Modelling the strategic pathways from AI transformation capability to healthcare sustainability through continuous improvement systems in Indonesia

The integration of artificial intelligence (AI) is transforming healthcare organizations worldwide, yet the mechanisms through which AI contributes to long-term healthcare sustainability remain insufficiently understood. This study develops and empirically tests a structural model explaining how AI Transformation Capability enhances Healthcare Sustainability Performance through continuous improvement systems in Indonesian healthcare organizations. A cross-sectional survey was conducted among 550 healthcare organizations across Indonesia that have implemented AI-based systems and continuous improvement practices. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to evaluate measurement validity, structural relationships, mediation effects, predictive relevance (PLSpredict), and managerial prioritization through Importance–Performance Map Analysis (IPMA). The findings reveal that AI Transformation Capability strongly influences the implementation of Kaizen initiatives and Lean Six Sigma practices. Both improvement mechanisms significantly enhance Quality Management Practices and Patient Safety, which subsequently drive Healthcare Sustainability Performance. Mediation analysis confirms that Kaizen and Lean Six Sigma partially mediate the relationship between AI capability and quality-related outcomes, indicating that AI-driven transformation contributes to sustainability primarily through structured continuous improvement systems. The model demonstrates strong explanatory power and predictive relevance, while IPMA results highlight AI capability and Kaizen as the most critical managerial priorities for strengthening sustainability performance. The findings provide strategic guidance for healthcare leaders and policymakers seeking to align AI investments with continuous improvement initiatives to achieve sustainable healthcare systems, particularly in emerging economies such as Indonesia.