"Digital Unless?" Evaluating Digital Transformation in a Dutch Hospital.

Facing rising care demands, workforce shortages, and cost pressures, healthcare systems increasingly view digital transformation as essential rather than optional. This paper presents a qualitative evaluation of such efforts within a Dutch hospital that formally embraced the "digital unless" principle, providing care digitally by default unless not feasible. Despite strategic commitment, actual implementation often lags behind due to organizational, cultural, and practical barriers. In April 2025, a structured internal session was held involving a diverse group of stakeholders, including the executive board, board of medical staff, nursing staff board, tactical management representatives, the innovation committee, CMIO, CIO, and the patient advisory council. The session included (1) a strategic proposition review, (2) a "fishbowl" dialogue focused on staff experience, and (3) a debate on patient needs and autonomy. Central questions included "Are we doing digitally what can be done digitally?" and "What is needed to make that a reality?" Thematic analysis of the session revealed five key lessons: (1) hybrid care is the realistic default; (2) mindset and working technology are interdependent; (3) tailored support for staff is critical; (4) adopting proven innovations from others is efficient and effective; and (5) patient autonomy must remain central. These findings are contextualized using current literature and implementation frameworks like the Technology-Organization-Environment (TOE) model. External sources provide empirical support for the operational, clinical, and human value of digital health. The study concludes that digital success depends less on vision and more on cultural readiness, staff alignment, and meaningful patient inclusion. This paper offers practical, evidence-informed recommendations to help hospitals translate digital ambitions into measurable impact.