Abstract: Digital health transformation is seen as a strategic way forward to safer, more efficient and patient-centred care in hospitals; however, it is not well understood how the organisational mechanisms can facilitate the transformation of digital investments into quality performance. The integrated model proposed and validated in this study suggests that digital health transformation positively influences quality performance both directly and indirectly through the variable of employee engagement, while quality governance (safety culture) positively influences the relationship between digital health transformation and employee engagement, and directly influences quality performance. The framework is based on the theories of sociotechnical systems, high-reliability organisations, resource-based view, dynamic capabilities and Donabedian's structure-process-outcome logic. A cross sectional explanatory design was designed with 612 doctors, nurses, allied health professionals, administrators, quality professionals and digitally enabled healthcare professionals of 12 NABH accredited multi-specialty hospitals in India. Constructs were thought of as multi-dimensional organisational capabilities and were measured using multi-item scales which were established and/or derived from the literature. Partial least squares structural equation modelling with 10,000 bootstrap subsamples was used to assess the measurement and structural models. The relationships between digital health transformation and employee engagement (β = .428, p < .001), and between digital health transformation and quality performance (β = .276, p < .001), and between employee engagement and quality performance (β = .357, p < .001) were all positive. In addition to the direct path, a significant indirect path via employee engagement was found (β = .153, p < .001) consistent with complementary partial mediation. Safety culture governance had a positive direct relationship with quality performance (β = .241, p < .001), and a positive relationship between transformation and engagement (interaction β = .124, p = .002). The model explains 41.2% of the variance of engagement and 62.8% of the variance of quality performance. The study contributes an employee-centered perspective of the digital value creation in hospitals and shows that digital capability is related to better quality performance in the context of accountable safety governance. Practical implications are provided for boards of hospitals, quality leaders, digital transformation teams, accreditation and policy makers who would like to leverage technology to align workforce engagement and safety governance.
Keywords: Digital health transformation, employee engagement, safety culture governance, quality performance, multi-specialty hospitals, PLS-SEM, India, patient safety.
Title: Digital Health Transformation, Safety Culture Governance, and Quality Performance: The Mediating Role of Employee Engagement in Multi-Specialty Hospitals
Author: Anita David, Dr. Sapna S Rathore
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
Vol. 14, Issue 2, October 2026 - March 2027
Page No: 83-98
Research Publish Journals
Website: www.researchpublish.com
Published Date: 10-November-2026
