Applying the Theory of Constraints to National Healthcare Digitalization: A Cross-Country Comparison

The digitalization of national healthcare systems is a complex and context-sensitive process that requires systematic analysis to identify both current progress and areas needing further development. Traditional assessments often rely on secondary data, which can overlook operational-level implementation challenges that constrain effectiveness and remain invisible to policymakers. To address this gap, we collected primary qualitative data from healthcare professionals in Austria, Bulgaria, and Hungary. Using the Theory of Constraints (TOC) thinking processes, we analyzed the implementation of national digital health initiatives and their perceived impact on service quality. Our findings reveal distinct systemic bottlenecks in each country and support the development of targeted policy recommendations based on TOC frameworks from operations research. By applying TOC in a cross-national qualitative study, we contribute to the literature on healthcare digitalization and demonstrate that national cultural factors shape both the nature of the constraints and the pathways to effective digital transformation.