Organisational capability for digital health transformation in long-term care: development of a conceptual framework

Background Digital health transformation in long-term care (LTC) involves more than the adoption of digital technologies. Organisations must coordinate leadership, workforce capability, infrastructure, governance and implementation processes to sustain digital systems within continuing care environments. Existing implementation and digital maturity approaches address important aspects of digital transformation but provide less explanation of how organisational capabilities interact as a system within LTC. Objective This study develops an evidence-informed organisational capability framework for digital health transformation in LTC and proposes relationships among capabilities potentially relevant to sustained digital system use. Methods An evidence-informed framework development approach was used. Published evidence from digital health, healthcare management, implementation and organisational research was examined to identify recurring organisational mechanisms associated with digital transformation. Related mechanisms were grouped into capability domains, and proposed relationships among the domains were conceptualised. The resulting domains were integrated into the Long-Term Care Digital Capability and Alignment (LTC-DCA) framework. Results LTC-DCA comprises seven interdependent organisational capability domains: strategic digital leadership, organisational readiness, workforce development systems, technology and data infrastructure alignment, governance and ethical oversight, implementation and integration mechanisms, and performance and learning systems. The framework conceptualises these domains as a connected capability system in which changes in one domain may influence others. Performance and organisational learning are proposed as feedback mechanisms that may support continued adjustment and alignment. Conclusions LTC-DCA shifts attention from technology adoption towards the organisational capabilities potentially involved in integrating, sustaining and adapting digital systems within long-term care. The framework is evidence-informed and conceptually specified rather than empirically validated. Future research could examine its domains, proposed relationships and indicators across different LTC settings and investigate whether they are associated with sustained digital system use and organisational performance.