Sustainable Digital Transformation in Public Hospitals: Strategic Enablers for Smart Healthcare Systems

Sustainable digital transformation in healthcare is becoming increasingly urgent; there is limited empirical research on the organizational factors that contribute to success in emerging economies. This study addresses this gap by analyzing how leadership, knowledge management, and technology acceptance influence the development of smart hospitals, using Thailand as a case study. A mixed-methods approach was adopted, combining semi-structured interviews with senior administrators and a survey involving 370 respondents from 37 hospitals. The data were analyzed using exploratory factor analysis and multiple regression. The results indicate that institutional knowledge repositories and leaders’ reading comprehension skills significantly enhance the digital maturity of hospitals. Conversely, reliance on traditional communication methods and an excessive focus on ease of use negatively impact outcomes. These findings suggest that leadership-driven cognitive readiness and well-structured knowledge systems are more important than merely simplifying digital solutions. The originality of this research lies in integrating sustainability principles into digital transformation, connecting management competencies with the resilience of health systems. This study offers actionable insights for policymakers in low- and middle-income countries and presents a framework for the sustainable development of smart hospitals. Limitations and suggestions for future research are also discussed.