Integrating AI Capability, Patient Safety Climate, and Operational Efficiency for Sustainable Hospital Finance: Evidence from a Multi-Hospital Study in Indonesia

Background: Hospitals operate under intensifying clinical demands alongside persistent financial fragility, yet it remains unclear how financial and AI-enabled analytical capabilities translate into sustainable financial performance and through which operational and safety mechanisms. This study examined how financial management capability and AI-enabled analytics capability contribute to hospital sustainable financial performance through operational efficiency and patient safety climate, and whether data interoperability readiness moderates the final links. Methods: A quantitative, cross-sectional survey design was used. Data from 233 managers and leaders in 14 hospitals across Indonesia were analysed with Partial Least Squares-Structural Equation Modelling (PLS-SEM) using a disjoint two-stage higher-order model, bootstrapped mediation and moderation analysis, importance-performance map analysis, and cross-validated predictive ability testing. Results: All six higher-order measurement paths were confirmed, and seven of the eight structural hypotheses were supported. Financial management capability and AI-enabled analytics capability were both positively associated with operational efficiency (β = 0.467 and 0.471) and patient safety climate (β = 0.381 and 0.527), with AI-enabled analytics capability the stronger driver (all p < 0.001). Both mediators carried significant indirect effects to financial performance, and operational efficiency (β = 0.438) exceeded patient safety climate (β = 0.342). Data interoperability readiness strengthened the efficiency-to-finance path (β = 0.354, p < 0.001) but, contrary to the hypothesis, weakened the patient-safety-climate-to-finance path (β = −0.360, p < 0.001): at high interoperability the conditional contribution of safety climate fell to null while that of efficiency strengthened. The model showed satisfactory out-of-sample predictive validity. Conclusions: Sustainable hospital finance depends less on acquiring technology than on aligning capabilities. Analytic capability embedded in workflow is the principal lever, operational efficiency is the most direct route to margin, and interoperability is a complementary asset that must be governed so that it amplifies efficiency without displacing the relational substance of patient safety.