{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T09:06:02Z","timestamp":1784106362603,"version":"3.55.0"},"update-to":[{"DOI":"10.12688\/f1000research.180694.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000}}],"reference-count":41,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"This work was supported by the Indonesia Endowment Fund for Education Agency (Lembaga Pengelola Dana Pendidikan\/LPDP)."}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns5:p>Background In the contemporary healthcare landscape, hospitals face a paradox between the need for digitally agile, emotionally engaging communication and the rigid, risk-averse nature of clinical bureaucracy. While social media enables narrative-based engagement, its implementation in hospitals remains constrained. This study aims to examine how institutional dynamics shape the implementation of narrative content and to explain the gap between audience engagement and observable electronic word-of-mouth (e-WOM). Methods This study employs a qualitative approach using Directed Qualitative Content Analysis (DQCA). Data were collected through in-depth stimulated recall interviews with hospital audiences and internal management, and analyzed using ATLAS.ti to identify thematic patterns related to institutional constraints, content implementation, and audience responses. Findings The findings reveal two key mechanisms. First, narrative content is constrained by institutional logics and bureaucratic processes, particularly approval bottlenecks, resulting in delayed, modified, or diluted implementation. Second, although narrative content generates high affective audience engagement, this does not consistently translate into public e-WOM. This engagement\u2013behavior gap is explained by the role of dark social, where content is shared through private channels due to privacy concerns, social norms, and perceived risks. Conclusions This study contributes by proposing a conceptual framework of institutional friction and introducing a practical Quality Control (QC) checklist to support the implementation of narrative content in hospital settings. The findings highlight the need to align communication strategies with institutional realities while recognizing that conventional metrics may underestimate the true impact of digital engagement due to the prevalence of dark social.<\/ns5:p>","DOI":"10.12688\/f1000research.180694.2","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T04:54:07Z","timestamp":1783054447000},"page":"820","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Institutional Black Box of Friction Between Digital Agility Demands and Clinical Bureaucracy in Hospital Social Media Management"],"prefix":"10.12688","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8573-3322","authenticated-orcid":false,"given":"Renaldi","family":"Renaldi","sequence":"first","affiliation":[{"name":"Health Policy and Management Yogyakarta Special Region of Yogyakarta Gadjah Mada University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri","family":"Ulfa","sequence":"additional","affiliation":[{"name":"Economic and Business Yogyakarta Special Region of Yogyakarta Gadjah Mada University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Rosa","sequence":"additional","affiliation":[{"name":"Economic and Business Yogyakarta Special Region of Yogyakarta Gadjah Mada University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6872-3311","authenticated-orcid":false,"given":"Erlin Eka","family":"Wulandari","sequence":"additional","affiliation":[{"name":"Economic and Business Yogyakarta Special Region of Yogyakarta Gadjah Mada University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulistiani","family":"Sulistiani","sequence":"additional","affiliation":[{"name":"Economic and Business Yogyakarta Special Region of Yogyakarta Gadjah Mada University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Rosyid","family":"Ridho","sequence":"additional","affiliation":[{"name":"Economic and Business Yogyakarta Special Region of Yogyakarta Gadjah Mada University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9900-1294","authenticated-orcid":false,"given":"Rani Surya","family":"Resiana","sequence":"additional","affiliation":[{"name":"Islamic Economy and Halal Industry The Graduate School Yogyakarta Special Region of Yogyakarta Gadjah Mada University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1057\/s41599-023-01820-w","article-title":"Healthcare professionals\u2019 editorial opinions on communicating with the public: shifting social media hesitancies.","volume":"10","author":"L Alhafez","year":"2023","journal-title":"Humanit Soc Sci Commun."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.56294\/saludcyt20251539","article-title":"The impact of social media on healthcare professionals\u2019 branding.","volume":"5","author":"C Andraus Quintero","year":"2025","journal-title":"Salud Ciencia Y Tecnologia."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"158-166","DOI":"10.1002\/nop2.123","article-title":"Directed qualitative content analysis: The description and elaboration of its applications.","volume":"5","author":"A Assarroudi","year":"2018","journal-title":"Nurs. 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We are deeply grateful for your meticulous and highly constructive feedback throughout this process. Your insights have significantly strengthened the methodological rigor and interpretive clarity of our manuscript. We have taken note of your final advice regarding the consistent positioning of the QC checklist for our future research endeavors. Thank you once again for your invaluable time and expertise.","URL":"https:\/\/f1000research.com\/articles\/15-820\/v2#referee-comment-16649","order":1,"name":"referee-comment-16649","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.199321.r490095, Nugzar Todua, Ivane Javakhishvili Tbilisi State University, Tbilisi, 19 Jun 2026, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/15-820\/v1#referee-response-490095","order":2,"name":"referee-response-490095","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Renaldi -<\/b>; \n<i>Posted: 24 Jun 2026<\/i>; Dear Prof. Nugzar Todua, Thank you for your constructive feedback and for awarding our manuscript an 'Approved' status. We have carefully revised the manuscript to address all your comments: \n<b>1. Insufficient Organizational Representation:<\/b> We revised Section 3.2 to explain our key informant approach for the 2 management actors. We also expanded Section 6 (Limitations) to explicitly acknowledge the absence of broader stakeholders (legal, medical leadership). \n<b>2. Weak Evidence for &quot;Dark Social&quot;:<\/b> We accept this critique. We reframed the findings (Sections 4.2 and 5) to state that the shift toward dark social is a &quot;plausible interpretation&quot; based on self-reported intentions, rather than measured digital trace evidence. \n<b>3. Overextension of Theoretical Claims:<\/b> We revised the Conclusion (Section 5) to clarify that our theoretical contribution is an exploratory, context-specific framework bounded by the single-hospital setting. \n<b>4. Limited Methodological Transparency:<\/b> We substantially enriched Sections 3.4 and 3.5, detailing the collaborative coding process using ATLAS.ti and clarifying our synthesized member-checking and audit trail procedures. \n<b>5. Practical Recommendations:<\/b> We have tempered our claims regarding the Quality Control (QC) Checklist in Section 4.5. We now explicitly position the checklist as a preliminary recommendation that requires future empirical testing.","URL":"https:\/\/f1000research.com\/articles\/15-820\/v2#referee-comment-16499","order":3,"name":"referee-comment-16499","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by the Indonesia Endowment Fund for Education Agency (Lembaga Pengelola Dana Pendidikan\/LPDP). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}