Digital transformation, strategy execution and operational efficiency in Uganda's medical facilities

This study examined the relationship between digital transformation (DT), strategy execution (SE), and operational efficiency (OE) in Uganda's medical facilities. Although digital adoption is promoted in healthcare modernization, little is known about its performance implications in low-resource settings. The study explored both direct and indirect effects of DT on OE, with SE as a mediator.

A mixed-methods design was employed using quantitative structured questions and qualitative open-ended interviews. Data were collected from 60 heads of public and private medical facilities, including 12 purposively selected key informants for contextual depth and validation. Partial least squares structural equation modeling (PLS-SEM) tested the hypothesized relationships among DT, SE and OE, guided by the technology-organization-environment (TOE) framework and dynamic capabilities theory (DCT).

DT did not directly affect OE but significantly enhanced SE, which strongly improved OE. SE fully mediated the DT-OE relationship, underscoring the role of execution capabilities in translating digital initiatives into performance outcomes.

The study reveals that digital transformation alone does not enhance operational efficiency in Uganda's medical facilities; rather, its impact is realized through effective strategy execution. Policymakers should focus on integration, governance and capacity-building beyond technology adoption. The research extends TOE and DCT frameworks, emphasizing managerial execution, contextual alignment and institutional capability as key to realizing digital value. It informs curriculum design by advocating training in digital governance, strategy, and change management to build leadership capacity. Societally, successful digital health outcomes depend on governance quality and execution, not technology alone. Future longitudinal studies should explore moderating factors influencing sustainable digital health reforms.

Policymakers should align digital investments with strategic goals, emphasizing interoperability, workforce readiness and sustainable financing. The findings highlight that digital health success in low- and middle-income countries (LMICs) depends more on execution quality and governance than technology adoption.

The findings of this study have significant societal implications for Uganda's healthcare sector and similar LMIC contexts. The evidence that digital transformation does not directly enhance operational efficiency, but rather operates through effective strategy execution, highlights that technology alone cannot improve public health outcomes, patient satisfaction or equity in access to care. This means that while the introduction of digital tools such as electronic health records, e-prescriptions and telemedicine platforms has the potential to enhance service delivery, their societal value depends on how effectively they are implemented, aligned with strategy and integrated into patient-centered workflows.

This study contributes novel empirical evidence from LMICs, emphasizing organizational and managerial enablers leadership, process alignment and executional capacity as true drivers of digital value creation. Integrating quantitative and qualitative insights, it offers actionable guidance for policymakers and practitioners.