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sustainability

Article
Project Sustainability and Public-Private Partnership: The Role
of Government Relation Orientation and Project Governance
Guoli Feng 1, * , Shengyue Hao 1 and Xiaoguang Li 2

1 School of Economics and Management, Beijing Jiaotong University, Beijing 100044, China;
haoshyue@bjtu.edu.cn
2 School of Economics, Peking University, Beijing 100871, China; xiaoguangli1987@163.com
* Correspondence: fengguoli@bjtu.edu.cn; Tel.: +86-188-1144-3439

Abstract: In China, the government is not only responsible for the supply of local public facilities and
services, but also the maker of public-private-partnership (PPP) policies and systems, and has a greater
voice in PPP projects. The attitude and behavior of the government are essential to the sustainable
development of PPP projects. This research focuses on the deep-seated connotation of the external
attitude and behavior of the government, that is, the impact mechanism and path of the government’s
relation orientation on project sustainability. First, enrich the connotation of the government’s
relation orientation, project sustainability, and project governance, and improve the measurement
scale. Then, construct a structural equation model, collect data through questionnaires, and explore
the path of the government’s relation orientation on project sustainability. The research results
show that: (1) different relation orientations have different effects on project governance and project
sustainability, among which instrumental relation orientation and rent-seeking relation orientation
 will directly affect project sustainability; (2) relationship governance and contract governance play

different mediating roles. The research results provide new ideas and perspectives for improving
Citation: Feng, G.; Hao, S.; Li, X.
project governance mechanisms and project sustainability in the practice of PPP projects in China.
Project Sustainability and
Public-Private Partnership: The Role
Keywords: public-private partnership; sustainability; relation orientation; project governance
of Government Relation Orientation
and Project Governance.
Sustainability 2022, 14, 4724.
https://doi.org/10.3390/
su14084724
1. Introduction
Producing and providing public goods or services with financial funds is the basic
Academic Editors: Elena Fregonara
economic function of the government. However, with the increasing demand of the public
and Cristina Coscia
for the quantity and quality of public services, limited financial funds have been difficult to
Received: 5 March 2022 meet the public’s needs for public services. It is very important to adopt the PPP model
Accepted: 12 April 2022 for investment and financing, construction, operation, and management of public projects.
Published: 14 April 2022 This is also an effective way to use the government’s limited resources to solve the problem
Publisher’s Note: MDPI stays neutral of public goods supply under the background of the new normal of China’s economic
with regard to jurisdictional claims in development and the supply-side structural reform strategy.
published maps and institutional affil- Sustainable PPP can not only increase capital mobility, improve project selection and
iations. improve project efficiency, such as reducing resource loss, improving labor productivity, and
reducing public management costs [1], but also promote economic growth and employment
increase in the project location. In the field of PPP research, researchers evaluate the project
performance in terms of Key Performance Indicators (KPI) and the whole life cycle but
Copyright: © 2022 by the authors. pay less attention to sustainability. For example, the standard emphasized in the Value
Licensee MDPI, Basel, Switzerland. for Money (VfM) evaluation of PPP projects mainly focuses on saving costs, striving for
This article is an open access article maximum output, and achieving expected results [2]. PPP projects are generally large-scale
distributed under the terms and
public infrastructure projects, and their construction and operation have a great impact on
conditions of the Creative Commons
the economy, society, and environment [3]. Today, sustainable development is increasingly
Attribution (CC BY) license (https://
advocated in the whole construction field. If a PPP project performance evaluation lacks
creativecommons.org/licenses/by/
attention to sustainability, it is incomplete and does not meet the requirements of healthy
4.0/).

Sustainability 2022, 14, 4724. https://doi.org/10.3390/su14084724 https://www.mdpi.com/journal/sustainability


Sustainability 2022, 14, 4724 2 of 20

development. Therefore, it is necessary to put forward a deeper connotation of project


sustainability, and design measurement items for empirical research.
On the other hand, in China, the government undertakes the supply task of local
public facilities and services and has the autonomy and decision-making power to choose
the supply mode at the same time. In PPP projects, the government is often in a dominant
or even strong position, and its behavior and governance ability in PPP projects have a
strong impact on the smooth implementation of the project. However, so far, due to the
unclear positioning of the public sector in PPP projects, it does not understand what role it
needs to play, what capabilities it has, and how to improve it in public-private partnerships,
leading to project failures from time to time. Therefore, the correct understanding and
effective implementation of the government is the premise and guarantee for the smooth
performance of the PPP project and the realization of the project value [4]. The attitude and
behavior of the government towards the private sector are crucial to the implementation of
PPP projects. Therefore, it is necessary to explore the in-depth connotation of the external
attitudes and behaviors of the government, that is, the relation orientation, and its impact
mechanism on project sustainability.
Relation orientation is not only an attitude but also a way of behavior [4,5]. However,
there is a lack of research on the relation orientation of the government in PPP projects and
its impact on project sustainability. This paper proposes that the government’s relation
orientation in the PPP project means the government takes “relation” as the basis for the
cognition of itself and the other sector, defines its own role, and reflects it through external
attitude and corresponding behaviors [4]. In addition, the existing literature generally
believes that relationship governance and contract governance, are two different aspects of
project governance [6,7]. It is reasonable to speculate that project governance plays a role in
the process of the government’s relation orientation influencing project sustainability, but
the mechanism of this function still lacks theoretical deduction and empirical verification.
In order to explore the gaps in the above-mentioned research content, this paper, with the
purpose of improving project sustainability, constructs a structural equation model to study
the function path of different government’s relation orientation on project sustainability in
PPP projects, and verify the mechanism of project governance in this process.
In conclusion, PPP project governance is a systematic project, which involves the
participation of multiple subjects such as the government, social capital, and the public.
It includes a series of interactions between public and private parties in each stage of
the project. At the same time, “relationship culture” is a unique cultural connotation in
China. Based on the government’s relation orientation, it is a new research idea to study
the improvement of project sustainability.
This study contains some potential theoretical contributions. The first is to combine
the reality of PPP projects in China, propose the definition and connotation of the govern-
ment’s relation orientation and project sustainability, and divide the dimensions, design
measurement scales, conduct empirical research. The second is to analyze the mechanism
of the effects of the government’s relation orientation on project sustainability and discuss
the mediating role of project governance in it. The research results provide new research
perspectives and ideas for the governance of PPP projects, which are conducive to the
healthy development of project sustainability.
Therefore, this paper mainly studies the relationship between government’s relation
orientation, project governance, and project sustainability. The following are two main
research questions (RQ):
RQ1: How does the government’s relation orientation influence project sustainability in
PPP projects?
RQ2: How does project governance intervene between government’s relation orientation
and project sustainability?
Based on the above research questions and ideas, the overall framework of this paper is
shown in Figure 1 below. (1) Define the connotation and dimensions of the main variables,
including the government’s relation orientation, project sustainability, and project governance.
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(2) Analyze the influence mechanism of government’s relation orientation on sustainability.


(3) The hypothesis of the action path is put forward and verified to draw a conclusion.

Figure 1. Research framework.

2. Theoretical Analysis and Hypothesis


2.1. Theoretical Analysis
1. Relation Orientation
At present, the research on organizational relationship orientation mostly focuses on the
fields of enterprise management and marketing, and less on project-based organizations. The re-
search of relationships in engineering projects, such as project relationship governance, often
focuses on the relationship rules such as communication, trust, and commitment between the
two parties. Compared with the static relationship rules, the government’s relation orientation
is not static, but a dynamic process reflecting the influence of socialization.
In PPP projects, the government has a great impact on project promotion, the private
sector, and project governance [4]. As a developing attitude and behavior, the government’s
relation orientation has different effects on the project. Combined with the characteristics of
PPP projects, this study divides the government’s relation orientation into three categories:
emotional relation orientation (ERO), instrumental relation orientation (IRO), and rent-
seeking relation orientation (RRO).
Specifically, ERO refers to that in PPP projects, the government tends to establish a long-
term friendly partnership with the private sector, emphasize mutual emotional exchange, and
show a series of behavioral reactions such as trust and cooperation, the two sides cooperate well;
IRO focuses on the spirit of contract and mutual benefit, it emphasizes the business attitude
in cooperation and the rational sharing of responsibilities and risks; RRO is to seek private
ownership, which is a damage to the interests of the private sector and the interests of the project.
For example, the government interferes excessively in the project implementation or operation
stage, or the price adjustment mechanism is unreasonable.
2. Project Governance
Crawford [8] believe that project governance is a set of common management frame-
work and procedures; Turner [9] points out that project governance is always serving
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the realization of enterprise objectives, covering a series of methods such as governance


structure, value system, process system and so on, which can help to achieve organizational
goals. The research of project governance can be divided into two categories: one is the
project governance structure, that is, from the organizational level, construct an organiza-
tional structure to achieve checks and balances on all parties [10]. The second is the project
governance mechanism, that is, to solve the conflicts at the institutional level, integrate
project resources and establish a coordination mechanism [11]. The governance mechanism
is divided into contract governance and relationship governance.
In PPP projects, contract governance (CG) refers to the design of formal contracts to
clarify the responsibility, achieve reasonable benefit distribution and risk sharing, reduce
opportunistic behaviors of both parties, and reduce cooperation risks through the con-
straints of formal contract terms. However, the complexity of the PPP project environment
and the characteristics of its social structure make contract governance unable to completely
solve the problem, and relationship governance (RG) needs to cooperate with it. Relation-
ship governance (RG) plays a binding role in the informal mechanism through emotional
constraints of public and private parties, such as trust, commitment, communication, joint
problem solving, etc. [12].
3. Project Sustainability
The United Nations system is currently promoting the PPP model guided by the
concept of sustainable development. The United Nations Economic Commission for
Europe proposed to use the PPP model originated in Europe as an important mechanism
and effective tool to promote countries to achieve sustainable development goals, research
and formulate more than 30 PPP international standards that match the 17 UN sustainable
development goals, and promote the realization of global sustainable development [13].
In order to solve the problems of financial budget constraints, insufficient provision of
public goods or services, poor efficiency of public management, and so on, the PPP model
came into being. The United States, France, Canada, Russia, and other countries are actively
using the PPP model for infrastructure project construction or public service supply [14].
It is very important to improve the quality and efficiency of public goods and services with
the help of the PPP model, especially after China’s economic development has entered
the new normal, the supply-side structural reform has become an important goal [15].
As of December 2021, there are more than 10,000 projects in the National PPP project
management database, with a total investment of 16 trillion yuan, involving municipal
engineering, transportation, comprehensive urban development, ecological construction,
environmental protection, and other industries.
This study holds that project sustainability (PS) refers to adhering to the develop-
ment concept of “people-oriented”, and the final result of PPP project development will
affect and promote economic development, social progress, and environmental protec-
tion. Project sustainability is not limited to the scope of the “iron triangle” (cost, schedule,
and quality) of project management, which requires careful thinking and action from a
macro and long-term perspective. The economy, society, and environment are recognized
principles of sustainable development and are widely described as triple bottom lines.
Combined with the research of other scholars, this study identifies the project sustainability
evaluation indicators of PPP projects from the three dimensions of economy, society, and
environment [16].

2.2. Hypothesis Development


2.2.1. The Direct Effect of Government’s Relation Orientation
1. The influence of government’s relation orientation on project governance
When the government shows an ERO, out of the maintenance of long-term partnership,
the government will strengthen the emotional connection with the private sector, and
express more willingness and enthusiasm for good cooperation [17], which is embodied
in friendly actions such as mutual trust, candid communication, mutual support, etc., all
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of which will help to improve the effectiveness of RG. EROs will also be more inclined to
consciously perform contracts, and at the same time, communicate equally with the private
sector in the process of contract negotiation and signing, which is conducive to signing a
contract that is satisfactory to both parties [18]. Therefore, the ERO is also conducive to CG.
The government of IRO focuses on the “mutual benefit” of both parties in PPP projects
and shows the characteristics of “instrumental rationality” in the process of cooperating
with the private sector [4]. First, it shows the spirit of contract in the government, focusing
on the contractual agreement and mutual restraint. The concrete manifestation in action
is to earnestly fulfill the responsibilities in the contract, for example, taking risks, paying
on time, and adjusting prices in a timely manner [18]. In addition, the government of
IRO realizes that it is in an equal position with the private sector. Each party performs its
own duties in the project and gives full play. Therefore, in the process of a project, it will
communicate with the private sector equally and effectively, rationally resolve emergencies,
do not shirk responsibilities, support each other, and give the private sector sufficient
autonomy and control over the project [19]. These behaviors contribute to the formation
and development of CG and RG.
Different from ERO and IRO, RRO focuses on short-term benefits. In PPP projects, the
RRO may obtain private benefits through some franchises and resources [20], which is not
conducive to the establishment and restraint of formal contracts and aggravates the conflict
between the two parties. In addition, in the Chinese social environment, people hate the
naked exchange of power and money and hate the use of power for personal gain. When
the private sector realizes that the government has a rent-seeking orientation, it may enter
into transactions with the government through bribery and other illegal means or other
gray means to fight for competition protection or allow the public sector to relax review
conditions. Although this kind of transaction will make the private sector obtain certain
short-term benefits, it will also cause the private sector’s psychological disgust and distrust,
which is not conducive to the establishment of a good relationship between both parties.
Based on this, the following hypotheses are proposed:
Hypotheses 1 (H1). ERO positively affects project governance.
Hypotheses 1 (H1a). ERO positively affects RG.
Hypotheses 1 (H1b). ERO positively affects CG.
Hypotheses 2 (H2). IRO positively affects project governance.
Hypotheses 2 (H2a). IRO positively affects RG.
Hypotheses 2 (H2b). IRO positively affects CG.
Hypotheses 3 (H3) RRO negatively affects project governance.
Hypotheses 3 (H3a). RRO negatively affects RG.
Hypotheses 3 (H3b). RRO negatively affects CG.

2. The influence of government’s relation orientation on project sustainability


Under ERO, the government gives full trust and support to the private sector, and
the two parties communicate smoothly and interact well. The public sector and private
sector will provide each other with true information as much as possible, the relationship
is closely maintained, and the opportunistic tendencies and behaviors of both parties will
be relatively weakened. Therefore, the cooperation satisfaction of both parties will be
improved, and the transaction costs will be reduced [21], which is conducive to improving
sustainability. Moreover, under ERO, the government will not be too strong, and the
cooperation atmosphere between the two parties is relaxed and pleasant. The private sector
has a certain degree of control and initiative, which can give full play to its advantages in
project management and contribute to the control of cost, schedule, and quality. In this way,
the project management efficiency is high, and the project results and output are guaranteed.
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In PPP projects, the cooperation between public and private parties lasts a long time.
In addition to the emotional maintenance brought by ERO, the mutual restraint under
IRO is also a very important means. Under IRO, the government pays attention to the
spirit of the contract, and mainly takes contract terms as the criteria for their actions in
projects. In cooperation with the private sector, based on the principle of “business is
business and mutual benefit”, the public and private parties can reach a more consistent
result on risk-sharing and benefit distribution, and the same goals can also give full play
to their respective advantages. On the one hand, it encourages the private sector to make
greater efforts for project performance and realize the supply of public products/services
in a more cost-effective manner [22]. On the other hand, in order to encourage the private
sector to provide more cost-effective products/services, the government will also provide
corresponding support, such as policy support, improving the efficiency and transparency
of the approval process, etc., which will help to achieve better PS.
On the contrary, rent-seeking behavior is based on the premise that the government,
which has specific resources, sacrifices social/public interests in exchange for personal
interests [20]. In this case, the private sector, the project user, or the public’s satisfaction
will inevitably suffer losses. In the process of project management, the private sector will
also pay additional costs for rent-seeking from the government, resulting in an increase in
project costs. In addition, the naked exchange of power and money is not conducive to the
maintenance of equal partnership between the two parties, and the supervision function of
the government no longer exists, which is not conducive to improving PS. Therefore, this
research proposes the following hypotheses:
Hypotheses 4 (H4). Government’s relation orientation has a significant impact on PS.
Hypotheses 4 (H4a). ERO positively affects PS.
Hypotheses 4 (H4b). IRO positively affects PS.
Hypotheses 4 (H4c). RRO negatively affects PS.

2.2.2. The Role of Project Governance in the Influence of Government’s Relation


Orientation on Project Sustainability
This article explores the path of the government’s relation orientation on PS. On the
one hand, it is to verify the direct role of relationship orientation, and on the other hand, it
is to verify whether “project governance”, as an important process to improve PS, plays
a mediating role in the influence of government’s relation orientation on PS. Therefore,
this article separately analyzes the role of RG and CG in the influence of the government’s
relation orientation on PS, and proposes corresponding hypotheses.
1. The role of RG in the influence of government’s relation orientation on PS
China is a typical relational society. The complexity of PPP projects makes the manage-
ment process not only pay attention to changes in the project transaction environment but
also deal with the impact of the social environment such as policy changes and government
personnel adjustments. In addition, there are many project stakeholders, so PPP projects
have significant social networking characteristics [10]. On this basis, many scholars add
relational governance into project-based organizations (including PPP projects) for research.
Many studies have confirmed the role of RG in improving PS. Benítez-Ávila [23] found
that relationship norms such as trust and partner contribution play an important role in
improving project sustainability; Yan Ling [24] combined with the Chinese scenario, found
that RG has a significant positive impact on PS in the empirical study of public project
governance, which is an important means to improve project management performance.
In short, in PPP projects, RG can make up for the incompleteness of CG, effectively prevent
opportunistic behavior, reduce transaction costs and improve PS. Therefore, Hypothesis 5
is proposed:
Hypotheses 5 (H5). RG has a significant positive impact on PS.
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For PPP projects, the government’s relation orientation not only shows its willingness,
enthusiasm, and determination to cooperate with the private sector but also contains
a series of specific behaviors. Research on the key success factors of PPP projects has
found that relationship orientation will affect the cooperation and risk-sharing between
public and private parties, and different relationship orientations will show different
participation enthusiasm and ways of handling problems in the project. In PPP practice,
a good relationship orientation of the government can derive good relationship norms,
which is conducive to the formation of mutual respect, trust, communication, and other
relationship mechanisms between public and private parties [25]. Both parties have the
same goals and solve problems together. The government provides policy support and
the tilt of public resources, while the private sector will also make more efforts to improve
performance. On the contrary, a bad relationship orientation will weaken the expectations,
communication, and mutual trust generated in the process of cooperation between the
two parties, which is not conducive to the role of RG, increases conflicts and opportunistic
behaviors between the two parties, thereby reducing management efficiency, and is not
conducive to improving PS. Based on this, put forward hypotheses:
Hypotheses 6 (H6). RG plays a mediating role between the government’s relation orientation and PS.
Hypotheses 6 (H6a). RG plays a mediating role between ERO and PS.
Hypotheses 6 (H6b). RG plays a mediating role between IRO and PS.
Hypotheses 6 (H6c). RG plays a mediating role between RRO and PS.

2. The role of CG in the influence of government’s relation orientation on PS


The contract clearly defines the responsibilities, rights, and obligations of each party
in written form, which is a mandatory constraint for both parties to regulate their own
behavior in the transaction process [6]. A PPP project is also a kind of temporary contract
organization. The public and private sectors can restrict opportunistic behavior through
the effective constraints of the contract, rationally allocate control rights, and ensure project
performance [18]. In long-term cooperation, even if both sides have a good cooperation
foundation and trusting relationship, it is necessary to sign a formal contract with clear
terms, so that both parties have clear constraints on their actions.
The academia has carried out a wealth of research on the role of CG in improving
project sustainability. Lumineau [26] believes that a well-designed complex contract has
detailed regulations on the distribution of benefits, and penalties for breach of contract,
which can reduce transaction costs, reduce the risk of “ripping up”, and ensure the sustain-
able development of transaction. The research of Roehrich [27] found that CG can restrict
the behavior of both parties and guarantee project sustainability through its legal coercion.
In summary, the role of CG in improving PS has been widely recognized. Based on this,
Hypothesis 7 is proposed:
Hypotheses 7 (H7). CG has a significant positive impact on PS.
The government will make behavioral decisions in line with its relationship orienta-
tion on the basis of preliminary expectations inspired by the inherent characteristics of the
private sector in the pre-qualification and evaluation stage. The relationship orientation
not only determines the efficiency of contract negotiation but also reflects the completeness,
flexibility, and subsequent performance of the contract with specific terms. A good relation-
ship orientation is conducive to promoting the contract terms of reasonable distribution of
responsibilities, risks, and benefits, ensuring the relative balance of risks, benefits, and con-
trol rights allocation. Contracts with different functional characteristics will have varying
degrees of impact on PS. Therefore, the following hypotheses are put forward:
Hypotheses 8 (H8). CG plays a mediating role between the government’s relation orientation and PS.
Hypotheses 8 (H8a). CG plays a mediating role between ERO and PS.
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Hypotheses 8 (H8b). CG plays a mediating role between IRO and PS.


Hypotheses 8 (H8c). CG plays a mediating role between RRO and PS.
Based on the above hypotheses, a conceptual model of “government’s relation orienta-
tion, project governance, and project sustainability” is proposed, as shown in Figure 2.

Figure 2. Conceptual model of the effect of government’s relation orientation.

3. Methodology
3.1. Sampling and Data Collection
This study takes energy PPP projects as the research object. The questionnaires are
mainly distributed to the managers of large construction enterprises who have participated
in the practice of PPP projects, financial institutions and investors who have participated
in the investment of PPP projects, and scholars with practical experience in PPP projects,
covering energy and power, water conservancy, environmental protection, and other fields.
The questionnaires were mainly sent out by email and on-site distribution. Of the 300 ques-
tionnaires sent out, 276 were retrieved. After deleting some unqualified questionnaires
(including missing information, unified answers, and the respondent declaring that they
do not know the relevant fields), 218 valid questionnaires were finally obtained, with an
effective rate of 72.7%, which satisfied the model test conditions.
From the distribution of the sample, 64.22% of the respondents are middle and senior
managers of PPP projects (27 senior managers; 44 department managers/deputy managers;
69 professional supervisors); 195 people with a bachelor’s degree or above (accounting
for 89.45%); Most respondents have been engaged in PPP projects for more than 3 years
(accounting for 62.39%). The respondents have rich experience in participating in PPP
projects and have a high degree of understanding of the whole process of PPP projects,
which ensures the validity of the survey data. The detailed descriptive statistical results of
the sample data are shown in Table 1.
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Table 1. Sample characteristics.

Measure Items Frequency Percentage (%)


Ph.D. and above 21 9.63
Master 93 42.66
Education
Graduate 81 37.16
Undergraduate 23 10.55
Less than 3 Years 82 37.61
Work 3–5 Years 87 39.91
Experience 6–8 Years 33 15.14
More than 8 Years 16 7.34
Senior management 27 12.39
Department Manager/Deputy Manager 44 20.18
Position
Professional director 69 31.65
General staff 78 35.78

3.2. Measurement
This paper divides the government’s relation orientation into three dimensions: ERO,
IRO, and RRO. It includes 6, 5, and 5 measurement items respectively. The research
on PS is relatively mature. In this paper, PS is divided into three dimensions: economic
sustainability, social sustainability, and environmental sustainability, with a total of 13 items.
The research on PPP project governance is also relatively complete. This article refers to the
research of Li Xiaoguang and others [18,28] on the mediating variables of RG and CG. RG
is measured from three dimensions of trust, communication, and joint problem solving,
with a total of 8 items. CG is measured from three dimensions of contract completeness,
contract flexibility, and strictness of contract performance, with a total of 10 items.
Survey items are listed in Table 2. The items were measured on a five-point Likert
scale, from 1 (strongly disagree) to 5 (strongly agree). Cronbach’s alpha for government’s
relation orientation, PS, and project governance is shown in Table 3.

Table 2. List of coded survey items.

Variable Code Scale Item


GE1 The government is willing to provide assistance when we need it
GE2 In the project, the government regards us as equal partners
Emotional GE3 The government treats us sincerely
relation GE4 The government is willing to share its feelings and experience of cooperation with us
orientation When there are objections in the project, we can understand each other and deal
GE5
with them through negotiation
The government believes that we have the ability to achieve the desired goals and
GE6
supports us
The communication between the government and us follows the principle of
GI1
business
Instrumental GI2 The government believes that their rights should be equal to ours
Relation The government deals with us mainly to achieve its expected objectives (such as
Orientation GI3 social benefits, environmental benefits, public satisfaction, etc.) and let us provide
better products or services
During the implementation of the project, the government strictly abides by the
GI4
project process
The extent to which the government helps us often depends on how we improve
GI5
project performance
The government is in a strong position in contract negotiation and operates
GR1 according to its own will (for example, unreasonable risk sharing, independent
Rent-seeking decision-making, excessive intervention in operation and management process, etc.)
Relation The government uses administrative power to set up entry barriers to provide
GR2
Orientation competitive protection for some social capital parties
GR3 The government wants to have one vote veto on most matters of the project
The government uses departmental legislation to form monopoly prices, which leads
GR4
to excessive pricing or the price adjustment mechanism is not in line with the reality
The government sometimes formulates cumbersome administrative examination
GR5
and approval procedures and deliberately sets obstacles
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Table 2. Cont.

Variable Code Scale Item


Both parties to the contract fully trust each other’s ability to
R11
achieve the expected results
Trust
The other party’s behavior is more consistent with our
R12
expectations
Relationship Both parties to the contract will take into account the interests
Governance R13
of the other party when making decisions
The information communication between the parties to the
R21
Communication contract is timely, accurate, and comprehensive
The communication channels between the contracting parties
R22 are flexible and diverse (such as joint office, on-site meetings,
and other communication methods)
Both parties can actively and continuously implement the
Joint R31
project plan
Problem
Both parties did not shirk responsibility for the problems in
Solving R32
the project
R33 Both parties can provide mutual support
The contract contains detailed special terms (project
C11 characteristics, rewards, treatment methods for breach of
Contract contract, etc.)
Completeness C12 The contract terms are completely detailed
The provisions of the contract on the responsibilities and
C13
Contract rights of each party are clear
Governance C14 The contract specifies the procedures for conflict resolution
The contract sets a renegotiation procedure that can be
C21
Contract changed and remedied
Flexibility The contract establishes a flexible and feasible price
C22
adjustment mechanism
The contract establishes a flexible incentive mechanism for
C23
the transfer of control rights
Strictness of C31 The contract has strong legal binding force on all parties
Contract All parties to the contract will consciously
C32
Performance perform the contract
C33 The contract establishes strict punishment measures
S11 Life cycle cost is low
Economic
S12 Project financing channels are rich
Sustainability
S13 Internal Rate of Return is high
S21 The project promotes local development
Social S22 The project provides local employment opportunities
Sustainability S23 The project is safe
Project
S24 After the project is completed, all stakeholders are satisfied
Sustainability
S31 The project has little soil pollution
S32 The project has little air pollution
Environmental S33 The project has little water pollution
Sustainability S34 The project has little noise pollution
S35 The energy consumption of the project is reasonable
S36 The project has good ecological effects
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Table 3. Reliability analysis results.

Variable Code CITC α after Deleting This Item Cronbach’s α


GE1 0.76 0.81
GE2 0.78 0.82
GE3 0.65 0.83
ERO 0.84
GE4 0.74 0.83
GE5 0.62 0.81
GE6 0.63 0.79
GI1 0.71 0.79
GI2 0.66 0.76
IRO GI3 0.76 0.78 0.80
GI4 0.71 0.77
GI5 0.69 0.79
GR1 0.74 0.81
GR2 0.80 0.82
RRO GR3 0.64 0.80 0.83
GR4 0.75 0.82
GR5 0.68 0.79
R11 0.73 0.88
Trust R12 0.81 0.85 0.90
R13 0.79 0.86
R21 0.87 0.90
Communication 0.92
R22 0.90 0.91
R31 0.80 0.81
Joint
R32 0.79 0.88 0.89
Problem Solving
R33 0.75 0.87
C11 0.78 0.87
Contract C12 0.84 0.86
Completeness 0.88
C13 0.79 0.85
C14 0.78 0.86
C21 0.81 0.86
Contract Flexibility C22 0.84 0.87 0.89
C23 0.80 0.84
Strictness of C31 0.79 0.81
Contract C32 0.76 0.84 0.87
Performance C33 0.81 0.86
S11 0.78 0.81
Economic
S12 0.72 0.85 0.86
Sustainability
S13 0.76 0.83
S21 0.74 0.85
Social S22 0.79 0.87
0.91
Sustainability S23 0.81 0.84
S24 0.77 0.79
S31 0.74 0.86
S32 0.85 0.87
Environmental S33 0.84 0.81
0.89
Sustainability S34 0.71 0.84
S35 0.76 0.78
S36 0.80 0.83

4. Model Evaluation
4.1. Hypothetical Model Quality Evaluation
1. Reliability analysis
The results of the reliability analysis are shown in Table 3. The CITC values were
greater than 0.50, and the Cronbach’s α values were significantly higher than 0.7, indicating
that the scale has a good reliability.
2. Common methods variance
Sustainability 2022, 14, 4724 12 of 20

In order to avoid homologous variance, this research ensures the anonymity of the
questionnaire and promises that it is entirely for academic research purposes and does
not involve commercial purposes. In the design of the questionnaire, a neutral context
was used as far as possible to obscure the function of the items, and the restriction of
the respondent in answering the items was eliminated to the greatest extent. In addition,
using Harman’s single factor test method, 47 measurement items were put together for
factor analysis. The result has shown that the load of the first principal component after
factor analysis was 21.15%, indicating that there was no single principal factor, that is, the
homologous variance was not significant and in a controllable state.
3. Validity analysis
The validity test is divided into convergent validity and discriminant validity. This
study used AMOS 24.0 software to do the Confirmatory factor analysis (CFA). Judgment
criteria include χ2 /df < 2, RMSEA < 0.05, RMR < 0.05, TLI, NFI, GFI, CFI and IFI were all
greater than 0.9, and AGFI was close to 0.9. The results are shown in Table 4.

Table 4. Convergent validity analysis results.

Variable Code Standardization Factor Load AVE CR


GE1 0.78
GE2 0.75
GE3 0.74
ERO 0.53 0.84
GE4 0.73
GE5 0.76
GE6 0.71
GI1 0.72
GI2 0.73
IRO GI3 0.75 0.56 0.86
GI4 0.71
GI5 0.80
GR1 0.74
GR2 0.78
RRO GR3 0.76 0.55 0.87
GR4 0.75
GR5 0.78
R11 0.82
R12 0.83
R13 0.80
R21 0.81
RG 0.59 0.87
R22 0.82
R31 0.81
R32 0.80
R33 0.83
C11 0.82
C12 0.80
C13 0.83
C14 0.81
C21 0.79
CG 0.58 0.88
C22 0.81
C23 0.78
C31 0.79
C32 0.77
C33 0.78
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Table 4. Cont.

Variable Code Standardization Factor Load AVE CR


S11 0.79
S12 0.84
S13 0.81
S21 0.81
S22 0.80
S23 0.79
PS S24 0.78 0.57 0.89
S31 0.78
S32 0.81
S33 0.79
S34 0.82
S35 0.77
S36 0.83
χ2 /df = 1.402, RMSEA = 0.038, RMR = 0.035, TLI = 0.969, NFI = 0.953, GFI = 0.947, FI = 0.958, IFI = 0.977, AGFI = 0.921.

The discriminant validity is determined by comparing the AVE value and correlation
coefficients value. As shown in Table 5, the diagonal bold part is the square root of AVE,
which is greater than the correlation coefficients of each variable, so that the model has
high discriminant validity.

Table 5. Discriminant validity analysis.

Variable 1 2 3 4 5 6
1 ERO 0.73
2 IRO 0.52 0.75
3 RRO 0.65 0.44 0.74
4 RG 0.66 0.63 0.59 0.77
5 CG 0.48 0.58 0.34 0.55 0.76
6 PS 0.56 0.52 0.48 0.61 0.57 0.75

4.2. Hypotheses Testing and Mediation Analysis


According to the model constructed above, this study used Amos 24.0 software to
carry out the path analysis, the results are shown in Table 6.

Table 6. Results of hypothesis test.

Standardized Path
Action Path p Value Test Results
Coefficient
H1a: ERO→RG 0.52 *** Passed
H1b: ERO→CG 0.08 0.42 Refused
H2a: IRO→RG 0.10 0.28 Refused
H2b: IRO→CG 0.59 *** Passed
H3a: RRO→RG −0.22 * Passed
H3b: RRO→CG −0.30 ** Passed
H4a: ERO→PS 0.11 0.19 Refused
H4b: IRO→PS 0.30 *** Passed
H4c: RRO→PS −0.25 ** Passed
H5: RG→PS 0.42 *** Passed
H7: CG→PS 0.45 ** Passed
Notes: * p < 0.05, ** p < 0.01, *** p < 0.001.

1. The effect of government’s relation orientation on project governance


Hypothesis 1 posits that the ERO of government positively affects project governance.
The standardized path coefficient of Hypothesis 1a is 0.52, and the p value is significant
Sustainability 2022, 14, 4724 14 of 20

at the level of 0.001; Hypothesis 1b posits that ERO has a positive impact on CG, and the
standardized path coefficient obtained is 0.08, but it does not reach the significant level
(p > 0.05), assuming Hypothesis 1b is rejected.
Hypothesis 2 posits that the IRO of government significantly affects project governance.
Hypothesis 2a posits that IRO positively affects the formation of RG, but the standardized
path coefficient obtained is 0.10, and p > 0.05, which is not verified. Assuming that the
standardized path coefficient of Hypothesis 2b is 0.59, and the p value is significant at the
0.001 level, hypothesis 2b is supported.
Hypothesis 3 posits that the RRO of government negatively affects project governance.
The standardized path coefficients of Hypothesis 3a and Hypothesis 3b are −0.22 and
−0.30, and the p value is significant at the level of 0.05 and 0.01. Hypothesis 3 is verified.
2. The effect of government’s relation orientation on PS
Hypothesis 4 posits that different government relation orientations have a significant
impact on PS. Hypothesis 4a posits that ERO has a positive impact on PS. The empirical
results show that although the path coefficient is 0.11, but p > 0.05, indicating that the direct
effect of ERO on PS is not significant, and hypothesis 4a is not supported. Assuming that
the path coefficient and p value of hypothesis 4b and hypothesis 4c are 0.30 and p < 0.001
and −0.25, and p < 0.01, both are verified.
3. The effect of project governance on PS
Hypothesis 5 posits that RG has a significant positive impact on PS, and Hypothesis
7 posits that CG has a significant positive correlation with PS. Hypothesis 5 has a path
coefficient of 0.42 and p < 0.001, and Hypothesis 7 has a path coefficient of 0.45 and p < 0.001,
both have been verified, indicating that RG and CG have a significant positive effect on PS.
4. The mediating role of project governance
This paper uses Bootstrapping based SEM test method to test the mediating role of RG
and CG with the help of Smart PLS statistical software. The test results are shown in Table 7.
The results show that the indirect effect of different government relation orientations on PS
is significant (p < 0.05), indicating that there is a mediating effect between them.

Table 7. Test results of mediating effect.

Hypothetical 95% Confidence Interval


Total Indirect Effects Indirect Effect p Value
Path Lower Limit Upper Limit
ERO→PS 0.24 * 0.18 0.35
ERO→RG→PS 0.17 ** 0.07 0.16
ERO→CG→PS 0.06 0.72 −0.05 0.13
IRO→PS 0.18 ** 0.10 0.26
IRO→RG→PS 0.04 1.06 −0.06 0.14
IRO→CG→PS 0.14 *** 0.15 0.27
RRO→PS −0.13 * 0.13 0.31
RRO→RG→PS −0.09 ** 0.06 0.14
RRO→CG→PS −0.05 * 0.12 0.27
Notes: * p < 0.05, ** p < 0.01, *** p < 0.001.

When the mediating variable RG is introduced, the indirect influence path coefficient
of ERO on PS is 0.17 and p < 0.01, which is verified; the indirect influence path coefficient
of IRO on PS was 0.04, but p > 0.05, failed to pass the verification; The indirect impact path
coefficient of RRO on PS is −0.09 and p < 0.01, which is verified. Combined with the above
verification results of direct effect, the conclusion is drawn: RG plays a fully mediating role
in the impact of ERO on PS, and plays a partial mediating role in the impact of RRO on PS.
It is assumed that Hypothesis 6a and Hypothesis 6c pass the verification, and Hypothesis
6b fails.
When the mediating variable CG is introduced, the path coefficient of the indirect influence
of ERO on PS is 0.06, but p > 0.05, which fails to be verified; The path coefficient of the indirect
Sustainability 2022, 14, 4724 15 of 20

influence of IRO on PS is 0.14, and p < 0.001, which passed the verification; The path coefficient
of the indirect influence of RRO on PS is −0.05 and p < 0.05, which is verified. Combining the
above verification results of direct effects, it is concluded that CG plays a partial mediating role
in the influence of IRO on PS and plays a partial mediating role in the influence of RRO on PS.
Hypothesis 8b and 8c pass the verification, and Hypothesis 8a fails.

5. Discussion
5.1. Discussion on the Direct Role of Government’s Relation Orientation
Through SEM model verification, it is found that different government relation orien-
tations have different mechanisms of effect on project governance and PS.
First, in PPP projects, ERO mainly plays a role by influencing RG, which further proves
the view of Huang and Chiu (2017) [29], and Shahzad et al. (2020) [30]. ERO helps the
relationship governance mechanism in the project play a role. However, the direct effect of
ERO on CG and PS is not significant.
It may be because ERO mainly promotes the flexibility of contract governance, and
has little effect on the completeness and strictness of contract performance, leading to
the positive effect of ERO on CG is not significant; starting from the practice of PPP
projects, with the development of PPP standardization, the quality of external emotional
relationships will not directly affect whether the contract is complete and strict, so the path
of action is not passed. Furthermore, the direct impact of ERO on PS is not significant, and
the hypothesis is not supported. This may be because, under ERO, the sincere treatment
and frank communication between the public and the private parties will make the project
management process easier and smoother, and will not directly improve the project cost,
quality, and progress [15]. The satisfaction of all parties to the project should also be
determined by the actual completion of the project, and the improvement of satisfaction
will not be guaranteed because of the good attitude of the public sector, so the direct effect
is not significant.
Second, IRO plays a role mainly by influencing CG and also has a direct impact on the
improvement of PS. This further proves the view of Byoun and Xu (2014) [31], David et al.
(2020) [32], and Lu et al. (2019) [33]. However, IRO does not promote RG, this may be
because under IRO, whether it is the support and assistance provided by the government
to the social sector or the communication and cooperation with the social sector, they all
adhere to the attitude of “business is business” and are more in the spirit of contract [34].
Behavior under the direction of project performance will not deepen the trust and sincere
communication between the two parties, so the impact on RG is not significant.
On the contrary, the negative effects of RRO have been verified, which is consistent
with the research of Guillermo Takano (2017) [20]. RRO will destroy the effect of RG and
CG, and is not conducive to the realization of PS.

5.2. Discussion on the Mediating Role of CG and RG


In the empirical research, the direct and indirect effects of CG and RG on project
sustainability have been effectively verified, which is consistent with the previous research
conclusions of most scholars on project governance, such as Tokede et al. (2021) [35],
Ngai et al. (2015) [19] and Pilar et al. (2021) [36].
The PPP project has a long time, heavy tasks, and a complex and changeable project
environment. The uncertainty of the project makes all participants have more excuses to
compromise in terms of cost, quality and progress, resulting in the project performance
falling short of expectations [31]. Signing a contract is a way to effectively allocate project
resources and curb opportunistic behavior. Among them, the completeness of the contract
is reflected in the detailed contract terms. For complex projects, the more complex the
formal contract is, the clearer the division of responsibilities and rights of both parties to
the transaction, which is conducive to the settlement of conflicts and disputes; contract
flexibility is an effective supplement to the completeness of the contract. Because the PPP
project is highly dynamic and uncertain, the contract cannot cover the possible situations
Sustainability 2022, 14, 4724 16 of 20

in the future. At this time, contract flexibility is needed to adapt to future changes and
maintain consistency with the external environment, such as price adjustment procedures,
reasonable distribution of control rights, dispute resolution, etc., so as to play the role of
flexible adjustment of the contract; the strictness of performance can effectively guarantee
the rigid constraint of project objectives through the cooperation of incentive and punish-
ment mechanisms. Therefore, the integrity, flexibility, and strict performance of contract
governance can effectively promote the sustainability of the project and ensure the success
of the PPP project.
RG can strengthen the expectation, trust, commitment, and other elements generated
in the transaction process, promote the formation of coordination, communication, and
other mechanisms, and then effectively solve problems and reduce risks. Specifically, a high
degree of trust between the public and private parties helps to improve the enthusiasm
to participate in the project and reduce conflict and opportunistic behavior; the two sides
maintain good and close communication, which is conducive to the transmission and
feedback of key information of the project, effectively reduce differences between the two
sides and reduce communication costs. By jointly solving problems, we can give full play
to our respective advantages, complement each other and support each other, so as to truly
achieve a win-win situation of cooperation. Therefore, a good relationship governance
mechanism can effectively improve the sustainability of the project.

6. Conclusions
This study explores the mechanism of government’s relation orientation on project
governance and PS in PPP projects. Through the literature review and theoretical analysis,
combined with the reality of the PPP project and expert interviews, a measurement scale of
the government’s relation orientation in the PPP project is developed. Then, we enriched the
connotation of PPP project sustainability and developed a PS measurement scale including
economic sustainability, social sustainability, and environmental sustainability. Afterward,
hypotheses were proposed to construct a structural equation model of the government’s
relation orientation, RG, CG, and PS. In the verification of the model, one used AMOS
software to verify the direct effect of each variable; the other used Smart PLS software to
verify the intermediary role of project governance. The following research conclusions
were drawn:
• First, different government relation orientations have different effects on project gov-
ernance and PS, among which IRO and RRO will directly affect PS.
ERO has a strong influence on project governance. In PPP projects, ERO is committed
to the maintenance of long-term partnerships. Therefore, more friendly information will be
released in the process of cooperation with the social capital party, such as giving sufficient
trust to the private sector, being sincere when communicating with the social capital party,
being willing to share project experiences and feelings, respecting the professionalism and
ability of the private sector, etc. These friendly tendencies will help RG mechanism in the
project to play a role.
IRO directly affects the CG process and PS. The government with IRO pays more
attention to the spirit of contract and emphasizes mutual benefit in cooperation with social
capital. For the purpose of successfully completing project goals and improving PS, the
government will complete the tasks according to the contract and bear the risks reasonably.
In case of emergencies, it is more inclined to negotiate with the private sector on an equal
footing and give some support, rather than blindly transfer the risks and responsibilities to
the social capital side. Under IRO, the two parties restrict and cooperate with each other,
which is conducive to the full role of CG, and the two parties can more smoothly reach an
agreement on the project objectives, which is conducive to improving the PS.
RRO has obvious negative effects on project governance and PS. RRO is the product of
the non-standard institutional environment of PPP projects. Due to the scarcity of resources
and public attributes of PPP projects, the public sector is endowed with innate choice,
supervision, and decision-making rights. If this inherent advantage is used by the public
Sustainability 2022, 14, 4724 17 of 20

sector for personal interests, such as taking whatever it wants in the selection of investors
or the setting of project cooperation conditions, setting an inappropriate threshold for the
entry of social capital, setting an unreasonable approval process, etc. These behaviors
are not conducive to the establishment of a good relationship between the public and the
private parties. They are also contrary to the equal subject status of both parties, are not
conducive to the smooth implementation of the contract terms, destroy the binding nature
of the contract, and are likely to erode the development foundation of the PPP project,
damage the public interest and cause the failure of the project.
• Second, RG and CG play different mediating effects on the impact of the government’s
relation orientation on PS: RG plays a complete mediating role in the impact of ERO
on PS, and plays a partial mediating role in the impact of RRO on PS; CG plays a
partial mediating role in the impact of IRO and RRO on PS.
Through the verification of the mediation effect, RG plays a complete mediating role
between ERO and PS. The reason why RG can be closely related to the relationship between
ERO and PS can be explained from the following aspects. Firstly, the trust relationship
between public and private parties in a PPP project is not invariable and achieved overnight.
Under ERO, the initial level of trust between the two parties is high, the positive sincerity,
trust, and communication are continuously strengthened in the process of cooperation, the
relationship is more stable, and the effect and level of RG are improved. Secondly, the role
of RG in improving PS has been verified by many scholars. Trust, communication, and
joint problem-solving in relationship governance can improve the cooperation satisfaction
of both sides and are an effective way to achieve PS. Finally, the complete mediating role
of RG also shows that RG is a necessary mediation way for ERO to affect PS. ERO can
effectively improve PS only if it is reflected in action and effectively improve the effect of
project relationship governance.
CG plays a part of mediating role in the positive impact of IRO on PS. This process
further improves the path and mechanism of IRO on PS. On the one hand, IRO will
directly affect the PS. On the other hand, IRO will play a role through the project contract
governance mechanism and then affect the PS. IRO can improve the supply efficiency
of public projects through direct interaction with the social capital, such as providing
additional help to achieve more cost-effective public goods/services. It can also affect the
setting and implementation of contract terms through the principles of “contract spirit”
and “mutual benefit”, thereby improving PS.
On the one hand, RRO will directly have a negative impact on PS; on the other hand,
it will also destroy RG and CG, which is not conducive to the establishment of a good
relationship and formal contract between both parties, thus damaging PS. Therefore, the
negative effect of RRO has a wide range of influence paths. In the actual project, rent-
seeking behaviors should be prevented and avoided as much as possible.

7. Practical Implications, Limitations, and Future Research


7.1. Practical Implications
• First, improve the top-level design of the PPP project and strengthen project life-cycle
management.
Chinese policy environment and economic environment are different from those in
western countries. Chinese legislation often needs to provide specific and micro implemen-
tation plans for certain issues in order to effectively solve problems that should be solved
spontaneously by society or the market. Therefore, PPP legislation related to performance
and sustainability can be more abundant and detailed, which can not only improve the
top-level design but also be applied to project practice. For example, further enrich the
necessary contents and terms related to sustainability in the PPP project agreement. On the
one hand, according to the principle of incentive compatibility, scientifically design the
contract terms, match the risks and interests, and clarify the key links such as project output
descriptions, performance requirements, and profit return mechanism. On the other hand,
Sustainability 2022, 14, 4724 18 of 20

strengthen performance supervision covering the life-cycle of the PPP project to match
the performance appraisal with project appraisal, price adjustment, and consideration
payment, so as to create conditions for social capital to obtain reasonable return while
realizing effective supervision. In addition, strengthen performance audits and third-party
evaluation. Combined with the characteristics of PPP projects, improve relevant audit
systems, procedures, methods, and methods, so as to make performance audit an important
link for improving the sustainability of PPP projects. At the same time, select experts in law,
economy, accounting, audit, engineering, environmental protection, agriculture, forestry
and water conservancy, and other industries, set up a third-party performance evalua-
tion organization, give full play to the expertise of experts and implement performance
evaluation of PPP projects.
• Second, the government should pay attention to the mechanism of ERO and IRO, and
reasonably grasp its own positioning.
In PPP projects in China, the government is often in a strong position because of its
resource advantages, so it is difficult to completely treat the private sector as an equal
subject, which is not conducive to the healthy and sustainable development of PPP projects.
The empirical results show that ERO and IRO are conducive to the improvement of project
governance and PS, and the direct effect of IRO is more significant. Therefore, the gov-
ernment should pay attention to the mechanism of government’s relation orientation in
the whole life cycle of PPP projects. Firstly, the government should establish the concept
of equal consultation and fully understand the existing laws and policies. In the project
start-up stage, it should be good at using the expert advice of the external brain to clarify
its own goal positioning. In the process of signing the contract, be honest with each other to
reduce unnecessary conflicts and frictions. The second is to clarify the boundary between
the two parties based on the contract signed by both sides. The more standardized the
contract is, the better the contract governance can play its role. In the process of project
implementation, the government should honor its promise to perform the contract, restrict
its own behavior according to the principle of equal responsibility and rights, and realize
reasonable benefit distribution and risk-sharing. So as to give full play to their respec-
tive advantages, establish a good partnership and jointly promote the development of
PPP projects.

7.2. Limitations and Future Research Directions


This study puts forward a new dimension and connotation of the government’s
relation orientation in PPP projects. On this basis, through empirical research to explore
the impact mechanism of government’s relation orientation on PS, the conclusions are
creative, but there are also some limitations, which can be further enriched and improved
in future research. One is that this study focuses on the impact of the government’s relation
orientation on project governance mechanism and PS, without considering the response and
role of the private sector. In the future, the behavior of the private sector can be included
in the research scope to further explore the mechanism and path of the government’s
relation orientation. Second, PPP projects face a complex external environment, and project
characteristics such as uncertainty and complexity will also have a great impact on the
government’s relation orientation and PS. In future research, project characteristics can
be incorporated into the research model to make the project research closer to the actual
situation. Third, we can further reveal the dynamic influence process of government’s
relation orientation through case studies to see whether we will draw more rich and
creative conclusions.

Author Contributions: Conceptualization, G.F.; Formal analysis, X.L.; Funding acquisition, S.H.; In-
vestigation, G.F. and X.L.; Methodology, G.F., S.H. and X.L.; Project administration, G.F.; Software, G.F.;
Supervision, S.H.; Visualization, G.F.; Writing—original draft, G.F.; Writing—review & editing, G.F. and X.L.
All authors have read and agreed to the published version of the manuscript. Funding: This research
Sustainability 2022, 14, 4724 19 of 20

was funded by the National Natural Science Foundation of China, grant number 71340008; and the
Fundamental Research Funds for the Central Universities, grant number 2018YJS066.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflict of interest.

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