Abstract Healthcare supply chains are increasingly required to achieve high levels of resilience while meeting growing sustainability and digital transformation demands. In Saudi Arabia, healthcare logistics systems face complex coordination challenges due to centralized procurement structures, large-scale public health operations, and rapidly evolving digital infrastructure. This study investigates how Artificial Intelligence (AI) and Physical Internet readiness influence the sustainability and resilience of healthcare supply chains by moderating the relationship between digital transformation barriers and supply chain performance. Using survey data collected from 619 healthcare supply chain professionals across Saudi Arabia, the study employs partial least squares structural equation modeling (PLS-SEM) to examine the relationships between digital transformation barriers, organizational resistance, and logistics performance. AI-PI readiness is modeled as a formative logistics capability because its dimensions, including AI-supported coordination, modular logistics infrastructure, interoperable data systems, and collaborative resource utilization, jointly form the capability. The study examines how this capability moderates the effects of digital transformation barriers on organizational resistance and sustainable healthcare supply chain performance. To evaluate the operational implications of these relationships, the empirical findings are integrated into an agent-based simulation model that examines system performance under disruption scenarios. The results show that technological and organizational constraints significantly hinder digital transformation in healthcare supply chains, while AI-PI capabilities moderate these effects by improving coordination efficiency and reducing systemic resistance. Simulation experiments further demonstrate that AI-enabled logistics architectures can enhance supply chain resilience while improving resource utilization and sustainability outcomes. The findings provide theoretical insights into the role of integrated logistics architectures in sustainable supply chain transformation and offer practical guidance for healthcare organizations seeking to develop digitally coordinated logistics networks aligned with national sustainability and healthcare modernization initiatives.
El-Nakib et al. (Sun,) studied this question.
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