Abstract
Digital transformation in long-term care remains uneven despite policy pressure and rising investment. Many initiatives fail to produce sustained improvement in care delivery and operational performance. Existing research explains adoption and implementation but does not show how organisations maintain transformation under workforce instability and regulatory constraint. This paper develops a dynamic capability architecture for digital transformation in long-term care. Drawing on an integrative review of healthcare management, implementation, socio-technical and governance literature, the study identifies seven organisational domains that operate as an interdependent system. The framework explains how alignment across leadership, workforce systems, infrastructure and governance enables sustained transformation through sensing, seizing and reconfiguring. It shows how breakdowns in alignment reduce system use, weaken accountability and limit service outcomes. The framework links organisational capability to public value, accountability and inclusion in long-term care.