Structuring resources in healthcare digital transformation: a comparison across public, private and research hospitals

Abstract

Healthcare organizations have witnessed major advances in the use of digital technologies. While prior research on Healthcare Digital Transformation (HCDT) has focused on the impact of digital technologies on healthcare operations, understanding how to manage the digital resources necessary for HCDT implementation remains unclear. We address this gap by examining how hospitals manage digital resources to foster HCDT. Drawing on the Technological, Organizational, and Environmental (TOE) framework and supported by the Resource-Based View, Relational View, and hybrid governance theories, we conduct a qualitative multi-case study of three large hospitals: one public, one private, and one research-oriented. Data collection includes semi-structured interviews, document analysis, and on-site visits. Our study reveals that HCDT strategies are shaped by hospital business models and financial structures, leading to distinct digital resource governance approaches: internal development in public hospitals, external sourcing in private hospitals, and hybrid governance in research hospitals. We propose a typology aligned with strategic logics and clarify how each model engages with digital ecosystems—ranging from internal coordination to external orchestration and collaborative innovation. Despite their dominant strategies, all hospitals maintain complementary resource bases to ensure resilience. Additionally, we contribute to theory by conceptualizing hybrid governance in research hospitals as a funding-driven mechanism, offering a new rationale for its adoption. These insights advance the understanding of digital resource management in healthcare and provide practical guidance for designing context-sensitive HCDT strategies.