Data Governance for Hospital Sustainability: Department Leaders' Interfaces amid Design and Strateg

In a data-driven era, digital innovation is increasingly sought to accelerate sustainability achievements within public hospitals. However, the strategic importance of data governance and hospital information systems (HIS) towards this change has been largely overlooked. In particular, there is scarce microlevel understanding regarding the role of hospital leaders (HL) and other frontline managers––interfacing for designing new creative solutions amid unique contextual conditions. Such efforts are necessarily collective and require unified leadership structures, which is more challenging in public hospitals, i.e., knowledge-intensive, regulated organizations with divergent objectives, multiple stakeholders, and ambiguous power dynamics. To advance understanding of––and adaptation to––present and future challenges faced by HL, we argue for new interdisciplinary dialogic spaces. Relying on fundamental pillars of grounded theory, we investigate how different HL and interdepartmental top management teams within an Italian public hospital interfaced over time to design new solutions. We identify 15 macro barriers—human, technological, and environmental—limiting HL action, analyzing their interrelationships via a hierarchical-configurational model using TISM-MICMAC. This supports a process perspective and conceptual leap on HL collective action related to data governance and HIS. The resulting contribution is a multi-stage theoretical framework advancing strategic HIS design for data governance and hospital sustainability.