Strategic Alignment: Driving Patient Satisfaction and Performance in Public Hospitals.

RATIONALE: Healthcare IT investments in Iranian public hospitals often fail to translate into better perioperative experiences when IT initiatives are not strategically aligned, leading to delays in diagnostics, scheduling, and discharge and, consequently, lower patient satisfaction. AIMS AND OBJECTIVES: Drawing on Dynamic Capabilities Theory, this study examines whether strategic alignment improves perceived organisational performance and patient satisfaction in perioperative care settings, assesses whether IT strategic orientation strengthens the alignment-satisfaction relationship, and tests whether patient satisfaction contributes to organisational performance. METHOD: A mixed-methods design was employed. Quantitative data from 91 public hospitals were analysed using PLS-SEM. Qualitative insights were obtained through semi-structured interviews with 374 patients, over 80% of whom had recently undergone surgery or other operating room procedures, to identify key sources of dissatisfaction. RESULTS: Strategic alignment positively influenced perceived organisational performance and patient satisfaction. IT strategic orientation moderated the alignment-satisfaction relationship, with stronger effects in hospitals with a disciplined, risk-aware, innovative IT orientation. Patient satisfaction did not significantly predict perceived organisational performance, suggesting that patient-facing improvements may not immediately translate into managerial resource/financial performance in public hospitals. Qualitative findings highlighted prolonged waiting times and the unavailability of preoperative laboratory tests as major drivers of dissatisfaction. CONCLUSION: Strategic alignment, particularly when supported by a disciplined, risk-aware, innovative IT orientation, improves non-financial outcomes in perioperative pathways. Hospitals should prioritise interoperable systems and perioperative workflow integration, while policymakers should support targeted digital transformation in public hospitals.