Healthcare transformation is a central pillar of Saudi Arabia’s Vision 2030, aiming to enhance healthcare quality, efficiency, and sustainability through digital innovation, governance reform, and system integration. This study systematically evaluates the impact of health sector transformation initiatives on hospital performance in Saudi Ministry of Health (MoH) hospitals, with a focus on recent implementation-phase evidence. A systematic review was conducted in accordance with PRISMA 2020 guidelines, including peer-reviewed studies and national reports published between 2010 and 2025. Eligible studies examined transformation components such as digital health systems, health clusters, virtual care, and governance reforms across key performance domains including access, patient experience, operational efficiency, patient safety, and system integration. The findings demonstrate consistent improvements in access and patient engagement, including higher satisfaction in virtual consultations (up to 97.4% compared to 84.0% for in-person care) and expanded utilization exceeding one million virtual consultations nationally. Referral coordination improved significantly, with acceptance rates reaching 74.13% overall and 100% for life-saving cases. Operational efficiency gains were also evident, including reductions in emergency department throughput time from 2:22:02 to 1:48:44 (p < 0.001) and improved hospital flow. Additionally, digital interventions enhanced continuity of care, with medication adherence increasing from 35% to 79% and preventable hospitalizations declining by 5.7% (p < 0.001). However, improvements in clinical outcomes, particularly mortality, remained inconsistent, with variability in safety culture and leadership capacity across institutions. Overall, healthcare transformation in Saudi Arabia is associated with significant improvements in access, coordination, and operational performance, but sustained clinical outcome improvements require stronger alignment between digital systems, workforce capability, governance structures, and organizational culture to ensure equitable and sustainable transformation.

Authors:

Mohammed Hamdy Mohammed Elnaggar, Aly Abdelhafiz Aly

 El-Sheikh Seoud, Prof. Eng. Samir Youssef Marzouk