From user voice to digital health innovation: Accountability through human-centered auditing in Chinese public hospitals

Objectives The governance mechanisms through which public hospitals translate digital transformation into digital health innovation remain underexplored. This study investigates the association between human-centered auditing and digital health innovation in Chinese public hospitals and examines whether organizational ethical culture moderates this relationship. Methods Drawing on perspectives from digital government, digital innovation, socio-technical systems, audit-and-feedback, and organizational ethics, this study conducted a hospital-level cross-sectional survey of 130 Chinese public hospitals between August 2025 and April 2026. Human-centered auditing was operationalized as an entropy-weighted composite index based on Likert-scale indicators encompassing user feedback, ethical and security auditing, interdepartmental coordination, and audit response mechanisms. Regression analyses incorporated organizational and contextual control variables, survey-month fixed effects, robustness checks, and subgroup heterogeneity analyses. Results Human-centered auditing was positively and robustly associated with digital health innovation. Organizational ethical culture did not significantly moderate this association across the sample, indicating that its contextual relevance may depend on broader institutional conditions. Exploratory subgroup estimates varied by hospital level, location, type, and digital health pilot status; however, their directions were not consistently aligned with the pooled interaction estimates, warranting cautious interpretation of subgroup differences. Conclusions This study conceptualizes digital health innovation as an outcome of public-sector digital governance and identifies human-centered auditing as an institutional governance mechanism associated with hospitals’ capacity to integrate user feedback, ethical safeguards, accountability procedures, and digital innovation. Public Interest Summary Digital technologies are reshaping how public hospitals deliver care, manage services, and interact with patients. This study examined 130 Chinese public hospitals to assess the association between human-centered auditing and digital health innovation. Human-centered auditing encompasses patient and staff feedback, privacy and security reviews, cross-department collaboration, and clearly defined follow-up actions for digital services. Hospitals with stronger human-centered auditing tended to report higher digital health innovation in technology use, management processes, and patient services. Ethical culture did not significantly moderate this association, although ethical values embedded in practical procedures may remain relevant to digital governance within public hospital settings. Overall, digital health outcomes were associated not only with technology investment but also with accountable, user-centered governance arrangements.