TITLE:
Moving beyond ROI: A Strategic Governance Framework for Value Realization in Healthcare Technology Investments
AUTHORS:
Bashir A. Agboola, Kim A. Critchlow
KEYWORDS:
Healthcare Information Technology (HIT), Strategic Governance, Value on Investment (VOI), Digital Equity, Social Determinants of Health (SDoH), Clinician Burnout, Triple AIM, Quadruple AIM, Quintuple Aim
JOURNAL NAME:
Open Journal of Business and Management,
Vol.14 No.2,
March
20,
2026
ABSTRACT: The systemic failure to optimize multibillion-dollar annual investments in healthcare technology poses a significant threat to organizational sustainability and patient equity. Healthcare information technology (HIT) executives who lack robust investment optimization frameworks risk compromising both operational efficiency and institutional resilience. This qualitative study explored the strategic approaches technology leaders use to align financial investments with enhanced patient experiences and equitable service access. Through a reflexive thematic analysis of interviews with nine senior healthcare executives and a synthesis of industry data, this study identified four critical pillars for success: (a) institutionalizing strategic investment governance; (b) implementing iterative, evidence-driven value realization cycles; (c) prioritizing human-centric design and clinical workflow integration; and (d) operationalizing digital equity as a core business strategy. A central finding suggests that leaders must pivot from traditional, narrow, financial return-on-investment (ROI) metrics toward a multidimensional “Value-on-Investment” (VOI) framework that accounts for broader stakeholder outcomes. Beyond fiscal efficiency, the findings suggest that strategic technology stewardship can bridge the digital divide for marginalized populations, bolster workforce sustainability, and ensure high-quality, inclusive care delivery.