Leveraging the VUCA Paradigm: A SWOT-Based Strategy for Sustainable Healthcare

Volatility in Healthcare

Volatility refers to rapid and unpredictable fluctuations that disrupt stability (Otter, 2019). Healthcare organizations must increasingly cope with volatile conditions due to shifting funding models, fluctuating resource availability, and sudden and frequently unanticipated public health crises (Ginter et al., 2018; Marzaleh et al., 2022). For example, the COVID-19 pandemic exposed the fragility of healthcare systems, forcing hospitals to reallocate resources and scale services under extreme conditions (Naamati-Schneider & Zaks, 2022; Zangrandi et al., 2020). Additionally, technological innovations in telemedicine, AI-driven diagnostics, and data analytics are evolving at an unprecedented pace, creating both opportunities and challenges in service delivery (Rathee et al., 2020).

Uncertainty in Healthcare Systems

Uncertainty arises when future developments are unpredictable, making decision-making difficult (Otter, 2019). In the healthcare context, regulatory changes, evolving disease patterns, and economic instability create uncertainty for organizations, policymakers, and professionals (Counte et al., 2019). Digital transformation, while essential for enhancing efficiency and accessibility, also introduces new uncertainties related to cybersecurity risks, interoperability, and ethical dilemmas in patient data management (Harjula et al., 2022; Sheaff & Schofield, 2016).

Complexity in Healthcare Structures

Healthcare is inherently complex due to its interdependent systems, multidisciplinary teams, and diverse patient needs (Benjamin, 2010). The growing integration of digital health technologies, AI-driven diagnostics, and remote care models has increased the number of variables in healthcare delivery, requiring new approaches to data management, workforce training, and regulatory compliance (Bhuvana & Vasantha, 2020; Marzaleh et al., 2022). A key challenge lies in aligning healthcare policies, financial models, and technological advancements while ensuring equity and quality of care (Coorevits et al., 2013; Wan et al., 2021).

Ambiguity and Decision-Making in Healthcare

Ambiguity refers to situations in which outcomes are unclear due to a lack of precedents or reliable data (Otter, 2019). In the healthcare context, ambiguity is particularly evident in emerging diseases, innovative treatments, and evolving patient expectations. For instance, while digital platforms have improved access to care, they also create ethical and legal ambiguities regarding patient confidentiality, liability, and informed consent (Whitten et al., 2010). Similarly, the shift in healthcare delivery models from hospital-centric to community-based and digital-first approaches has introduced new challenges in defining roles and responsibilities among healthcare providers (Sheaff & Schofield, 2016).

1.1 Technological Competition as a Catalyst for Innovation

Several interviewees identified digital transformation as a key driver of competition between healthcare organizations, stimulating improvements in service quality and accessibility. One participant noted: The more devices or new technology you have, the more patients it will attract to your organization. It has a very strong impact. For us too, whether as clients or as medical staff, it works in our favor and helps us. Another participant reinforced this perspective, stressing the benefits for patient care: In certain ways, yes. . . technology helps us provide better and higher-quality care.

In general, participants perceived this drive for technological leadership as beneficial, fostering a culture of continual advancement and responsiveness to patient needs. Another participant, however, emphasized that technology alone does not guarantee competitive advantage: In my field, I think we already understand that technologies themselves do not lead the competition. What can actually win in competition is service, because technology can always be bought. In fact, technologies alone are not such a strong competitive tool, since everyone can buy them.

These pressures were not perceived as negative but rather as catalysts that pushed institutions to explore novel solutions and expand their capabilities. One participant emphasized the broader impact: Then came Zoom, and from a departmental management perspective it created a whole new world. We now hold structured meetings with multidisciplinary teams, significantly raising the level of our work. For me, this has placed us at the forefront of operating at the highest level.

1.2 Organizational Vulnerability Due to Technological Lag

While digital transformation fostered innovation and institutional advancement, participants also highlighted the risks faced by organizations that adapted slowly or struggled with uneven adoption. Limited access to advanced technologies, insufficient training, and outdated infrastructures were seen as critical vulnerabilities. As one participant explained: There is a lot of technology that is still not adapted to the whole system. Not every place knows how to use this technology. You need very skilled people to use smart technology. . .. The courses we’ve taken over the years constantly need updating.

Another participant pointed to inequities in access and efficiency: The technology is very smart, but it requires skilled people. First of all, it is not available to everyone, only to a limited number of people. And again, some technologies take more time and ease our work, others take less time. . . but mainly, not everyone gets to use them.

These accounts illustrate how technological lag found expression in practical inefficiencies, unequal access, and skill gaps, ultimately undermining organizational capabilities. Institutions that failed to ensure widespread access and systematic training risked falling behind in both service quality and operational effectiveness.

2.1 Diagnostic Uncertainty and Digital Support

Many participants emphasized how access to digital tools has substantially improved their ability to make timely and informed decisions in ambiguous clinical situations. Technologies such as digital imaging, laboratory test integration, and electronic health records were seen as reducing reliance on intuition and enabling more evidence-based practice. As one participant explained: We do everything on the computer, making it possible to access patient information from anywhere, whether from the HMO or another hospital. . . including imaging, actually viewing the different layers of CT scans, X-rays, ultrasound. . . this greatly improves the way medicine is practiced.

Another participant highlighted how these tools enable real-time collaboration and rapid consultation: You can send ECG images, a video of a child with suspicious movements to check whether the child is having a seizure, or a photo of a rash to a dermatologist. These extraordinary tools are being increasingly used in practice.

This technological ability was particularly valued in urgent settings, where swift access to accurate data is critical. As another participant remarked: For example, if I am doing follow-up today, I want to see the patient’s vital signs, blood tests from this morning and so on, and I would like the hospital system to display this without me having to go back and search for it.

The immediacy of this access was described not only as improving clinical outcomes but also as enhancing the confidence and decisiveness of care providers. This real-time information availability enhances clinical autonomy and supports faster, more informed decision-making under pressure.

2.2 Emotional Uncertainty in Remote Care

Whereas digital tools have improved the technical clarity of clinical practice, participants expressed concerns about the emotional disconnection that often accompanies remote or technologically mediated care. The transition to telemedicine, though deemed necessary at certain times, was seen as compromising the interpersonal dimension of caregiving. As one participant explained: There’s no substitute for face-to-face meetings. You can’t always take responsibility for what you don’t see. It’s a screen, it’s filtered, it’s not the same as seeing with your own eyes.

Another participant reflected on the disproportionate negative impact of technology on vulnerable groups: The people who come from the most difficult backgrounds are the ones most harmed because they don’t understand the system; they experience it as dismissive and humiliating. And when the encounter is not face-to-face, it has the potential to create even more alienation.

Others pointed to the therapeutic value of simple gestures such as physical touch that are lost in remote care: Placing a hand on the patient’s shoulder, seeing how they are - that’s part of the human need. Half of the treatment is just that.

This form of uncertainty is not about medical data, but about presence, empathy, and trust, all elements that are difficult to replicate in virtual settings. Professionals described the tension between achieving efficiency through digital platforms and preserving human contact, particularly with patients in distress or facing chronic conditions.

3.1 System Fragmentation and Parallel Workflows

One of the most frequently mentioned challenges involved working with multiple non-integrated digital platforms. Participants described the strain of having to navigate several systems simultaneously, often repeating the same information across different interfaces. As one clinician observe: Everything is through the computer; software is used for everything. I worked at several places, and each place has its own system.

Another participant highlighted the lack of interoperability between departments: If a department uses the same system as we do, the information transfers automatically, but for example the emergency room does not use our system, so the data is not transferred automatically.

Yet another participant reflected on the burden of duplicating documentation: With patients we use manual documentation, even though everything is also entered into the computer. This allows us to be present with the patient, but it complicates the process because we end up documenting things twice.

This duplication of tasks driven by fragmented digital infrastructure not only consumed valuable time but also introduced risks of data omission and reduced attention to patient care. Additional frustrations stemmed from incompatible systems across organizational boundaries. These misalignments reflected a systemic weakness that undermined the potential benefits of digital documentation.

3.2 Interdisciplinary Role Expansion and Task Burden

Beyond technological complexity, participants noted expanded professional expectations that blurred the lines between clinical, administrative, and technical roles. The digital transformation increased the number of tasks clinicians were expected to perform, often without sufficient support. As one participant commented: When I get stuck with the software or the devices, I call a technician and show him the screen so he can tell me what to do. And if I can’t find a specific form in the digital archive, I ask our secretary, who is younger and much more adept with all the technology and electronic systems.

This reliance on technical and administrative support reflects the growing overlap between clinical care, IT troubleshooting, and bureaucratic demands. A nurse working in an emergency unit added: Every woman who comes to triage - I have to indicate that I gave her guidance. . . it’s just another form to fill out. It wastes time. To me, it’s pure bureaucracy.

Rather than streamlining the work, in some instances digital tools added additional bureaucratic demands to already stretched workflows, reducing opportunities for meaningful clinical interaction. Such accounts highlight the tension between digital documentation requirements and the desire to provide meaningful, patient-centered care.

3.3 Human Resource Gaps and Administrative Exhaustion

The complexity introduced by digital systems was further exacerbated by staff shortages. Participants emphasized the cumulative toll of filling multiple roles while managing fragmented workflows. As one nurse described: Examining the situation over time, I see that nurses are working under unreasonable workloads. It’s really a double-edged sword. There is a lot of good in it, but it is also very burdensome.

This exhaustion was not limited to physical fatigue, but also reflected the cognitive load of juggling incompatible systems, administrative duties, and patient care under increasing pressure. The experience of complexity, therefore, is not simply a matter of organizational design. It is experienced and felt by professionals in the field, shaping their ability to perform effectively, remain engaged, and avoid burnout.

4.1 Inconsistent Understanding and Informal Learning

Many professionals reported being introduced to new digital systems without structured instruction or shared protocols. This lack of standardized onboarding led to divergent interpretations of how systems should be used. One participant observed: I actually define myself as a technophobe, but at work I somehow manage. . . Still, it’s true that there needs to be proper training and implementation before introducing a new system or device to ensure that everyone knows what it’s about, rather than just throwing us into the water.

In the absence of formal guidance, staff often relied on informal peer-to-peer learning. Another participant commented: What’s important is how the technology is explained. Some people need more than explanations; they need hands-on experience. Touching and trying—that’s what works. In my department, because the team is small, I can give individual training. Some need only one training session, others three or four, and some even a week or a month until they really get it.

Even though this approach allowed work to continue, it also resulted in inconsistent practices across individuals and teams. The variability in digital literacy and interpretation reduced workflow efficiency and introduced potential safety risks. Professionals described this inconsistency as frustrating, especially when expected to comply with protocols that were never clearly communicated.

4.2 Generational Gaps in Digital Adaptation

Ambiguity also emerged in how staff members from different generations responded to digital change. Participants highlighted that though younger employees adapted relatively quickly to new systems, many senior professionals struggled to keep pace. As one nurse noted: I’m a young nurse, so it’s easier for me to adjust to these changes, but for others it was really difficult. . . especially the computer part. This generational divide in digital fluency generated operational friction within teams.

Another participant reflected on the toll this change took on older colleagues: I see that the midwives with more seniority get stuck using the technology. It takes them time, it causes frustration and stress, it just makes things harder for them and takes them longer in practice. These challenges often led to uneven task distribution, with younger staff informally absorbing more digital responsibilities.

For some more veteran staff members, the shift to digital tools disrupted long-standing routines and professional confidence. One participant explained: It took much, much longer for the older staff. It was really hard for them, and for us it was a bit easier. It’s really a mindset change. . . especially since their generation wasn’t born with computers. We were trained to treat patients, not machines.

These accounts underscore the human implications of digital transformation when adaptation is assumed but not structurally supported, particularly for experienced professionals who face steep learning curves late in their careers.

4.3 Ambiguity in Human Connection and Communication

Several participants expressed concern about how digital tools have disrupted the human element in healthcare. One interviewee reflected: We must remember that beyond all this technology, there is a patient. . . and sometimes with all this technology, we forget there’s a patient. . . we have less face-to-face time with the patient and we need to dedicate time to them. And this is something I really, really regret.

Others emphasized the emotional disconnect caused by digital mediation. Another participant stated: There’s no substitute for face-to-face meetings. And this needs to be said. Sometimes you can’t take responsibility for what you don’t see. It’s a screen, it’s filtered, it’s not the same as what you see with your own eyes.

These sentiments highlight a growing ambiguity in healthcare, as digital systems prioritize efficiency at the expense of interpersonal depth. For some professionals, this shift increased the burden of emotional labor, as they struggled to maintain patient-centered communication within a system dominated by screens and protocols.

4.4 Fragmented Infrastructure and Uneven Implementation

Ambiguity was further reinforced by inconsistencies in infrastructure and technological availability across departments and institutions. Professionals described how digital tools were introduced unevenly, with some units equipped with updated systems and others still relying on manual methods. One participant commented: Some departments are fully computerized, while others still rely on paper files. In places where computers are not used at all, patients are transferred with their paper charts, and sometimes essential details are forgotten or missing, creating further problems

Another interviewee elaborated: Since we’re in some sort of evolving system, things aren’t consistent and identical everywhere. Yet another participant noted: You experience this more in certain departments in which they’re testing things. . .. Hospitals differ greatly, with government hospitals using one system and hospitals affiliated with the Clalit HMO using another. This fragmentation was illustrated most clearly in the transition between departments. As one participant recounted: After surgery patients go to recovery—another department that does not use computers at all. It’s a problem—patients are sent with paper files, sometimes with the wrong file or missing important notes, and we have to call the department.

These inconsistencies not only slowed down processes but also created uncertainty around preferred practices. The lack of standardization made it difficult to establish clear expectations, leading to fragmented routines and hesitation in using available tools.

4.5 Security and Confidentiality Concerns

Ambiguity extended to digital security and confidentiality practices. Professionals expressed concern about the accessibility of sensitive patient information and the ethical dilemmas arising from insufficient safeguards. One participant reflected: Confidentiality. . . I often meet patients who share very personal things. . . I’m constantly trying to figure out what I can enter into the patient file and what I shouldn’t, to make sure that children and adolescents won’t feel that what they tell me will immediately be read by their parents. I think all these issues of confidentiality are extremely important.

Concerns were not limited to documentation but also included the conditions under which information was recorded and stored. One participant explained: Even if it looks like only you and I are in the meeting, there’s still the issue of medical confidentiality. Some people are unsure; maybe someone is listening or watching behind the screen. They’re not entirely used to this, and it causes discomfort. Another participant added: People are very afraid the information will leak, even though we’re all bound by medical confidentiality. It creates certain trust issues. The information is there, but it still needs to be protected.

These reflections illustrate how the lack of standardized privacy protections and inconsistent system implementation generate uncertainty for clinicians, who must constantly navigate between maintaining ethical standards and operating within unclear digital frameworks.

Macro Level (Policy and System-Wide Governance)

At the national level, health authorities should address the structural inequities that hinder cohesive digital transformation. As the findings show, fragmented infrastructures and inconsistent system adoption create volatility and ambiguity that compromise continuity of care and institutional responsiveness. Standardizing digital platforms and ensuring interoperability across hospitals, HMOs, and governmental sectors are of critical importance. Equally important is fostering equitable access to technology along geographic and socioeconomic lines. Investment in national frameworks for digital literacy and cybersecurity, particularly for aging workforces and under-resourced regions, can mitigate systemic threats and promote sustainable innovation (Figueroa et al., 2019; Marzaleh et al., 2022). Applying the VUCA-SWOT lens at this level facilitates strategic regulation that is both resilient and future-oriented.

Meso Level (Organizational Strategy and Management)

At the institutional level, digital transformation should be treated as a long-term strategic process requiring continuous adaptation. The study identified complexity in the form of duplicated documentation, parallel workflows, and blurred role boundaries—challenges that reflect underlying organizational weaknesses. Addressing such challenges demands a shift toward integrated systems, clear role delineation, and streamlined workflows. From a business administration perspective, workforce development in the healthcare context should prioritize tailored digital competency training for both professionals and administrators to serve as a critical enabler of responsive, resilient organizations. Empirical data from an EU-wide needs-assessment study reveals that while over half of healthcare workers report basic digital skills, only one in five effectively uses advanced tools such as telemedicine and smart data systems in clinical contexts. Learning uptake is uneven despite technology awareness (Lapão et al., 2024).

A broader systematic review published early in 2025 highlights that interventions such as short-term targeted training, skills assessments, and structured managerial curricula effectively enhance digital readiness and adoption among healthcare administrators and professionals (Smith et al., 2025). Complementing this, studies focusing on healthcare administrators affirm the value of a multi-tiered workforce development model with formal curricula, workplace-embedded learning, and credentialing to cultivate digital leadership competencies aligned with organizational transformation (Chen et al., 2024). This implies that capital invested in digital tools should be matched by investments in human capital, setting clear ROI metrics and integrating performance-driven training governance. Organizations that employ such policies can bridge skill gaps (evident in OCED data tracking demands for AI, telehealth, and data analytics competencies) and thereby enhance institutional agility, reduce adoption resistance, and bolster long-term efficiency (Manca & Eslava, 2025). Therefore, institutions should embed SWOT analysis into routine strategic planning to proactively identify risks, optimize resource allocation, and align technological capabilities with operational needs (Marino & Diaz Paz, 2025).

Micro Level (Clinical Practice and Professional Experience)

At the level of day-to-day clinical work, the focus must remain on preserving the human dimension of care within increasingly digital environments. As reflected in the findings here, professionals struggle to maintain empathy, interpersonal presence, and therapeutic trust when care is mediated by screens. Hybrid care models that combine digital efficiency with in-person connection offer a viable path forward. Supporting this transition requires more than technical training; it also entails fostering communication skills, emotional intelligence, and interpersonal awareness within virtual care settings (Subramanya et al., 2023). Role clarity, emotional support, and collaborative team culture are essential for reducing burnout and ensuring that care remains ethically grounded and patient-centered.