Aligning digital strategy and resources to create Healthcare 4.0 organizations: Implications for smart operations and smart working

This study investigates the organizational foundations required to implement Healthcare 4.0 (H4.0) by examining how digital strategy, internal and external digital resources, and network embeddedness support the development of smart operations and smart working in healthcare organizations. While prior research has predominantly focused on technology-driven improvements in healthcare processes, less attention has been given to the sociotechnical integration of people, processes, and technologies, particularly from a strategic and managerial perspective. Drawing on a survey of 303 hospitals, we assessed the role of digital strategy and digital resources in advancing H4.0, conceptualized through the dual lenses of smart operations (technology for process automation) and smart working (technology to support workers). Using hierarchical regression and bootstrapping techniques, we find that digital strategy positively influences both smart operations and smart working. However, internal and external digital resources mediate this relationship only in the context of smart working. This indicates that while process automation relies primarily on strategic clarity, supporting workers requires stronger resource structures. Additionally, we find that healthcare network embeddedness positively moderates the relationship between digital strategy and external digital resources, but not internal resources. This suggests that external collaborations enhance a hospital's ability to translate strategic intent into actionable use of external resources, particularly in support of smart working. Our findings contribute to a deeper understanding of how strategic alignment and network embeddedness shape sociotechnical systems in healthcare. They offer guidance for managers seeking to design holistic digital transformation strategies to build H4.0 organizations.