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Purpose: The purpose of this research is to examine the relationship between high- performance work systems (HPWS) and organisational innovation in hospital settings, examining the role of employee engagement as a mediator in this relationship. Additionally, the study aims to investigate the moderating role of perspective-taking between HPWS and employee engagement as well as the moderating effect of trust in leader on the connection between employee engagement and organisational innovation., Design/methodology/approach: A quantitative-deductive causal method, along with a cross-sectional approach, was utilized. Structural equation modelling was applied to analyse data from a sample of 530 doctors employed in hospitals, practicing human resources management in the public and private sectors of Sindh province, Pakistan., Findings: The findings show positive effects of HPWS on employee engagement and organisational innovation. Additionally, employee's engagement partially mediates the relationship between HPWS and organisational innovation, while the moderating role of perspective-taking significantly influences the link between HPWS and employee engagement., Originality/value: While HPWS are recognized for enhancing organisational innovation, this study confirms their positive effects on individual and organisational outcomes, particularly within the healthcare sector in Pakistan. This study suggests that when HPWS are effectively perceived and implemented, these integrated practices can be beneficial for both employees and organizations, even in challenging situations., (© Emerald Publishing Limited.)