A digital twin framework for lean strategic facility management in the UK healthcare built environment

Purpose This study develops a socio-technical maturity process for digital twin implementation in National Health Service healthcare estates, where operational costs exceed £13.6 billion annually and current frameworks fail to address human technical integration. Design/methodology/approach Sequential mixed methods within Design Science Research combine surveys (n = 30), interviews (n = 16), and expert evaluation (n = 8). Statistical and thematic analyses enabled process and matrix development and validation. Findings The four-phase process (Awareness, Adoption, Adaptation, Optimisation) with Technology Transition Matrix addresses capability gaps wherein organisational dimensions demonstrate the largest deficits (ΔM = 1.73, d = 1.73) exceeding infrastructure gaps (ΔM = 1.50). Systematic analysis identified 70 implementation challenges with 84% requiring coordinated socio-technical interventions. Originality/value This research advances socio-technical systems theory, demonstrating that digital twin implementation requires dynamic capability technology coupling rather than sequential deployment. The process operationalises socio-technical progression through phase-specific requirements, whilst the matrix provides tactical guidance through seven stages with phase stage alignment demonstrating systematic relationships (χ2(9) = 47.23, p < 0.001, V = 0.52). Both address gaps in existing maturity models through explicit technical organisational integration validated across 54 participants.