From Construction Innovation to Operational Reality: Barriers to Technology Diffusion in the Operations and Maintenance of Public Hospitals in South Africa

South Africa’s public hospital system faces mounting pressure from ageing infrastructure, rising patient demand, and constrained maintenance budgets. While significant investment has been directed toward the construction of new healthcare facilities, the diffusion and adoption of advanced technologies within operations and maintenance (O&M) remain uneven and underdeveloped. This misalignment limits the long-term performance, safety, and sustainability of hospital assets. This study investigates technological diffusion within the O&M environment of a newly commissioned 500-bed regional hospital in Durban, KwaZulu-Natal. A qualitative single-case study approach was adopted, drawing on semi-structured interviews with 14 stakeholders across project delivery and facility management functions. Data were analysed thematically to identify systemic patterns and operational constraints. Findings reveal a persistent reliance on manual, reactive maintenance practices, with minimal integration of digital tools, including building management systems, predictive maintenance technologies, and real-time monitoring platforms. Key barriers include unclear institutional roles, inadequate handover processes, limited technical capacity, and the absence of strategic leadership to drive innovation. A critical disconnect was also identified between managerial expectations and operational realities. The study argues that technological adoption in hospital O&M is not merely a technical challenge but an institutional one. It recommends targeted capacity development, structured transition frameworks, and stronger governance mechanisms to enable sustainable digital integration.