Hospital Change Management in the Digital Era: A Systematic Literature Review of Leadership, Ambidexterity, and Innovation
DOI:
https://doi.org/10.37385/g4rpyv34Keywords:
Hospital Change Management, Digital Transformation, Digital Leadership, Paradoxical Leadership, Ambidexterity, Innovative Work Behaviour, Psychological Safety, SPAR-4-SLR.Abstract
Purpose: Hospitals are undergoing digital transformation through electronic health records, telemedicine, virtual care, artificial intelligence, patient portals, and data-driven operations. Yet the implementation of these technologies frequently produces organizational tensions that cannot be explained by technology-adoption logic alone. This systematic literature review examines hospital change management in the digital era by integrating evidence on leadership, ambidexterity, and innovation. Design/methodology/approach: The review followed the SPAR-4-SLR logic of assembling, arranging, and assessing the literature and used a PRISMA-informed screening flow. The evidence boundary was deliberately restricted to Scopus-confirmed Q1/Q2 journal articles. From 1,343 raw records, 1,323 unique records were retained after deduplication. After source-quality, document-type, and topical screening, 175 articles were included in qualitative synthesis. Findings: The review identifies five interrelated patterns. First, hospital digital change is a sociotechnical process that reshapes workflow, accountability, professional identity, and care coordination. Second, readiness is multidimensional, combining digital competence, technological self-efficacy, managerial capability, psychological safety, and learning climate. Third, leadership operates as a translation mechanism between executive digital strategy and frontline clinical practice. Fourth, ambidexterity provides a strategic explanation for how hospitals balance reliability, standardization, and safety with experimentation and innovation. Fifth, innovative work behaviour is a proximal behavioural pathway through which digital change becomes embedded in practice. Originality/value: The review develops a paradox-informed digital leadership framework for hospital change management. It contributes by connecting hospital digital transformation, paradoxical leadership, digital leadership, ambidexterity, and innovative work behaviour into a coherent agenda for future empirical research.
References
Atalla, A. D. G., Mostafa, W. H., & Ali, M. S. S. (2025). Exploring the link between paradoxical leadership and nurses’ career maturity: The mediating role of organizational learning. BMC Nursing, 24, 559. https://doi.org/10.1186/s12912-025-03179-6
Beecham, E., Brady, G., Bondaronek, P., O’Carroll, J., Siassakos, D., Glaser, S., Gilchrist, K., Dorey, J., Knagg, R., & Vindrola-Padros, C. (2026). Beyond the report: A qualitative exploration of safety incidents in maternity services. BMJ Open Quality, 15. https://doi.org/10.1136/bmjoq-2025-004020
Binsaeed, R. H., Yousaf, Z., Grigorescu, A., Condrea, E., & Nassani, A. A. (2023). Emotional intelligence, innovative work behavior, and cultural intelligence reflection on innovation performance in the healthcare industry. Brain Sciences, 13(7), 1071. https://doi.org/10.3390/brainsci13071071
Binsar, F., Hamsal, M., Ichsan, M., Abdinagoro, S. B., & Dwidienawati, D. (2026). Environmental dynamics and digital transformation in lower-middle-class hospitals: Evidence from Indonesia. Healthcare, 14(2), 182. https://doi.org/10.3390/healthcare14020182
Cartland, J., Green, M., Kamm, D., Halfer, D., Brisk, M. A., & Wheeler, D. (2022). Measuring psychological safety and local learning to enable high reliability organisational change. BMJ Open Quality, 11, e001757. https://doi.org/10.1136/bmjoq-2021-001757
Elsehrawy, M. G., El-Ashry, A. M., & Abou Zeid, M.-A. G. (2025). The effect of paradoxical leadership on nurse’s job performance: The mediating role of thriving at work. BMC Nursing, 24, 1140. https://doi.org/10.1186/s12912-025-03800-8
Friary, P. M., McAllister, L., Martin, R., Purdy, S. C., & Barrow, M. (2024). Allied health new graduates’ voice behavior: New perspectives using realist synthesized narratives. Journal of Health Organization and Management, 38(7), 1050-1071. https://doi.org/10.1108/JHOM-06-2023-0199
Fu, Q., Cherian, J., Ahmad, N., Scholz, M., Samad, S., & Comite, U. (2022). An inclusive leadership framework to foster employee creativity in the healthcare sector: The role of psychological safety and polychronicity. International Journal of Environmental Research and Public Health, 19(8), 4519. https://doi.org/10.3390/ijerph19084519
Hu, X., Jiang, L., Willis, S., Casey, T., & Wu, C.-H. (2024). Paradoxical safety leadership: Conceptualization and measurement. Journal of Organizational Behavior. https://doi.org/10.1002/job.2826
Joseph, M. M., Mahajan, P., Snow, S. K., Ku, B. C., & Saidinejad, M. (2022). Optimizing pediatric patient safety in the emergency care setting. Pediatrics, 150(5), e2022059674. https://doi.org/10.1542/peds.2022-059674
Majcherek, D., Hegerty, S. W., Kowalski, A. M., Lewandowska, M. S., & Dikova, D. (2024). Opportunities for healthcare digitalization in Europe: Comparative analysis of inequalities in access to medical services. Health Policy, 139, 104950. https://doi.org/10.1016/j.healthpol.2023.104950
Malik, R. F., Buljac-Samardzic, M., Amajjar, I., Hilders, C. G. J. M., & Scheele, F. (2021). Open organisational culture: What does it entail? Healthcare stakeholders reaching consensus by means of a Delphi technique. BMJ Open, 11, e045515. https://doi.org/10.1136/bmjopen-2020-045515
Mohammadi, F., Farjam, M., Gholampour, Y., Tehranineshat, B., Oshvandi, K., & Bijani, M. (2020). Health professionals’ perception of psychological safety in patients with coronavirus (COVID-19). Risk Management and Healthcare Policy, 13, 785-794. https://doi.org/10.2147/RMHP.S261410
Odeh, Y., & Shamieh, O. (2025). Bridging the digital readiness gap in palliative home care: A process to data approach. Digital Health, 11. https://doi.org/10.1177/20552076251346380
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Paul, J., Lim, W. M., O’Cass, A., Hao, A. W., & Bresciani, S. (2021). Scientific procedures and rationales for systematic literature reviews (SPAR-4-SLR). International Journal of Consumer Studies, 45, 1-16. https://doi.org/10.1111/ijcs.12695
Pearce, C. L., & van Knippenberg, D. (2024). Moderated paradoxical leadership: Resolving the innovation team leadership conundrum. Journal of Product Innovation Management, 41, 3-11. https://doi.org/10.1111/jpim.12713
Scott, I. A., Sullivan, C., & Staib, A. (2019). Going digital: A checklist in preparing for hospital-wide electronic medical record implementation and digital transformation. Australian Health Review, 43(3), 302-313. https://doi.org/10.1071/AH17153
Tenggono, E., Soetjipto, B. W., & Sudhartio, L. (2025). Dynamic managerial capabilities in action: Advancing strategic agility and digital readiness in healthcare organizations. Journal of Organizational Change Management, 38(3), 548-568. https://doi.org/10.1108/JOCM-12-2024-0772
Xi, C., Zhang, Y., & Qu, X. (2025). Informational faultlines, team boundary work, and idea implementation: The moderating role of paradoxical leadership. Journal of Business Research, 192, 115323. https://doi.org/10.1016/j.jbusres.2025.115323
Zhang, Y., & Zhang, Y. (2025). Paradoxical leadership and employee creativity: The role of cognitive complexity and flexibility. Journal of Business Research, 199, 115542. https://doi.org/10.1016/j.jbusres.2025.115542
Zhao, K., & Mohd Kamil, N. L. (2025). How and when paradoxical leadership nurture innovation: The role of self-leadership and leader-member exchange. SAGE Open, 15(2). https://doi.org/10.1177/21582440251346997
Template
