Healthcare transformation is a central pillar of Saudi Arabia 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 hospitals, with a focus on recent implementation-phase evidence. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Findings reveal significant improvements in operational efficiency, patient safety outcomes, and digital health adoption. However, challenges related to organizational culture, workforce readiness, and sustainability of reforms remain. The study provides evidence-based recommendations for policymakers and hospital administrators engaged in large-scale health system reform.