social desirability especially when assessing leadership and performance. Although the two-wave design reduces some of the concerns, future research can even enhance validity by including multi-source data, including supervisor ratings, peer ratings or objective sustainability measures.
Third, the research was carried out in the Pakistan healthcare industry, which has specific institutional pressures, professional standards and resource limitation systems. Consequently, the results cannot be entirely typical to other industries or national conditions. Extreme care needs to be taken in generalizing the findings to organizations or healthcare systems in developed economies in the private sector. The model needs to be replicated in other industries and cultural contexts in future research in order to evaluate the soundness and boundary condition of the results.
Conclusion
This study demonstrates that responsible leadership directly and indirectly enhances sustainable performance in Pakistan’s healthcare sector through exploitation and exploration knowledge search, consistent with social exchange theory. A key novel finding is that work morale strengthens the effect of responsible leadership on exploration knowledge search but not on exploitation knowledge search, highlighting an asymmetric boundary condition. Overall, the study advances understanding of how and when responsible leadership supports sustainable performance in a developing economy.
Acknowledgements
I would like to express my profound and sincere gratitude to Dr. Naseer Abbas Khan, my MS supervisor for his invaluable guidance, unwavering support and continuous encouragement throughout the entire research process. His exceptional academic insight, constructive feedback and mentorship greatly enriched the quality of this study and contributed significantly to my scholarly development. I am deeply thankful for his dedication, professionalism and commitment.
Authors’ contributions
1. **Author Jianhua Zhang:** Supervised the research and approved the manuscript before submission. 2. **Author Maria Akhtar:** Conceptualization, Data Collection, Manuscript Drafting, Editing, Writing original manuscript. 3. **Author Azmat Yar Khan:** Formal Analysis and Software Utilization, Visualization and Validation. 4. **Author Bing Bing Wang:** Conceptualization and Editing.
Funding
This research received no external funding. The article processing charge (APC) will be covered by the corresponding author.
Data availability
The study data are not publicly available due to confidentiality agreements. However, anonymized data may be shared with qualified researchers upon reasonable request and ethical approval.
Declarations
Ethics approval and consent to participate
The study received ethical approval from the Institutional Review Board of Zhengzhou University, China (Protocol No. E-Z-2025001; approved July 21, 2025), which served as the host institution. All procedures followed established ethical standards, and informed verbal and written consent was obtained from participants in accordance with the Declaration of Helsinki (1964).
Informed consent was obtained from all participants on a voluntary basis after clearly explaining the study’s purpose, confidentiality measures, and anonymous nature. Participants faced no risks or compensation, and returning the completed questionnaire constituted informed consent.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Data Availability Statement
The study data are not publicly available due to confidentiality agreements. However, anonymized data may be shared with qualified researchers upon reasonable request and ethical approval.